On the Frontline of Integrative Healthcare: A Practitioner's Perspective on Merging East and West

By Bryan Isacks, MS, LAc

It seemed as though my professional training had culminated in this one moment: Three MDs and a small army of physical therapists were sitting in a tight semicircle in front of me. I had their undivided attention; indeed, they had invited me to come speak for them. In an odd twist of fate, I, the acupuncturist, was dressed in a crisp black suit, while the rest of them were in t-shirts and cargo pants. I had already begun sweating. I had received my New York State license approximately three days earlier. They did not look particularly impressed with the suit.

Then the questions began: “Do you treat RSD? What about phantom limb pain? I referred to an acupuncturist for a spondylitic radiculopathy, and I didn't see great results; what can you do for that? Are you able to treat T4 syndrome? Does acupuncture treat lymphedema?”

I had given a presentation on biomedical acupuncture for pain management, emphasizing research from the WHO report and the 1997 NIH consensus statement on acupuncture. I thought I did a reasonably good job presenting the research in a literate way; I certainly hadn't felt stupid. In the face of a swirl of pain syndromes that I could barely pronounce, much less speak competently about, I felt lot—revealed as a charlatan. I stood in front of them, trying to find words to explain our diagnostic framework in a way that wouldn't sound quaint. What came out of my mouth were three words that I thought would be the kiss of death for my presentation, but turned out to be pretty much the only thing that would convince them I was legit. Quite simply, I said “I don't know.”

From there, I explained that we look at patterns of symptoms, assessing both the functional aspects of the illness as well as the patient's constitution, and we create a diagnosis based upon the pattern of symptoms present. I explained that acupuncture has a lot of mechanisms involved that we understand, and some that do not. I assured them that while there was a growing pile of research indicating acupuncture was effective for a wide body of conditions, some of the most interesting research looked at the biomechanics of what acupuncture actually did in the body.

By the end of it, some of the doctors were nodding, and a couple of the therapists were mouthing initials of patients they wanted to refer. Since that day, I have managed to convince the Pain Center at our local hospital, as well as eight other medical offices, to refer to me. The flow of patients from medical doctors has been, along with word of mouth from patients, the singular driving force behind my steady practice. I suspect I am part of a new generation of acupuncturists who will be working with the Western medical community in a very involved way. There are lessons I've learned and pitfalls I've had along the way; however, hopefully we as a profession will be able to stumble through these together to come out on the other side.

Here are three lessons I've learned about integration since I started my practice.

Lesson One: The In-Service Lunch

Acupuncture is an interesting topic, and you will have no problem finding places to give talks about it, but if you want to have doctors as your audience, you have to bring lunch to them. Yes, it is expensive, and, no, they don't overtly demand it, but the words “In-Service Lunch” are like a skeleton key that will turn through their office receptionists. Here is the thing: doctors are busy. They don't really have time to talk to you in a meeting. Pharmaceutical reps have created a system by which they are guaranteed access to the doctors: they bring lunch to the entire office. Doctors, receptionists, nurses... everyone has to eat. Hence, every doctor's office I have ever called has been just fine with booking one. But you have to use the magic phrase, “in-service lunch.” Expect to spend a hundred bucks or more on it and make sure to do it right. Get tasty finger-foods that everyone likes, as well as some vegetarian options. Gourmet sandwich platters, sushi, and Chinese food have all been winners for me. One caveat: You do not eat the stuff yourself. You talk while they eat. This is your ticket in the door.

From there, do not expect the physicians to sit in rapt attention for an hour while you give a PowerPoint presentation. My experience says pt simply never works like that. People mosey in and out of the room in small groups of two or three. They grab food, sip coffee, and entertain whatever you're saying in fifteen minute chunks. Make sure you have an interesting packet that is research-heavy but not boring. Have a “prescription pad” for acupuncture recommendations ready for them. You can have them printed up cheaply at any copy shop. It can be fun for the office when you do a live demonstration. If you choose to do this, it is imperative that you follow clean needle technique to a fault. Finally, shake their hands and get out of there before you have worn out your welcome. Leave the food and all of your cards and literature.

Lesson Number Two: How can the patients pay?

It took me a while to realize that the main thing that holds doctors back from referring to us isn't their lack of belief in Oriental medicine; it is that they don't know how their patients are going to pay for it. The first questions I get at in-service lunches are rarely medical, they are: “Do you take worker's comp, no-fault auto, and/or private insurance?” And as all my colleagues are aware, this can be a tough question to answer accurately. In New York, where I practice, insurance coverage is spotty. Most no-fault will pay for acupuncture, but few acupuncturists are willing to go through the hassle of billing for it. Worker's compensation is completely hit or miss, and the laws on the books for it are limiting. As far as private insurance goes, you have about a 50/50 chance, and only for a select group of conditions. So, then, do you take insurance?

I have found a good balance in offering comprehensive billing for no-fault auto insurance, super-billing for private insurance, and only taking worker's compensation claims with prior approval. When a doctor asks me if I take insurance, I say “Yes.” If all you offer is a cash-based practice, that's fine, but understand that most doctors will not view you as a viable option for the vast majority of their patients. As far as I can tell, billing is the only thing that holds some hospitals back from hiring us. There is no certainty that they will be paid for our services. I believe that amending the Medicare act in congress to include acupuncture services will almost certainly be a lynchpin to creating salaried positions for acupuncturists, but that is a different article all together.

Lesson Number Three: Talk like a Medical Professional

Let me be clear: I work with qi. I treat wind heat and utilize the extraordinary meridians. I always take the pulse, and I keep a copy of the Shang Han Lun in my car for light reading. I am an old school TCM practitioner. When I talk to doctors, however, I transform from an energy worker into a biomedical pain specialist. I talk about randomized control trials, myofascial trigger points, and endogenous opioids. I present research, and I am able to speak in a literate way about all the common biomedical diseases we treat best. One thing I rarely talk about: qi.

I get the impression that most acupuncturists are stuck in the same mode of presentation: talk about qi, yin, yang, and the five elements. These are crucial elements of how we practice our medicine, but unfortunately, they are elements that make us sound more foreign and mystical than we actually are. My presentations to doctors target specific illnesses acupuncture treats well; I offer an evidence base for the assertions and end with actionable suggestions of how to refer to me. I will touch on symptom patterns and the complexity of the medicine, but I rarely go into obscure sounding Chinese medical terminology when all I have is an hour to present.

So, here is the formula for the presentation:

1. Target the conditions you want referrals for.
2. Evidence base indicating how and why you treat those conditions well.
3. Direct, actionable suggestions for how to refer to you.

Above all, it is imperative that we look, talk, smell, and behave like the practitioners of medicine that we are. Doctors, hospitals, physical therapists, and other biomedical folks are, above all, concerned about sending their patients to a quack. We aren’t quacks, but sometimes it is easy for us to look like them. We have to be biomedically literate, willing to play ball with insurance companies, and be able to speak competently about the biomechanics of our art. If we are able to do this, it is simply a matter of time before our dreams of full integration become a reality.