On Regulars

This weekend we have a class on “Regulars” at POCA Tech, and I’m thinking I’m going to approach it differently than I have in the past, hence this post to help me get my thoughts together.

We talk about regulars a lot in community acupuncture, in part because having regular patients who are very invested in the clinic is absolutely key to having a financially sustainable practice. Another reason is that acupuncture can be stellar at managing chronic conditions, and the people who use it for that purpose tend to become regulars. Either way, if you’re a community acupuncturist, you need to prioritize your relationships with your regulars.

But I’m thinking it might be helpful to specifically talk about three regulars of WCA who are in a sense extreme examples: they were anchor patients, their presence has made the clinic what it is, and their results were dramatic.

The first is T. I wrote about T. in this post, and a couple of days ago WCA received this letter in the mail:

“I’m a friend of T.’s and I’m sad to tell you that she passed away last month due to her poor health. For awhile she was going to acupuncture almost every day, and you helped her a great deal. She was quite sure she wouldn’t have survived as long as she did, and been able to deal with the pain she was having, without your help. You asked her, at one point awhile back, to write about how acupuncture helped her (editor’s note: I think this was in 2018)...I typed this from her handwritten notes:

First of all, I’d like to thank my God for healing and for putting people in my life who’ve helped me along the way...I can’t say how grateful I am for the people, the wonderful people at Working Class. I enjoy the downtime as well, doing prayer and meditation. When I first started coming I was very, very sick, on oxygen 24/7. Now thanks to God I only use it during naps and at night. I truly believe they held my hand, helped me through some of my hardest times ever, just to talk with me. I consider them my family, my other family. My doctor gave me one or two years to live. That was three years ago. I feel I am truly blessed. Thanks so much for saving me.

Acupuncture makes me feel more relaxed and sort of in balance with myself. I sometimes sit back and relax and literally feel the blood flowing in my body. It also serves as downtime from worries, stress and pain. It gives me a sense of healing the body after some of the years I abused it, being a recovering alcoholic. I have three years clean. I first tried acupuncture many years ago, just for help with triggers. I had no idea how many things it could be used for. I do now. (The punks) are wonderful to me. I bring my puppy Festus with me to acupuncture. He likes it there...I love him lots. I am truly grateful to God for almost everything.”

Okay, that last line did it. I’m going to take a break to go cry about this, back in a minute.

The second regular patient that I want to talk about is G., who was a regular at WCA from sometime in 2003 until his death in 2019. Like T., G. was also part of a big Native American family and also had severe late stage lung disease -- in his case, asbestosis. When G. started getting treatment he was seeing his doctor every six weeks and would get pneumonia a couple of times every winter. After a few years of regular acupuncture (twice a week like clockwork in his case) he stopped getting pneumonia and only saw his doctor every six months. He often commented, “If I’d known I was going to live this long, I would’ve taken better care of myself.” He was 73 when he passed away.

Finally, the third regular patient I want to talk about was actually one of my first, and one of the reasons that WCA happened at all. C. was an artist and a musician who had lived a colorful life first as an Orange County Republican, then as a hippie in the Oregon Coast Range; he and his wife were one of the original participants in Portland’s Saturday Market. I started treating him in 1999 when he was on hospice due to stage 4 lung cancer. Like G., before acupuncture he got frequent pneumonia and coughed up blood; acupuncture twice a week stopped both. If we missed a week he started coughing up blood again. He got kicked off of hospice. He’s the patient whose pulmonologist called me soon after WCA opened to ask me to explain why his cancer had stopped spreading (I told him I couldn’t explain that) and to tell me that if C. wasn’t actively dying, I needed to help get him off the high doses of morphine he was taking. Like T., C. was an evangelical Christian; he often read the Bible while getting acupuncture. He was 62 when he was diagnosed with cancer and 72 when he passed away; his wife swore that acupuncture added 5 years to his life.

T., G., and C. all received similar treatments: lots of needles in their chests. As noted in this post that type of treatment is relatively more risky than what we usually do at WCA, because it’s deliberately needling directly over the lungs (although it’s gentle needling with very fine gauge needles). We do it because apparently, sometimes, it adds years to people’s lives so the risk seems to be worth it. T., G., and C. each received hundreds of treatments -- the same thing over and over and over, local lung points plus some distal points that varied based on whatever else was going on for them. The treatments were never dramatic or even particularly interesting -- only the results.

There are many good reasons to have a community acupuncture clinic but if I’m honest with myself, C., G., and T. represent THE reason for me -- that acupuncture not only improves people’s quality of life, sometimes dramatically, but it can add years to people’s lives. (I didn’t know this for sure about T. until we received the letter from her friend -- though I suspected, because of the oxygen tank she stopped bringing to the clinic, and also, she fit the profile of “people we do this for.” Doing the math, it sounds like acupuncture added 3-5 years to her life.) It’s very meaningful to improve somebody’s quality of life and I’m so happy we do it. Being able to extend the life of somebody who is seriously ill and also, still very engaged in their lives, and also, beloved and important to a lot of other people? That feels like a whole other level AND a form of responsibility. Like, if acupuncture can do that, don’t we have an obligation to try to do that? For as many people as we can?

C. and T. couldn’t pay for their treatments. G. not only paid for his own treatments, he paid for a lot of other people’s as well. (At one point we counted and he had paid for first treatments for more than 60 of his friends, family, and associates). All three of them, though, demonstrate why high-priced individual treatments just don’t work for a lot of people. I used to have a “normal” acupuncture practice; C. broke it. I mean, it wasn’t like I was all that happy with it anyway, but it’s still true that he broke it. I could not fit him and his needs into the paradigm I learned in acupuncture school. So if you’re going to serve the C.s, G.s, and T.s of the world, you are going to have to treat a LOT of other people. There are certain things you can’t do in a low-cost, high-volume setting (see also: the fight I had with Peter Deadman) and there are certain things you can’t do anywhere else.

POCA Tech students have a class called “Why We Can’t Have Nice Things” in which we explore all the consequences of the foundational decision to make acupuncture treatments cheap (and not cheap like a 10% discount off the going rate of $100 a treatment, cheap like $20 and under.) A subset of that conversation is, what happens when you’re committed to treating a certain percentage of people who can pay nothing or almost nothing? I’m not going to try to recreate that class in a blog post (in part because it’s so much fun to do in person) but what I do want to emphasize, though: if you’re going to have regulars like C., G., and T., the relationships you have with them are going to shape the parameters of your whole practice.

(You might as well shape your practice around the C.s, G.s, and T.s of the world, because if you do anything else, they’ll just break it anyway.)

Your other choice, of course, is not to treat them. And a lot of community acupuncturists don’t: acupuncturists who never drop the low end of their sliding scale, acupuncturists who don’t want to treat a lot of patients or who never want to take walk-ins (T. depended on medical transportation to get to WCA, she had no control whether she was on time or not). Having a clinic that works for the C.s, G.s, and T.s of the world means that WCA’s acupuncturists make less money, and also there are other patients that we don’t have relationships with, because the clinic that works for C., G., and T. isn’t the clinic they want.

That’s a trade-off that we’ve made peace with. This time in the class about regulars, I’m going to unapologetically advocate for creating relationships with at least some regulars with awful, late-stage diseases (lung diseases especially) and (probably) not enough money, who will break your heart when they die and might break your practice beforehand. Having relationships with them isn’t some kind of romantic exercise in martyrdom, it’s just a choice you make, knowing that choosing them will mean giving up a bunch of other things (and people) but that it will be worth it. Choosing them is why WCA is 19 years old this spring, having survived any number of crises. The C.s, G.s, and T.s of the world are our core, and it turns out they’re a good strong core to build a clinic around.