Articles by

Lisa Rohleder

Not a Weapon

January 10th, 2021 — Part of a culture of safety is the sense that we don’t have to hide our mistakes, and in fact we don’t want to; what we want to do is learn from them, together.

Safety and Organization

January 4th, 2021 — In order to create safety, you need to have a certain amount of organization. Safety doesn’t thrive in chaotic environments; it likes structure and stability.

Let Us Tell You about Our AERD! No, wait, come back...

January 1st, 2021 — Granted, you have to be a true safety nerd to get excited about an adverse events reporting database. Given that the acupuncture profession has never actually had one, though, we thought when we made one back in 2018, everybody else would be at least receptive. Not quite.

Why Be an Acu Safety Nerd?

December 15th, 2020 — I'm an acupuncturist, and the topic of acupuncture safety used to scare me.

Reflection: Risk

January 26th, 2021 — What we’re aiming for is a neutral, analytical, non judgmental, safety-positive relationship to risk. To get there, it helps to identify what might be in the way.

"That Last Treatment Made Me Worse"

February 4th, 2021 — The phone rings in your clinic. When you pick it up, a patient says, “Hi, I need to talk to you about something. I think that last treatment made me worse.” What do you do next? Here’s an outline of how to create a positive outcome, i.e. make some safety, from this stressful and unavoidable situation. If you treat enough people, you will certainly get this phone call at some point!

Intro to Boundaries

February 20th, 2021 — There’s no area of safety practice that isn’t impacted by the need for boundaries.

Reflection: Harm Reduction

January 27th, 2021 — Like trauma informed care, harm reduction is a public health approach that employs a non-punitive concept of safety. Sometimes safer is a better goal than safe.

More about Sketchy Guys (and Related Topics)

March 17th, 2021 — Many clinic safety incidents, before they actually happen, include some kind of quiet internal warning for the practitioner -- a sense that something about the situation is “off” or some misgiving or hesitation about a choice that in hindsight, turns out to be a mistake.

Boundaries in Community Acupuncture, Part 1

March 28th, 2021 — Although your relationships with patients will vary based on a number of factors, not least how invested they are in receiving acupuncture, there should be a core consistency in how YOU approach them.

Boundaries in Community Acupuncture, Part 2

March 29th, 2021 — The Chinese proverb “the superior doctor prevents sickness; the mediocre doctor attends to impending sickness; the inferior doctor treats actual sickness” is often interpreted by acupuncturists to mean that any illness can be prevented by maintaining mental, emotional, and spiritual harmony, and so a “sage healer” or “scholar-physician” is primarily a teacher or a guide for ordinary people in how to live so that they don't get sick. There are some boundary issues with that.

Safety/Risk Continuum for Talking to Patients

March 27th, 2021 — Just like with needling, the more invasive/aggressive you are and the more territory you cover in verbal communication, the more risks you’ll encounter. Choose wisely.

Holding Space in Community Acupuncture

February 28th, 2021 — For a community acupuncturist, maintaining a patient base is a lot like being the nucleus at the center of a little electron cloud of patients. This is helpful background for understanding boundaries in the clinic.

Stray Needles and Swiss Cheese Safety

January 12th, 2021 — Of the 160 incidents reported so far in our AERD, 26% are related in some way to forgotten or stray needles. This post is about the difference between following safety guidelines and creating safety.

If Safety Were a Deck of Cards

April 3rd, 2021 — If safety were a deck of cards -- bear with me for a moment here -- I think it would have four suits: organization, communication, boundaries and self-care. Any safety situation could be analyzed by asking what relationship each suit has to it.

Anatomy of a Safety Incident #1

January 4th, 2021 — A veritable cornucopia of misunderstandings, stray needles, and boundary issues.

Anatomy of a Safety Incident #2

January 26th, 2021 — Boundaries and empathy don’t have to be in an either/or opposition to each other; creatively making safety (even out of bad situations) allows them to be both/and.

A Tale of Two Needle Incidents

January 30th, 2021 — One of the things you learn as a community acupuncturist is what an amazingly wide range of relationships people have to their bodies, their emotions, and to acupuncture itself. Here we have a perceived adverse event that apparently ended a patient’s relationship with acupuncture, and an objectively verified adverse event requiring medical attention that *didn’t*.

When Acupuncture Overwhelms

April 7th, 2021 — Psycho-emotional triggers aren’t listed in the Clean Needle Technique Manual as an adverse event related to acupuncture, but according to our AERD data, they’re more common than fainting (which is listed).

Boundaries in Community Acupuncture, Part 3

March 31st, 2021 — Or, what I learned about boundaries by having an internet fight with Peter Deadman.

Altered States (or, the Sketchy Guy)

March 12th, 2021 — Patients and potential patients in altered states represent an interesting category of interactions for community acupuncturists. Altered states are sometimes, but not always, a reason why it might not be safe to offer a treatment to that person at that time.

A Queer Perspective on Acupuncture Safety

December 28th, 2020 — I’m going to argue that all of us need to learn how to think and talk about acupuncture safety in the same way that a lot of people in the queer, poly, and kink communities have learned how to think and talk about sex: without shame, without judgement, enthusiastically and in a lot of detail.

Anatomy of a Safety Incident #3

April 12th, 2021 — There’s always a dynamic tension between safety and access. You can’t treat someone if you can’t treat them *safely* -- which means unfortunately you can’t treat everyone. Even though, as a community acupuncturist, you want to treat everyone.

Kind of Like a Pit Bull

January 18th, 2021 — A common argument among acupuncturists is that nobody can safely practice acupuncture without at least three years of post graduate training at an accredited acupuncture school. Also, dogs.

Homemade Swiss Cheese: Making (Imperfect) Safety

December 31st, 2020 — This post is the first of a series about lessons we learned from dealing with COVID that also apply to acupuncture safety in general.

If Your Patients Aren’t Breaking Your Heart, Are You Really Doing Community Acupuncture?

April 30th, 2021 — Anchor patients are the people who make the clinic what it is, who help set the tone of the organization, who remind the punks why we do what we do and make us want to keep doing it. The presence of anchor patients is one way the clinic creates social safety, and also is an indicator that a certain amount of social safety is present already.

The Man Who Stared at Women

May 5th, 2021 — Some behavior in the clinic is inappropriate, and some inappropriate behavior is also gendered and/or sexual. Not all inappropriate behavior makes the clinic environment less socially safe (sometimes it’s just annoying and/or disruptive, like patients answering their cell phones in the treatment room) but all inappropriate behavior that’s gendered and/or sexual presents a social safety problem.

Treating Sexual Complaints in a Community Acupuncture Clinic

May 5th, 2021 — Treating sexual complaints in a community acupuncture clinic requires an active, intentional approach to creating social safety. There’s no one right way to do that, and doing it doesn’t mean you’ll be able to treat everyone.

Leadership and Safety Part 1: Consent

May 7th, 2021 — Inspirational leaders make other people want to do things that those people were otherwise not motivated enough or not confident enough to do on their own. They get people to transcend their own self-interest to serve a bigger vision. That’s wonderful, right? Yeah, no, not really.

Leadership and Safety Part 2: "Edna Mode" Mode

May 9th, 2021 — “I know we decided to follow the CDC guidelines for COVID in the workplace, but now that we have something we need to follow them ABOUT, what if they’re WRONG?” This is when you need Edna Mode.

Work in Progress: Safety/Risk Continuum for Acupuncture Styles

January 28th, 2021 — As part of encouraging a neutral, analytical, non judgmental, safety-positive relationship to risk, it seems like it’s worth describing a safety/risk continuum for acupuncture styles. There’s no one right way to practice acupuncture AND certain styles are clearly less risky than others.

Why Write about Safety Incidents?

May 21st, 2021 — Approaching safety issues from a structural and a trauma-informed perspective requires significantly more effort and more communication than the approach of “something scary happened, let’s find somebody to blame!”

Work in Progress: POCA Tech Needling Policy

March 4th, 2021 — A crucial aspect of becoming a practitioner is learning to navigate safety and risk. Declaring a practice legal or illegal is not the same thing as making it safe or unsafe. Regulation and safety are not identical, though many people in the acupuncture profession believe they are.

Anatomy of a Safety Incident #4, Part 1

May 21st, 2021 — A drama in six episodes about boundaries, communication, organization and self care.

"How Bad Is It REALLY to Date a Patient?"

May 26th, 2021 — The practice of acupuncture involves a certain amount of intimacy between humans, in the context of a society that’s just beginning to learn about consent, with capitalism telling us all that there’s never enough of anything good. (Spoiler: it's still a bad idea to date patients.)

Dual Relationships in Community Acupuncture

June 8th, 2021 — What they are, why you can't avoid them if you're a community acupuncturist, and some things to think about.

Practitioner Persona: Cyborg Edition

May 13th, 2021 — What can be confusing about being a community acupuncturist is how personal and how impersonal you have to be at the very same time. That’s why a cyborg is a helpful metaphor for how to be in the practitioner role: it has both organic and inorganic components and they have to work together seamlessly. Your organic components are about you, your selfhood, while your inorganic components are about your decision to serve your community in a (relatively) selfless way.

On Regulars

May 15th, 2021 — The relationships you have with certain regular patients will shape the parameters of your whole practice.

On Realistic Expectations

June 23rd, 2021 — Self-care includes self-compassion, which requires either knowing your limits or being willing to get to know them -- and once you meet them, to treat them with respect.

Intro to Self-Care

June 23rd, 2021 — Self-care isn’t just a good thing, it’s a necessary thing for acupuncturists, as foundational as Clean Needle Technique. Just like CNT, self-care needs to be part of an acupuncturist’s routine, not something reserved for special occasions. Here are some suggestions.

Why Be an Acu Safety Nerd, Part 2

December 26th, 2020 — Acupuncture is basically safe. It’s so much safer than other forms of medical intervention that you should hardly have to even think about it. Right? Except for the times that you do have to think about it.

On Firing Patients

June 27th, 2021 — If you’re treating enough humans to have a sustainable practice, you’re treating enough humans so that every now and then, things will go off the rails with one of them and you will have to end the relationship.

Reflection: Trauma Informed Care

January 24th, 2021 — A lot of what we’re advocating on this blog is a predictable, neutral approach to acupuncture safety that’s grounded in being 1) well-organized and 2) tolerant of humans being human. In our experience, those two elements fit together quite nicely.

Blog Housekeeping (Work in Progress)

April 15th, 2021 — A check-in about the state of this project, what’s done, what still needs to be done, and where the Acu Safety Nerd is going afterwards. Link-fest ahead!

Tasks and Tools of Safety

June 2nd, 2021 — Because you *can* manage risk without spending most of your time and energy worrying about what could go wrong -- the way you do it is by focusing on building something positive.

Anatomy of a Safety Incident #4, Part 2

May 22nd, 2021 — Or, the 20/20 hindsight version. This incident clearly demonstrates the dynamic tension between safety and access, and I kind of hate that.

Risk, Entrepreneurship, and Acupuncture Schools

September 20th, 2021 — Or, “Why is a member of POCA Tech’s Advisory Board doing a conference presentation titled ‘For the Medicine to Survive, the Profession Must Burn’”?

Pneumothoraxes and a Culture of Safety

August 9th, 2021 — We can’t make good individual decisions about risk unless we have better collective conversations about safety.

"It's Best If Everyone Keeps Their Clothes On"

February 27th, 2021 — No, that's *not* always obvious.

More on POCA Tech and the Acupuncture Profession

October 18th, 2021 — Because people keep asking about it.

Where Is the Line?

November 15th, 2021 — So many safety issues involve figuring out where the line is, why it’s in that particular place and not somewhere else, and what to do when somebody crosses it.

Purpose Vs. Idealism

November 18th, 2021 — WCA has a difficult relationship with people who think of themselves as idealists; sometimes it seems like we attract them over and over even though we always end up disappointing them and they always end up frustrating us. It’s like moths to a flame -- if the flame were tired and exasperated and wishing the moths would do something more useful with themselves.

Re-Focus: ACMAC Conference Presentation

November 6th, 2021 — Giving a good treatment, whether in a community clinic or in any other setting, is largely a matter of focus. Our tools, our needles, are literally very small, you have to look hard to be able to see them (a fact that you’re reminded of whenever you drop one on the floor). Just finding the points in order to needle them -- that requires a lot of focus too. And then there are all the other skills of a good acupuncturist: paying close attention to a patient’s body language, knowing when to turn the intensity of your needling down or up, making sure the needles are neither too deep nor so shallow they’ll fall out, looking for the subtle signs of pain relief in someone’s face or movements in order to know if your treatment is working. Not to mention, in a community setting, keeping an eye on all the other patients in the room....Essentially, in order to give a good treatment, you have to pay close, close attention to a lot of minute details (and your fine motor coordination has to be excellent as well!). You can’t be a good acupuncturist if you’re distracted or careless. In the treatment room, you have to really concentrate. You have to control your attention.

IM4US Conference Recap (and Intro to the Blob)

October 3rd, 2021 — Acupuncture as medicine and acupuncture as a profession are not the same thing. The acupuncture profession has been making a concerted effort for about fifty years to argue that they are, but if you look closely enough at their respective histories, you’ll see that they aren’t. And the difference between them is particularly important for community acupuncturists -- as well as anybody else who is interested in acupuncture safety -- to grasp.

The Small Business Mindset

November 21st, 2021 — Being an entrepreneur isn’t just about learning specific skills like bookkeeping, marketing, negotiating with landlords, etc. You certainly need those skills, but any of them are arguably easier to attain than the overarching mindset that makes somebody happy to work in a small business setting. This is something we’re belatedly recognizing at POCA Tech, so from here on out, you can expect us to never shut up about it.

Trying to Be Trauma-Informed about Everything

November 30th, 2021 — One thing I know about trauma is that recovering from it requires facing as much of the truth as you can. You might not be able to stand much truth at first and so you have to build up your tolerance over time. Facing the truth, like other forms of healing, is often a slow, incremental process. But I’ve learned that I can count on the truth to show up as a relief and also as a friend -- eventually.

Don't Get Punched in the Face

December 6th, 2021 — At POCA Tech we teach Trauma Informed Care because it’s a basic, pragmatic safety measure; sometimes people with trauma histories might be cute fluffy sad things, but a lot of the time they’re... not.

Critique Is Different than Building, Part 1

December 11th, 2021 — Imperfect acupuncture works. Imperfect patients get great results from it. In order to build a community acupuncture clinic, not only do you have to accept that what you’re building will be filled with imperfect treatments and imperfect humans (including you), you kind of have to lose interest in finding fault, period.

Mercury Retrograde

January 21st, 2022 — Mercury retrograde indicates a period of “review and reflection”, particularly in relationship to challenges that have come up in the past. We seem to be having a review of past safety incidents -- not all safety incidents, just the epic ones!

Safety CEUs!

February 12th, 2022 — We have some! And they don't suck!

Why We Do This, Part One

March 22nd, 2022 — If we’re going to practice “energetic medicine” we need some kind of routine and some kind of container to deal with unexpected outcomes that we can’t explain or anticipate. It’s better for punks to not be at a loss when we have a “WTF, why did that happen?” moment, because those moments are just an unavoidable part of the job.

Clean Needle Technique, Social Safety, and the Benefits of Being a Safety Nerd

April 12th, 2022 — The idea behind Clean Needle Technique is that an acupuncturist needs to approach every patient as if they had all possible bloodborne diseases. This is important for your individual safety as a punk because you can’t depend on patients to 1) know their status or 2) tell you. But approaching every patient in the exact same way is also crucial to the social safety of the clinic -- and the bigger the clinic, the more people involved, the more concerning the potential consequences become for *not* treating every patient in the same way.

Why We Do This, Part Two

April 20th, 2022 — It’s hard for students (and also licensed acupuncturists!) to wrap their minds around the range of ways that people can respond to acupuncture, which in turn makes it challenging for them to learn how to manage risks associated with treatment. It’s hard to take risk seriously when it doesn’t feel real! And often the only thing that can make risk feel real is firsthand experience of an unintended outcome.

Heading for the Cliff

October 29th, 2022 — For over a decade, all signs have pointed to the acupuncture profession being on a road (by choice) that leads to the edge of a cliff. That cliff can be defined as the point at which the cost of an acupuncture education is so clearly not a good investment that people stop entering the profession and thus stop funding its infrastructure (particularly the NCCAOM, which is one of the main gatekeepers for entry into the profession and so depends on, you know, people wanting to enter the profession).

Hope Is a Risk: Leadership and Pain Management

November 4th, 2022 — Successfully managing pain requires not fighting pain, because fighting pain involves focusing on pain, and focusing on pain makes pain worse. Resisting pain amplifies pain. Successfully managing pain, as a practitioner, means helping people focus instead on incrementally reducing their pain and incrementally increasing their quality of life. But the focus has to be on living life, not on fighting pain. And this requires leadership skills, because for most humans, the default setting is to fight pain.

AERD 2022: the Year in Review

January 1st, 2023 — Sometimes "go home and rest with tea" is the exact wrong thing to say to a patient.

Heading for the Cliff, Part Two

January 23rd, 2023 — Myths aren’t the same as fairy tales or folktales or any other story; they’re powerful and generative in a distinct way. Myths can make things happen, for better or worse. I think the acupuncture profession in the US possesses, and is possessed by, one of these: the myth of the scholar-physician with a hospital job.

Heading for the Cliff, Part Two

January 23rd, 2023 — Myths aren’t the same as fairy tales or folktales or any other story; they’re powerful and generative in a distinct way. Myths can make things happen, for better or worse. I think the acupuncture profession in the US possesses, and is possessed by, one of these: the myth of the scholar-physician with a hospital job.

Your Mom Doesn't Work Here

January 30th, 2023 — Acupuncturists (at least in the US) have a lot of trouble navigating the tension between autonomy and security. We struggle to understand the tradeoffs between the two, and this can result in a weird, tortured, destructive relationship with organizations.

Acupuncture as Work

February 6th, 2023 — Practicing acupuncture in a way that allowed me to make my living was more like raising a child than having a job or a career. And this isn’t because I’m a community acupuncturist instead of a private room acupuncturist, it’s because I was running a small business, period.

Four Stages and the Acupocalypse, Pt 1

February 13th, 2023 — Dalton, Price and Thompson's model for leadership development applied to the acupuncture profession...and the acupocalypse.

Four Stages and the Acupocalypse, Pt 2

February 16th, 2023 — It’s common for acupuncturists to suggest that acupuncture schools should teach more business and practice management. I wouldn’t necessarily disagree with that, but teaching skills without being clear about the level of self-leadership needed to enact them isn’t helpful. A person at Stage 1 who took fantastic classes in marketing, bookkeeping and acupuncture business management but who can’t put any of it into practice without supervision isn’t going to be able to run a small business. It’s not about what you know, it’s about what you’re able to motivate yourself to DO.

Order of Operations and the Acupocalypse

February 24th, 2023 — In community acupuncture, in acupuncture safety, and in running a small business, I’ve found that order of operations often represents the difference between being effective in solving a problem, versus unproductively spinning my wheels. You have to know where to start.

Anatomy of a Safety Incident #5, Part 1

March 21st, 2023 — This particular incident is pretty irresistible as a teachable moment because nowhere in our materials on trauma informed care do we really dig into how bureaucracy can function as a trauma trigger, especially for low income people, and I bet there are a lot of people who don’t really understand how that works.

Anatomy of a Safety Incident #5, Part 2

March 21st, 2023 — As passionate as I am about trauma informed care, it was definitely not my goal to put on a demonstration of the need for it.

Anatomy of a Safety Incident #5, Part 3

March 21st, 2023 — In general, when somebody gets triggered by bureaucracy the way I did, the best case scenario for what happens next is NOTHING. The person gets overwhelmed and flees the scene, and that’s all. Maybe they pull themselves together to try again another day. It’s more likely, though, that what follows is punitive consequences in some form or another, from the bureaucracy itself.

AERD Report 2023 Q1

April 5th, 2023 — So many bruises! Also, an error without an adverse event, and some intriguing "symptoms worse" reports.

Four Stages and the Acupocalypse, Pt 3

May 18th, 2023 — Dalton, Price and Thompson’s research helped me recognize that while acupuncturists want professional careers, collectively we just haven’t put in the work to create the underpinnings that professional careers require.

Four Stages and Safety

May 22nd, 2023 — Legally, we’re responsible for managing adverse events in our practices, not just avoiding mistakes. Lots of acupuncturists are confused about that. Insisting that safety incidents only happen as a result of bad practitioners (see also, “undertrained physical therapists”) does everybody a disservice.

Four Stages and the Acupocalypse, Pt 4

May 30th, 2023 — Leadership is less about making decisions and more about making things happen, with and for and through other people. Contributing through other people creates interdependence and requires surrendering some of your independence and autonomy -- which a lot of acupuncturists really don’t want to do.

Uncertainty and the Acupocalypse

June 9th, 2023 — Acupuncture is full of uncertainty. Sometimes people are drawn to acupuncture’s other good qualities without realizing that uncertainty is part of the package.

AERD Report 2023 Q2

July 13th, 2023 — So many safety issues arise in the gap between how patients experience receiving a treatment vs. how practitioners experience giving a treatment. Also, mind those Apple Watches!

AERD Report 2023 Q 3.75

November 27th, 2023 — Apologies for the delay! More AERD Greatest Hits, plus some interesting data about possibly increased risk of adverse events after medical testing.