John made an appointment to be seen in my clinic for "frozen shoulder." When he came into my office I was shocked; his shoulder was the size of a basketball. The mass was impressive, to say the least: there were open sores from the skin being stretched so thin, it was hard to the touch and slightly warm – all signs this was a case for a trip to the hospital.
I lost a lot of sleep over the weekend on how I was going to proceed with this case, which was clearly a major red flag and possibly an emergent situation.
I realized I had a unique opportunity to help this patient see allopathic medicine in a new light, and to coach him in his progress to allow a Western physician onto his care team. Through careful and thoughtful conversation, actively listening to the patient's concerns and offering insights as to how he might approach seeking out a doctor, I was able to get him to the place where he felt comfortable seeing a physician – something I considered a major win, especially when looking at where we started.
An Opportunity to Bridge the Gap
I imagine the patient who fears or is repulsed by Western medicine isn't an uncommon patient in most acupuncture clinics. It's important to be aware of the very fine line where the capabilities of acupuncture, herbs and the rest of our scope of practice bridge the gap that modern medicine leaves behind; and knowing what we can and cannot do for our patients.
Finding our place in our patient's health care team is a crucial step in providing good and necessary care for them, so what happens when we notice a situation that needs modern medical care and the patient refuses to see an MD?
I've heard of many colleagues flat-out refusing to treat a patient in this scenario, but I think to myself, Does this actually help the patient? Or is this kind of dismissal only causing more harm? Perhaps they leave your office and seek out another provider who agrees with their choice to not seek medical care and they rapidly decline; or maybe they don't seek out care at all. In this situation, we have an opportunity to help our patients feel more comfortable in navigating the world of Western medicine.
What's Causing Their Fear?
The medical system in the United States is, quite frankly, a dumpster fire. We rank 37th among developed nations for health care outcomes, yet spend more than any other country. I think this discord with the medical system is really what precipitates this distrust in the allopathic physician and methods.
Getting care is expensive and often important factors are missed or overlooked because of bureaucratic policy and overloaded physicians. When patients don't feel seen or heard, or they've had a previously poor experience with Western medicine, it's sure to set a precedent for distrust in future visits with MDs.
Tips for Coaching Patients
As an acupuncturist, you are a bridge to your patient's complete care. We are in a unique position of having knowledge of both complementary and modern medicine practices, and we can tell when a patient needs either. This can be potentially life saving if we know how to coach our patients correctly. So, how can we do this?
#1: Identify the main concern with their hesitation. The list of possible root causes of the hesitation is neverending, but asking questions and being open is the first step in identifying where to start. For my patient, it was a belief that modern medicine lacked spirituality. For another, it might be that they've had bad experiences before or have seen others go through that. Maybe there's a fear of the "worst-case scenario." Identify this main root concern with compassion and empathy; it may not make sense to you, but it is their reality.
#2: Offer insights, information or different perspectives to help pull them out of their concern or belief without judgment. With my patient concerned for his spirituality, it was helpful to reframe a medical treatment as a great opportunity to experience spiritual healing in a different way. Some patients might respond well to facts and statistics, but most often we have to appeal to their emotional reality.
As their acupuncturist – their bridge between modern and natural medicine – your counseling here will often be heard much more deeply than that of an MD or scientist; and you might even be the first person to make them aware of the seriousness of their issue.
For some of my vaccine-hesitant patients, for example, it's come down to helping them understand risk vs. benefit ratios, demystifying medical papers that were misquoted to them, or understanding other effects of COVID than just death, like long COVID.
Patients who mistrust medicine in general may be greatly helped by understanding that we can make a separation between the system and the provider or medicine. For example, "Yes, antibiotics are overused, but they also serve an important function when necessary.'"Offering vetted referrals and your assistance to support them through the process can help them feel safer.
#3: Be patient, open, compassionate and understanding; but also realistic. For most patients, the decision to trust in something they've distrusted for a long time isn't going to be made overnight. We need to be persistent, yet understanding and patient. It's important to not ignore red flags and explain the importance of receiving proper care, but also to be patient and nonjudgmental throughout the process.
We'll catch more flies with honey, and not making our patient feel bad, wrong or stupid can go a long way in this process. Empower them to make educated decisions about their care, help them to see things in a new light, and motivate them to take charge in their healing.
Click here for more information about Kim Peirano, DACM, LAc.