When people first come for acupuncture, they generally do not know what to expect. The use of appointment time in my own practice varies significantly from patient to patient, based on both immediate need and long term goals. I discuss this variation in more detail in another article entitled Strategizing in Chinese Medicine. The use of appointment time is also dependent upon scheduling considerations, which is discussed in the article Scheduling, Compassion and Ethics in Chinese Medicine. The topic of this article is specifically the overview and flow of an acupuncture and Chinese medicine appointment. This discussion applies primarily to regular office visits. First time appointments are significantly longer and provide an overview of physiology and diagnosis, treatment goals, etc.
In the course of a one-hour long office visit, which is the most common arrangement in my practice, the time is generally split in half. The first half hour is interactive and allows time for:
- Updates on response to treatment
- Questions about treatment, symptoms, other medical visits and tests, goals
- Continuation of discussions from prior treatment
- Ongoing discussion about diet, lifestyle, stress, emotions, dreams
- Pulse and tongue evaluation
- Palpation (assessing the organs, channels, circulation, muscles, etc. through physical examination)
- Local tendino-muscular acupuncture treatment or dry needling
The second half hour of treatment is simpler:
- Insertion and manipulation of needles for systemic acupuncture, followed by:
- Lying on the table with acupuncture needles retained for 15 to 30 minutes
As might be evident from the above lists, the first half of treatment is more varied, active, dynamic and engaged than the second half. It is not possible to include all of these components in one visit, but over the course of time they can all be addressed. For example, as pain resolves less time is needed for dry needling and there may be more time for discussion about diet or emotional issues that contribute to the pain. Or, once dietary considerations are addressed, there is more time for discussion about lifestyle changes.
Even within a given topic or therapy, there will be variation and progression. Sometimes I may insert needles while someone is face up, sometimes face down, sometimes on the side, sometimes two or three of these in the same visit. Basic discussion about diet can progress to more detailed and in-depth conversation. None of this is fixed; all aspects of interaction and treatment are meant to be dynamic and responsive.
When more time is necessary for discussion or treatment, additional time or extra treatment sessions can be added. Sometimes it is useful to devote a session solely to dietary education, or to local work on the shoulder, or to reviewing medical tests, etc. Included in this, it is important to emphasize that patients typically have particular needs or questions that arise during the course of treatment. People should always feel free to express what is on their minds. These concerns will always receive response, whether during a regular session, a separate session, over the phone or through email or text.
A great deal can be accomplished in 30 minutes of well-used appointment time. When people come regularly for office visits, over the course of time those 30 minutes sessions add up to many hours of purposeful, interactive time that is intended to educate people about Chinese medicine, acupuncture, their own condition, diet, lifestyle, exercise, and preventative care.