Shi Dou (Sp 17) Food Hole: A Forgotten Acupoint

Most Chinese-trained acupuncturists rarely use the point Shi Dou. It is not considered an important or particularly useful point according to current Chinese acupuncture education. In fact, it is probable that most Western acupuncturists promptly forget everything about this point after taking their licensure exams and would be more likely to use its neighbor, Da Bao (Sp 21) if a local point in this region were required.

However, according to the Bian Que Xin Shu (Bian Que’s Heart Writings), a Song dynasty text by Dou Cai as interpreted by Sung Baek in his book Classical Moxibustion Skills in Contemporary Clinical Practice,¹ direct moxibustion of this point with tiny threads of high grade mugwort moxa is singularly useful in many if not most cases of spleen qi vacuity, liver-spleen disharmony, spleen dampness, and especially where the qi mechanism (upbearing and downbearing) is impaired due to a combination of liver depression, qi vacuity, dampness, and heat existing all at the same time. In fact, when reading author Sung Baek’s description of this point’s uses, what he appears to be describing is Li Dong-yuan’s yin fire theory. There are several sites in his book that support this idea.

In one case, Baek states that moxa on this point is of vital importance in cases of edema with urinary retention and the inability to breath when lying down. This symptom picture suggests that treatment must downbear turbid counterflow qi and also supplement the lung qi (by supplementing the spleen qi) so that is can properly depurate and downbear both qi and body fluids.

In another case, he suggests using Shi Dou for the treatment of spleen stomach damage with dry heat above due to excessive consumption of cold food causing loss of communication between the three warmers. This again suggests that moxa on this point promotes qi rectification, clearing of heat, and spleen qi supplementation.

In a third case, the same author suggests applying 300-500 threads of moxa on Sp 17 in case of chronic malaria in order “to balance hot and cold within the body” by fortifying the spleen.

Finally, he suggests the use of moxibustion on this point for all types of edema due to inadequate engenderment of latter-heaven qi by the spleen, in cases of high fever but where the lower limbs are cold, in cases of diarrhea due to spleen qi vacuity, nue-type diseases with alternating fever and chills, vomiting and loss of appetite, yellow jaundice with red-colored urine and yellow eyes due to cold damage, and chest and rib-side pain due to poor digestion. Also, he insists that these complex disorders must be treated first by fortifying spleen qi. He further states that treating Shi Dou on the left is for specifically for supplementing the spleen, while, on the right, it is for soothing the liver.

In searching for other views on the use of this point, I found that Felix Mann’s The Treatment of Disease by Acupuncture, which is a translation of the treatment formulary section of the Zhen Jiu Da Cheng (Great Compendium of Acupuncture & Moxibustion), states that Shi Dou can be used to treat chest and limb heaviness, diaphragmatic pain, intermittent fever of the spleen, paralysis and numbness, ascites, and pulmonary congestion. Again, if we look at these symptoms, we see the disease mechanisms of spleen qi vacuity, blood vacuity, dampness, and liver depression qi stagnation with possible damp heat.

According to Li Dong-yuan, the disease mechanisms of yin fire include spleen qi vacuity, liver depression, damp heat, yin and/or blood vacuity with vacuity heat, and stirring of ministerial fire. If one analyzes his treat protocols, it becomes clear that, to treat this kind of complex disease mechanisms, one must, at the very least, supplement the spleen, rectify the qi, and clear heat, as well as doing whatever else is necessary in each patient’s case. Based on Baek’s and Mann’s description of this point’s effects, we see that it is exactly these disease mechanisms which are being treated. We also see that they are discussing difficult-to-treat, complicated conditions similarly to Li Dong-yuan.

As a final note, it is my own clinical experience that this point will be tender, often exquisitely so, when it is most needed. I also agree that it is necessary to burn many, but very tiny, moxa threads on the point, usually at least 50 and often as many as 200. Needling the point is not suggested as a replacement for moxibustion since the two types of therapy do not perform the same functions as well as the fact that it is just over the lateral lung in a very slender person. If time does not permit you to treat both sides with moxa, I suggest using the right side, since it is away from the heart and prevents the possiblity adding unwanted heat to that organ (although I have not had that happen in actual clinic practice). I have used this point with excellent results on many patients and hope you will consider it the next time you encounter a patient with a similar complex condition. Knowing the type of patients that most of us see every day, you may find yourself treating this point on a regular basis.

For more information about moxibustion, see Lorraine Wilcox’s Moxibustion: Modern Clinical Handbook and Moxibustion: The Power of Mugwort Fire. For more on yin fire theory, see Bob Flaws translation of The Treatise on the Spleen and Stomach and his one-hour online course, Li Dong-yuan’s Theories on Internal Damage Disorders.

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¹ Baek, Sung, Classical Moxibustion Skills in Contemporary Clinical Practice, Blue Poppy Press, 1990. Out of Print

Have Patients with Anxiety Attacks?

Q. Hi Honora, A few years ago I came to a seminar you taught. During that weekend, I remember you suggested an interesting treatment for anxiety disorder. A patient came in last week with anxiety attacks as a major complaint and I wondered if you could refresh my memory on that treatment. –Sarah in Chicago

A: Hi Sarah, There are several good treatments for anxiety disorder. In fact, acupuncture in general has an anti-stress, down-regulating effect on many patients. That said, however, there are several approaches that I suggest you consider as rotating treatments, using them in succession and then repeating from the beginning. Here you go:

1. Start with Four Bars (often called Four Gates) as an opening treatment. While these needles are in, do some simple massage on the head and neck, dragging across Yin Tang and doing small circles on Tai Yang, GB 20, along the cervical spine and occipital ridge.* (The only time this is inappropriate is if the person really is not comfortable being touched and we do, on the odd occasion, get patients like that.) If they don’t like to be touched, but a needle into Yin Tang.
2. The next time that patient comes in, hopefully within a few days, do the treatment that you saw me do, which is a cross treatment as follows.

a. Insert LI 4 and Sp 4 on the right

b. Insert Per 6 and Liv 3 on the left

c. If using Ion pumping cords, use black clips on the right and red clips on the left. Connect LI 4 to Liv 3 and connect Per 6 to Sp 4.

d. If using polarized needles, use Gold plated needles in place of the red clip and Stainless steel in place of the black clip.

e. Insert needles very shallowly, because electrical flow in the body is strongest on the surface.

f. No jewelry; don’t leave the room during tx; 15-20 mins or until they wake up.

3. As a third alternating treatment, you could do Miriam Lee’s Great 10 Needles adding points such as Liv 2 and LI 11 for excessive heat, Ht 7 and CV 17 for palpitations and severe fearfulness, or An Mian (extra point), Sp 6, and Ear Shen Men for insomnia.

4. In terms of self care, suggest that the patient use exercise, stretching or progressive muscle relaxation routines, calming music, aromatherapy oils, and an anti-inflammatory diet high in Omega-3a and plant-based protein and low in sugar and caffeine! While acupuncture can calm people down in the moment very quickly and effectively, in the long run the patient has to find ways to help him-or-herself as well.

5. I received a comment from a reader suggesting that, since most anxiety attacks are at least partially due to the qi and blood not nourishing and constructing the heart qi, herbal formulas that do this are vital for long term change in such patients. She is right about this, so if you have access to herbals, choose or create a formula appropriate for your patient to help rectify this pattern.

Hope that helps. If you want details of the theory that goes along with either Four Bars treatment, Miriam Lee Great 10 Needles Treatment, or ti Ion Pumping Cord treatment, check out my online CEU courses attached to these links. Thanks for your question and best wishes.

Lots of patients are anxious these days...

Q. Hi Honora, A few years ago I came to a seminar you taught. During that weekend, I remember you suggested an interesting treatment for anxiety disorder. A patient came in last week with anxiety attacks as a major complaint and I wondered if you could refresh my memory on that treatment. –Sarah in Chicago

A: Hi Sarah, There are several good treatments for anxiety disorder. In fact, acupuncture in general has an anti-stress, down-regulating effect on many patients. That said, however, there are several approaches that I suggest you consider as rotating treatments, using them in succession and then repeating from the beginning. Here you go:

1. Start with Four Bars (often called Four Gates) as an opening treatment. While these needles are in, do some simple massage on the head and neck, dragging across Yin Tang and doing small circles on Tai Yang, GB 20, along the cervical spine and occipital ridge.* (The only time this is inappropriate is if the person really is not comfortable being touched and we do, on the odd occasion, get patients like that.) If they don’t like to be touched, but a needle into Yin Tang.
2. The next time that patient comes in, hopefully within a few days, do the treatment that you saw me do, which is a cross treatment as follows.

a. Insert LI 4 and Sp 4 on the right

b. Insert Per 6 and Liv 3 on the left

c. If using Ion pumping cords, use black clips on the right and red clips on the left. Connect LI 4 to Liv 3 and connect Per 6 to Sp 4.

d. If using polarized needles, use Gold plated needles in place of the red clip and Stainless steel in place of the black clip.

e. Insert needles very shallowly, because electrical flow in the body is strongest on the surface.

f. No jewelry; don’t leave the room during tx; 15-20 mins or until they wake up.

3. As a third alternating treatment, you could do Miriam Lee’s Great 10 Needles adding points such as Liv 2 and LI 11 for excessive heat, Ht 7 and CV 17 for palpitations and severe fearfulness, or An Mian (extra point), Sp 6, and Ear Shen Men for insomnia.

4. In terms of self care, suggest that the patient use exercise, stretching or progressive muscle relaxation routines, calming music, aromatherapy oils, and an anti-inflammatory diet high in Omega-3a and plant-based protein and low in sugar and caffeine! While acupuncture can calm people down in the moment very quickly and effectively, in the long run the patient has to find ways to help him-or-herself as well.

Hope that helps. If you want details of the theory that goes along with either Four Bars treatment, Miriam Lee Great 10 Needles Treatment, or ti Ion Pumping Cord treatment, check out my online CEU courses attached to these links. Thanks for your question and best wishes.

What is SEO and Do You Need it?

I recent received the following question from a student:

Question: "I've been told that my website need search engine optimization and there seem to be about a zillion companies in all different price ranges that do these services. What should I look for in a service? Can I do anything myself?"

Answer: Search engine optimization (SEO) is a huge subject and, while I’m not an expert, I do know a few things about it. First, the answer is yes, there are definitely things you can do yourself when you are creating your site or working on the text. There are also many things your web designer (if you have one) can and should do for you from the beginning. Here are a few tips for starters:

1. You should be conscious of placing appropriate keywords throughout every aspect of your site: your titles, content, URLs, and image names. Think about your keywords as search terms -- how would someone looking for information on this topic search for it? For example, they might search in the following ways:

- acupuncture in Chicago

- acupuncture services in Chicago

- acupuncture for hay fever in Chicago (or whatever disease you want to treat)

- acupuncture treats hay fever

So when you write text for the home page (and all the other pages), try to use as many words as possible that people might use to search for your services.

2. Have your web designer create a site map -- a page listing and linking to all the other major pages on your site -- makes it easier for search engine spiders to search your site. The fewer clicks necessary to get to any given page on your website, the better. People will often click on the site map first if they are not sure where to go on your site.

3. The name of your site should be a keyword itself if possible… and may be the most important one! So choose your URL name carefully. For example, www.backhealthacupuncture.com is better than www.crazyhorseacupuncture.com.

4. Flash designs look pretty, but are not “search-friendly.” Text created in Flash and similar programs is not searchable. Don’t use them in your title on your home page and only sparingly thoughout your site (they’re also slower to load, which your visitors don’t like).

5. Pictures may be worth 1000 words, but not to the search engines! Make sure there is keyword rich text near (above or below) all photos or videos. For example a picture of your clinic, inside or outside, should have the name of the clinic in a caption or title above it. If you are doing a treatment on someone, describe what you are doing in the caption suing words that someone might search, such as: “A patient at our clinic getting acupuncture for hay fever” (the last four words are key words that someone with hay fever might use in a search).

6. Update your content regularly. Every time you add or change something on your site, the search engines have to go and look at the site again. This is easy to do with a blog, which is also a way to reach out to your customer base, but you can also add video, photos, articles, or other elements.

7. Place links to any and all fresh content on your site in any appropriate social networking platforms. In other words, if you post a new blog, article, video, ebook, class announcement, special offer, photo, anything at all, announce it at whatever social media sites on which you participate (Facebook, Twitter, LinkedIn, Britekyte).

8. If you have friends and colleagues with websites, get them to link to yours and you do the same for them. Could you get 100 links from friends and classmates? Are there local businesses with whom you could reciprocate this favor? What this means is that there are lots of other websites pointing back to your website on the internet. This sends a message to the search engines that “this website is more important” and brings you up in the search standings…i.e., your site is more search-engine-optimized.

SOME OF THESE THINGS SHOULD BE DONE BY YOUR WEBISTE DESIGNER. Good ones should coach you about links, blogs, keywords, how to write optimized text, and other basics. Beyond that, if you hire out these services, here are the things I would look for in a good service.

1. Make a list of the above items and then shop around to different services. Prices could be all over the map, but I would expect to pay around $1500-$2000 for really good service with the right kind of follow through for a web page of 6-10 pages.
2. Ask for referrals from any company you are considering working with.
3. Get a contract for the specific work to be done in what time frame.
4. Consider making the final payment be contingent on demonstrable results that they have to show you on Google Analytics and compete.com or other websites that show you how you rank against competitors sites.
5. Get a real person or two with actual phone numbers that you can call to check on progress. Ask for regular updates.
6. Ask if they will teach you how to do some simple things on your own to keep yourself on the top pages of Search Engines!

That’s my advice and I hope it helps. There are lots of articles and resources about SEO all over the internet, so don't stop with my advice. But remember, if no one can see your website, why pay or do the work to have one in the first place?

20 Ways to Re-energize Your Practice, Part One

We all sometimes get bored or discouraged or set in our day-to-day patterns about our practice. It’s easy to rest on our laurels or be satisfied with the size and nature of our practice. But how many practitioners are really thrilled with the size of our practices and the actual work we are doing? If you can answer “I am!” to that question then read no further! If you’d like a little inspiration…here are some ideas you could implement right away to put a shine back on your practice and your mental attitude about it. Good Luck!

1. First, I think it’s important to remember that it’s rarely ever just one thing that we do that keeps us being successful forever. It’s the daily effort of working on our business instead of just working in our business that keeps it growing and continuing to be successful…sort of like a marriage!
2. The Tao Te Ching says, “wealth is the fruit of generosity.” That does not mean giving away your treatments or undercharging for your work. To me it means that we approach our work and our patients with a generosity of spirit and an open heart that our patients will resonate with and be drawn to. It means not being emotionally stingy. It may also mean making as much information as possible available to your patients. It may also mean tithing of your time in some way… such as donating a couple of days per month to a free clinic or volunteering in your community in some other way. What goes around comes around.
3. Have you ever attended a city council or county commissioner meeting and introduced yourself to all the players? Remember that political types have health problems, too, and they talk to lots of people every day.
4. Have you re-considered your front office procedures recently? How I your phone answered? (I hope you are not still answering it yourself all the time). Whoever is answering it, have you written down exactly how, at what speed, and with what tone of voice you want the phone to be answered? For example…have you ever called a company in our industry that you weren’t sure if you got the company you thought you called? You need to make sure that when anyone calls they are immediately
1. Sure of whom they called
2. Know that the person on the phone was happy to answer the phone
3. That the person will help them with whatever reason they called
4. The person or people who answer your phone are the voice of your business! Make sure that your customers will like what they hear. If that person is you, practice with a recording to see if you need to sound more “perky” or speak more slowly.

Finally, have you written specific scripts for your reception person for the four or five most common questions people ask. These are pretty universal questions and you can write out exactly what you want your staff to say in response. Ask them to memorize these simple sentences. If you are the answerer, have a script will help you sound professional and will also help you be clear about what you really want to do say about “how many treatments,” “how much it costs,” “will it hurt,” “can you take my insurance,” and can you treat my ___ (named condition or disease).”

5. If you don’t have any front desk help, what would it take for you to hire someone? I absolutely guarantee that you can make more money with someone to run your front desk that you can by doing it yourself. Think about this…if you pay someone $13-15 per hour, but you are charging $50-60-70 per treatment, would you rather pay yourself the $15 or the $60? There is even a list of 20 other things this person could be doing when the phone is not ringing in Points for Profit (my biz for acupracs book). And, if this person’s presence allowed you to treat 2 extra patients per day on average, you’d more than pay for their services, be able to give someone a job, and make your office more professional at the same time.
6. Create a niche market for yourself. Say you’ve been in practice for three years and you have found that you are attracting patients with diabetes. Why not really study this subject and specialize in it? It could be weight loss, skin care, post-surgery pain reduction, the list is relatively endless. So, as your practice fills, notice what you really enjoy treating. What conditions do you like to hear people say when they call for the first time? What do you fell successful with most of the time? Slowly start to focus your practice in that direction. Why?

It’s easier to get good at treating a few conditions than to get good at everything. Also, it’s easier to avoid burnout and stress when you know you are agood at something and can reliably reproduce patient improvement in a limited sphere of conditions. That type of confidence shows and your patients will fell it, too.

7. Under-promise and over-deliver. If you want your patients to become raving fans, you have to do something more than just a good acupuncture treatment. That seems unfair, doesn’t it? Just remember, a merely satisfied customer will not sing your praises the way a customer that you have given a “wow” experience will do. For example:
1. Do you write down and refer to little things they mentioned about their life the last time they cam to see you (the grandkid who just took the SAT exam, the promotion they were up for, the art show they just exhibited, etc.)
2. Do you always call them during the first 24 hours after the first treatment?
3. Do you send them clippings from articles you find about their condition?
4. Do you provide free hot water and tea in the waiting room?
5. Do you take the mental time to touch them with intentional love and care?
8. Join a club or organization where you ideal patients are members.
1. Do you want to treat sports enthusiasts, join a gym or an active country club with lots of tennis and golf players. Participate in tournaments and other activities these groups sponsor. Join an bicycling or runner club.
2. Do you want lots of well-heeled women patients? Join the Hospital Fundraising Committee, the AAUW, the local Women’s Club, the Breast Cancer 10K Run Steering Committee, you get the idea.
9. Volunteer your services one day per month at a local free clinic, homeless shelter, or other service agency. Everybody else who works there as well is a potential patient. This group may not fill your pocketbook really fast, but it will fill your heart and could become newsworthy at some point, as well as getting your name into the Social Service/Government worker grapevine.
10. Create an acupuncture specialists group, where each member agrees to refer patients to all the others for a specific specialty. Don’t worry about losing patients…it’s likely to work the other way round! Find out in your area who specializes in what and create an active referral base. The person who reaches out to start this type of group becomes and energy nexus around which qi will circulate!

So that’s part one of this blog. I’ll cover ten more re-energizing ideas in part two next week! Thanks for being a reader and I hope there’s at least one idea here that you can jump on today.

If you have other ideas for me to share to help everyone in our profession, send them to me at honora@bluepoppy.com. Thanks for reading and feel free to share my blog with friends!

Handling Difficult Communications with Patients

My friend and colleague Nancy Bilello wrote a book for us a number of years ago that I have always liked. We titled it, perhaps inauspiciously, Understanding the Difficult Patient. It is all about problematic patient communication, dealing with all those moments where you don't know how to handle a patient: when they are angry, non-compliant, needy, overly-familiar, seductive, don't show up or don't pay, or all the other weird moments that we hate as practitioners but which do happen. It's a wonderful book but it never got the attention we thought it deserved. We are now making it available as an ebook for a very reasonable price and here is the first chapter for those of you who actually have experienced these problems and know that any advice we can get for these is hugely helpful! difficult patient-chapter1.pdf

Please enjoy.

Shoulda, coulda, woulda...what records you REALLY need to keep on your patients!

by Honora Lee Wolfe

One of the things that many acupuncturists struggle with is what records they should keep on their patients and for how long. It’s actually quite a list and I can tell you that I think it's all a total pain in the ***, but has to be done! My first advice: digital record keeping may make this more automated, but either way create a system so that you always repeat these procedures the same way every time...it's less like to make you crazy that way, and more likely to actually get done for every patient!

Below I’ve written the basics of what you need, whether digital or hard copy. If anyone thinks of something that should be on this list, I hope you send it to me! I’ve given a short rationale for each of these, unless it’s so obvious as to not need explanation. If you use digital files, some of these instructions could change or be less relevant, which I will discuss as I go through these.

• The patient name should appear on all pages. While digital record-keepers could have the patients name connected with each relevant file, in paper files it’s best if the patient name is somewhere on each physical page. While there is no reason to think that you will mix up one chart with another…you never know. What if your moving guys were moving large file cabinet drawers and they dropped one?

• All pages in paper files secured into the treatment folder. It’s easy to purchase file folders with metal clasps or tabs that hold all the papers at the top of the file (Smeed Classic Fastener folders #14537). Both sides have the fasteners, so you can separate money/legal papers from treatment papers. Then, even if the clumsy moving guy drops the cabinet drawer, the papers are all secure inside!

• Organized chronologically (most recent date on top). This makes it easy for you to track what you did from one week to the next. This will be automatic with digital record keeping systems.

• Write legibly, be consistent, clear and concise. Easier said than done, but important. When your patient moves to New York and asks to have their chart sent to a new practitioner, it’s nice if you can be proud of what you are sending. Will what you have done and why you did it be clear and easy to understand?

• Maintain record in ink, use the same pen for each entry on the same day. This is important if your charts are ever subpoenaed in a legal case. If you are using only digital records, the software will know when entries were made.

• Do not alter the records, do not erase, use correction fluid, or use adhesive labels to cover up anything. If you made a mistake or need to make a correction, reference where it goes in the chart relevant to which date, and simply put it into the chart from where you are. Or, clip or staple a page onto the page that needs to be changed and reference the specifics.

• Fill in all blanks, do no skip lines or leave spaces, line through large blocks of space. In addition to conserving trees, which is certainly worthy enough, this rule keeps you or someone else from being able to go back and easily add erroneous information or change things in that day’s entries.

• Do not “squeeze in” notes and do not indent… same thing as above.

• Make additions and changes appropriately, on the page where you are, reference the page you want to change and why, or add a clipped note to the page that needs to be amended. In digital files, date any changes or additions to another day’s notes.
• Record all patient contact of every type
a. Missed appointments are documented
b. Telephone messages are documented
c. Entries dated, timed and initialed by you
d. Patient non-compliance is documented
e. Faxes, emails are documented

• Initial all externally generated reports (X-ray, lab, diagnostic, consultant) before filing them

• Dictation and correspondence and reports proofread, initialed by you before filing. Keep dated copies of any item that you send anywhere for or about a patient.

• Maintain a legend for any codes or abbreviations used. This list should be in your employee manual, or procedures manual, or kept somewhere that employees can reference it if necessary or copy it to be mailed with any records that have to be sent anywhere.

• Document the reason for the visit. This should be done every time the patient comes in, even if it is just a short visit to reconfirm a diagnosis or an acupuncture follow up visit with no further diagnostic assessments.

• Document any unusual events. If the patient does or says anything unusual or alarming, or if there is a strange interaction between a patient and any staff member, this should be in absolute detail in the chart notes.

• Avoid or explain contradictions. If something about what you wrote some other visit is for any reason no longer correct, explain why this happened. If you take a complete u-turn in your treatment modalities with a patient, explain why. If you did something that you now think was wrong, explain why and what you will now do about that.

• Clinical findings (positive/negative) documented and the problem or complaint list is kept current. Don’t leave out diagnostic details, but be as concise as possible.

• Treatment plan documented. This is both the short term (today) and long term (series of treatments) treatment plan. This can and will change throughout the overall course of treatment.

• Entries are objective; do not get personal beyond what’s necessary to write up the case and what you did about it.

• Never criticize other providers or their treatment methods. You will get patients who have seen other practitioners, including other AOM practitioners. You may not agree with what others have done with your patient. You must, to the best of your ability, leave that past behind and simply do what you think is right for the patient in the present moment. It is unprofessional to criticize other practitioners’ work, even if you think they are a total idiot.

• Properly identify the file, the record keeper (you or your employee), the techniques employed in the treatment, the table and/or room used and the channels and points treated. When the patient comes back a few days later and says, “that was a great treatment; can you do that again?” you do not want to be in the situation of not remembering what treatment you gave and then find that you did not write it down!

• Patient instructions are documented. If you know what you asked the patient to do as homework, there is an engaged discussion to be had with the patient that makes them feel that you are paying attention to their case. If you don’t write it down, you won’t remember what you told them, unless you only have three or four patients in your practice!

• Document any patient non-compliance. If they did not do the homework, take the herbs, change their diet, whatever, they should not be complaining that they don’t feel any better!

• Informed consent is in the chart. This is one of the fundamental legal documents that you must have in order to legally stick needles in patients (or do moxa, or do whatever)

• Be certain that the “Release of Records Authorization” form in the chart is correct and valid. If you need the patient’s records from a previous practitioner, this form is vital.

• Referral letters from other practitioners are kept in the file. If you keep digital records, scan the letter or copy the email and store it.

• Prescription list is in the chart, both Western and Chinese. If the patient is taking western meds, that list needs to be in their chart. Whatever herbals or supplements you recommend must also be kept up to date.

• Herb list is current, when due to refill, reactions or allergies, or positive results documented.

• Patient education materials given to patient is documented. If you give a patient a brochure, copy of research, a book or an article to read, keep a note of this in the chart.

• Keep financial and clinical information separate. In a digital record-keeping system, this is automatic. If you use paper records, the Smeed Classic Fastener file folders help you keep both sides of the chart (a. financial/legal and b. clinical) tidy and separate.

• Retain patient records forever because of the statue of limitations on malpractice cases is very, very long. If you have paper records, you may at some point want to scan them and keep them on a CD or in a back up system.

• Signature of the provider of services on each new treatment date in the chart. Each time the patient comes in, a new signature by you as treating practitioner or any acupuncturist-employee you hire to do treatments must be in the chart notes for the day you or they did the treatment. Every time.

Final thoughts

Customize the forms you use for your specific clinic and style of work. Your forms should probably not be a clone of anyone else’s…unless you think that form is already perfect for you or they are all digital files in any case!

I Repeat again!!!: Create a system for keeping your charts (whether paper or digital) that you always repeat the same way with each patient every day in clinic. Don’t vary this procedure once memorized. Teach your employees how to help you and where their participation is appropriate, legal, and vital; this ins another reason to hire a front desk staff person! You don't want to do all of this yourself.

The most important thing to remember about record keeping is this: if you did not document it, it never happened from a lawyer’s point of view.

Good luck!

Everything you could ever ask about acupuncture needles

Here's a lovely blog by Shawn Kirby of Blue Poppy...

How to Buy Acupuncture Needles

by Shawn Kirby L.Ac.

Buying acupuncture needles is a lot like going to a really great smorgasbord – there are a lot of choices but it’s not always easy to know what you want and/or need. This handy little guide is designed to help you easily find and order the type of needle you know and love, and might even inspire you to try something new.

Handle Type

People are often confused as to what the various differences are between one type of handle style and another. What are the advantages of a given style, and why are they like that in the first place?
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The first, and absolute best, way to choose the type of handle that you use in your acupuncture practice is to experiment with many different styles of handle and choose the one that feels best to you. No two people are alike, and everyone’s hand is different. Only you can truly determine what handle style will work best for you in your practice. That being said, there are a number of different styles of handles available on the market, each catering to certain styles and techniques.

Here's a link to the rest of this great article...

http://www.bluepoppy.com/blog/blogs/blog1.php/how-to-buy-acupuncture-needles

Borrowing $$ from family? Do it right!

It's common enough. Especially if you already have debt from student loans. You go to a well-off (or at least better-off!) family member to help you start your business. Still, you are likely to maintain healthy family relationships if you do this right and protect your family as much as you can if you ever had to default on the loan. Here are some tips to help you keep happy family relationships: 1. Don't think about borrowing from anyone until you have done a thorough business plan. Know exactly how much you need, what you need it for, and how you will market and grow your business to pay the loan back! If you aren't organized and grown up enough to do this work, you are not likely to be grown up enough to run a business in any case. 2. Establish the amount of the loan and terms of repayment in writing...with signatures. 3. Treat this loan the same as you would a bank loan. Make your payments in full and on time. 4. Keep you family updated about what is happening at your business. Send them regular reports in writing. That way, you don't have to discuss it during Thanksgiving dinner or other family gatherings! 5. If things go badly and you cannot make a payment, don't avoid the issue. Tell them immediately and request an extension. 6. If you think that you may have to default on the loan, don't avoid that issue either. Doesn't your family member deserve to know about your problems first? 7. Do a UCC Filing your loan as part of the initial establishment of the terms. (http://wiki.answers.com/Q/What_is_a_UCC-1_agreement) This gives your family member a better chance at getting their money if you have repayment problems or even go into default, and especially if you are also going to borrow some from a bank. http://secondwindconsultants.com/2010/04/26/if-you-borrow-money-from-your-family-you-need-to-do-it-right-for-reasons-you-are-not-even-considering/ 8. Don't even consider borrowing money from someone in your family who cannot afford to lose it. If this person can lose the money without causing financial hardship, you will sleep better, and so will they. So it's better NOT to borrow money from friends or family if you can avoid it. I have only done it once in my life and it worked out fine, but added a level of stress to the relationship that was undeniable until it was paid off. If you decide this is the only way you can get your business started or up to the next level, be sure you know what you are doing and why and what actions are going to allow you to grow enough to pay the money back.
Honora Wolfe writes and speaks on business and practice success at schools and conferences all over the world. Her upcoming classes include an all day workshop at the NEW England School of Acupuncture on March 20th, an Internet Marketing class for the AOBTA conference in Austin on April 7th, and a keynote speech on business success at the Acupuncture Society of NY on May 22nd.

When was the last time you called your inactive patients?

It's difficult to overemphasize the power of patient re-activation phone calls. It's way easier than cold calling (calling people who don't know you) and it's a tried and true method to get a positive response from the universe in growing your practice.

You don't need to have a huge agenda for the calls, but it may be easier if you write a few "scripts" for the calls. Here are some ideas for those:

1. For patients where you parted ways after treatment success: "I saw a recent article about your condition (which I'd be happy to email to you if you're interested) and it made me think of you. How are you doing? Still no more symptoms?" Then listen to the patient and see what they say. If they are still better, you have at least reminded them of your ongoing care for them as a patient. You might suggest a "tune-up" appointment or two at the next change of season to maintain their health.

2. For the patient that cancelled and disappeared: "I see you cancelled your last appointment and then we never heard from you after that. Can you tell me how you are doing? I was just wondering if you disappeared because you were feeling great, or was there something that did not work for you at our clinic...something that we could have done better?"

3. For the patient where their written contact information no longer works: "I'm calling for two reasons...one just to check in and see if you are still feeling improvement from your treatment through my clinic. Second, I see that your email address as changed. Did you still wish to be on our mailing list? We really hope so, but we need an updated email address!"

4. The patient where your interaction was OK, but you don't know why they stopped coming: "Hi Jane. It's been awhile since I saw you and I just wanted to say hello and see how you are. I know you had ...(you divorce finalization, our son's graduation, your mother's serious illness, your new job, whatever). I know that was stressful for you and I wondered how you are doing."

After each of these possible openers to the conversation, you then be quiet and see where the patient will take the conversation. If they haven't much to say, you can ask if they'd like to continue to receive your email newsletter; you can offer to send them a coupon for 1/2 off the next time they might want to come in for a visit; you can let them know about a new class you are teaching or a new skill you have acquired; you can tell them about a free lecture you are giving somewhere; you can remind them that regular tune-up treatments can keep them symptom free. Whatever feels appropriate.

After the call, you might follow up with a card or a personalized email and include a piece of research or an article on their condition if you can find one (check out our TCM Infoline here at Blue Poppy for lots of free research: see the search mechanism in the center at the top of our home page). If you send a regualr piece of snail mail (what a concept), include a copy of your biz card as well.

Does this take a little courage? You bet, but then if you were a wimp you probably would not be running your own business anyway. Plus, you don't know what fruit this will bear. For every ten phone calls you make, you will likely get one patient to make an appointment right away and another one to call back for an appointment within a few weeks, or to refer a friend since they have now been reminded about you and your services. Or perhaps one of them calls and asks if you will come and give a talk for their special group. You just don't know.

So don't abandon your inactive patients. Make it a monthly task to call six-or-eight-or-ten of them. The more you do, the eaiser they become (and what's the worst that could happen anyway?). It's easier to get your old patients back into your clinic than to develop new ones who have never been there before!

Honora Wolfe is the author of POints for Profit: The Essential Guide to Practice Success for Acupuncturists. She is teaching a class on biz and practice success at the New England School of Acupuncture on March 20th. Check it out here.http://www.nesa.edu/calendar/show_item/112

I Stole These 15 Marketing Ideas from Other Industries (and you should, too)

Do you read magazines or publications from other niches and industries? I find it very revealing and worth my time as a marketer to check out all kinds of ads, articles, and ideas from industries outside the world of Chinese medicine and then “cross-pollinate” the ideas in ways that make them relevant to improving the marketing plans for my company and my clients’ in private acupuncture practice. Try out some of these and see where your creativity may take you.

1. Use holidays to tie in with your promotional efforts. Go to www.holidays.net/index.htm or http://www.holidayfestival.com/ and look for lists of holidays or commemorations that may somehow be related to health. Can you write an article about any of those subjects, give a lecture, or create an event that will attract attention? Example: Feb 3rd (yesterday!) was Chinese New Year. It is a common tradition to give red envelopes containing money to family members and especially children. You might have a party at your clinic inviting all your patients. At your party, fill a basket with red envelopes, each one containing a coupon for something (A free treatment during February, a discounted series of treatments, a free bottle of herbs, whatever. On the back of each coupon put a Chinese proverb. Serve tea and fortune cookies!) You can spin this idea for any day, week or month of the year....National Breast Cancer Prevention Month to Mental Health Week. Check out Chase's Calendar of Events at your library for endless ideas about this.

2. Give your patients value-added information every time they come in. This might include bookmarks, pocket guides to dietary health, free books (buy in bulk for wholesale prices), a CD with a recent lecture you gave to some organization and have taped (CDs are not expensive to make), a small pocket guide to "Using Chinese Herbs to Enhance Your Diet". These ideas are endless. And don’t forget that everything going out your door should have your contact information on it, website, etc.

3. When contacting the media about covering your clinic, use odd times of the day. These people often work weird schedules, but the gatekeepers who work for them work regular 9-5 schedules. Thus, if you call at 7:30AM or PM, who knows who will answer and what access you may have?

4. Teach classes and workshops. Find any excuse or reason to teach for anyone who will listen on any subject you are comfortable speaking about. The students in the classes will, more often than not, become your patients. Does your local YMCA or community college offer continuing ed classes? How about your church, PTA, large local corporations, or Better Business Bureau? Don’t be shy and make sure you have flyers, business cards, and brochures to give out.When you get a gig, also take along a sign-up sheet to receive your e-newsletter or blog.

5. If you get a speaking engagement, follow up with a Thank You card to the person who was your contact.

6. Have something really exciting to share? Contact every syndicated columnist in the US. You can purchase a list for $20 from Editor and Publisher. Contact subscription services at circulation@editorandpublisher.com, (888) 732-7323.

7. Start and maintain a support group. These may be other acupuncturists or other kinds of business people. Napolean Hill, in his famous book, Think & Grow Rich, calls this a “master mind” group. You can meet for breakfast once each month or each week. At each meeting, take on one or two people’s questions or problems and share your ideas for a solution. This is tremendously powerful!

8. Want to be a radio personality? If you’ve got something interesting to share, go to http://www.ontheradio.net/cities/boulder_co.aspx for a list of stations.

9. If you want to be an expert on a specific subject (improved sports performance, preventing anorexia, treating or preventing fibromyalgia, go to your local/regional paper and TV station websites and find the names of relevant editors (health, special features, modern living, etc.) and send them a short, to the point email message. Keep it to three paragraphs and use powerful words and sentences to get across your message. If possible, reference or tie to a previous story that this journalist has written or covered.....and never use attachments. Give them the guts of what you have to say in a sound bite. Deliver it in a way that makes their job easier and who knows, you might become their main contact for alternative health for years to come.

10. Create a affiliate program on your website to sell products you love. This is not a new article, but you can get started with affiliate marketing using Lisa Hanfiletti's information here: http://www.insights-for-acupuncturists.com/affiliate-information-for-acupuncturists.html

11. When there are no patients in your office, don’t sit and read clinical books, go out and meet people. Are you in a building with other offices? Does every other business in your building know who and where you are? If not, go introduce yourself and take your business cards. Walk every street in each direction for a mile or so and give out cards and brochures to all who will take them!

12. Are you Hispanic in origin and/or fluent in Spanish language? Find every Spanish language newsletter, paper, TV or radio station. Then try #9, 8, 4, 3, and 1 above....but do it with Spanish!

13. Use artwork for free. Check out http://www.aaaclipart.com. You can download over 30,000 free images. Brochures, business cards, flyers, signs, and more.

14. Have a great piece of artwork you’d like to share? Take it (and your contact information) to Kinko’s or a local printer and have posters made. Give away to your best patients. Make sure that a sticker with your phone and email are on the back.

15. For women only.......does your town have a Women’s Networking Entrepreneurial Training resource? You can find out from the U.S. Small Business Administration in your area. They offer wonderful classes and networking opportunities in most metropolitan areas.

16. Cruise over to www.morenewpatients.com .....originally for Chiropractors, but has some great ideas no matter what services you offer to your patients.

17. Want to sell your practice? Get a free quote and selling ideas from Professional Practice Specialists, Inc. www.practicesales.com 800-645-7590.

18. Want to create beautiful window signage? Contact www.grafia.com or 800.767.5609 for eye-catching window decals, banners, light boxes, sidewalk and interior signage.

Ok, so that was more than 15. I got carried away looking at ideas from other publications and websites while writing this article. I encourage you to look at every publication you can with a “marketing eye” and steal ideas from everywhere. You’ll be surprised at how your creativity is sparked by other industries’ solutions to marketing problems. Pick one of these 18 ideas and just do it....see how the added qi makes your practice grow!

Good luck!

Honora Wolfe is the co-author of Points for Profit: The Essential Guide to Practice Success for Acupuncturists, available from Blue Poppy Press at www.bluepoppy.com. She is teaching an upcoming one day biz class at the New England School of Acupuncture, March 20, 2011.

A Simple Way to Introduce Yourself to the MD Community in Your Town

Here's the link to my other blog, where I posted this piece today!
Thanks.
http://www.bluepoppy.com/blog/blogs/blog1.php

20 In Person Promotions on a Shoestring

So if you're tired of learning how to market your practice on Facebook and LinkedIn...and especially if you live in a smaller town, here are some ideas for marketing yourself and your practice that can cost little or nothing. Some are better than others and some are easier to pull off than others, but it’s a list of creative ways you can promote your business on a shoestring budget. You can probably pick up from #20 and keep going with the list.

As a matter of fact, why not do that? Think up 20 more promotional ideas and then let your friends or partners rank them based on the following criteria:
• realistic (as in you could actually pull it off)
• fun and whacky (people will respond to things that have entertainment value)
• doing good in the community (this will often get you into the paper or on the 5 o’clock news)
• purple cow value (it’s different and remarkable compared to anything in the acupuncture community has already done)

Then narrow down your list to the best three promotions ideas. Then have a discussion with anyone else who might be participating or a stake-holder in the work and the outcome and choose one to try out. Doing just one of these promotions will give you experience and will most likely bring interest to your clinic or at the very least, get you some free publicity.

Here are mine for today…
1. Sports venue contest - Partner with a local sports venue and your state acupuncture association and host a contest that will give the winner free passes to watch a professional sports game in the box seating area. People will love the promotion and it is sure to get a lot of press. What could the contest be? An essay contest about “Why Sport Participants Should Love Acupuncture” with the winning essay going on your website, into the local newspaper, or out in your monthly patient email blast and being printed in the health or sports section of the local paper.

2. Joint Venture with another or several other small business - Joint venture with one or more small businesses in your neighborhood and display each other’s products/services in your respective show room or reception area. This trade could be with a beauty salon with proprietary products, a climbing gym with health-related products, a health-food store, a local spa, a specialty bookshop, or even a company that sells clothing and prostheses for women who have had mastectomies.

3. Niche sales – with other acupuncturists or your state association, sponsor special offers, talks and classes, or products for specific communities (niches) of people who give to the community such as firemen, teachers and policemen. This could be a “Teacher’s Appreciation Day.” An “over 65” senior adults event can be popular as well. Offer a series of lectures on health, stress, posture, diet, exercise, anti-aging, or special products sales that might appeal to these niches. Donate the profits of all your sales of product at these classes to the professional organization or group who sponsors the talk and you can get in the paper as well as their association newsletter! Some of these folks will definitely become your patients.

4. Car/Truck signs – while you may have to pay a bit more for your license plates if it is a commercial vehicle, why not have your vehicle be a moving billboard for your clinic? Have something like “Headaches? Acupuncture Works! Call 333-333-3333 today for more information.”

5. Positive picketers - Positive picketers who picket your business with signs that say how good your work is. If you employ this tactic, call the newspaper and they’ll probably cover it. Call the local T.V. station, too. This could be a bit of a stretch, but then, no one else has used this idea for acupuncture yet, so why not?

6. Get all the acupuncturists in your city to co-sponsor a toy collection for the local homeless shelter for the holidays...or the local battered women's shelter. Get it on the news when you are delivering the toys and you all get some great publicity for being great community citizens.

7. Create a bumper sticker - Give your customers special incentives to put a bumper sticker on their cars. Your bumper sticker could read, “I Got Relief at Acme Acupuncture Clinic! 333-444-5555”

8. T-Shirts - Get a bunch of t-shirts made up and go down to the local 5k or 10k race and give them away to the runners and participants. By the way, while you’re at the race you should hire a couple of youngsters to tote a banner around with your clinic’s name on it (I was just in Seattle, WA at a 3K run and a local chiropractor was getting a lot of attention using this idea.)

9. Participate in Local Parades - If you live in a small city participating in a local parade is a fantastic way to get visibility. Rent a flat-bed truck and get two or three family members (or local public figures, celebrities, the mayor? etc.) to sit on the back with needles sticking out of their head, ears, legs, whatever and wave at the people. It will get a lot of attention. Don’t forget to get a big banner to put on the side of the truck with your clinic name and phone.

10. Host or Sponsor an Award - The best award to give are the best teacher award. Just contact the schools and ask them for submissions. Give away prizes to the teacher (free 6 months of acupuncture or herbs?). This affiliates you with a good cause and you have the opportunity to get a lot of free publicity.

11. Sponsor a Block Party in Your Clinic Neighborhood - Announce the party and provide food, drinks, and music for a few hours. Give everyone a clinic or acupuncture related t-shirt to wear while attending the party. (OK this one is not so shoestring budget, I admit.)

12. Free 4th of July Giveaway - Give away your services for the entire day on 4th of July (or other holiday) in your home town. Start displaying the free giveaway with your company name on it at the beginning of May. You can even sell tickets for a raffled item and give any proceeds to a local charity. Display your event at the local Chamber of Commerce (if you're a member of the chamber of commerce) or in your window or on signs in your clinic waiting area.

13. Good Cause Day - Proclaim a day in honor of a good cause. For instance, suppose your could establish an “Insomnia Day” because acupuncture can help people to sleep drug-free or you can take advantage of an existing day like “Arthritis Day?” You can submit your day to Chase’s Calendar of Events to dedicate your day to a good cause! Call the local press and other associations and let them know about the proclamation.

14. Host a “Free Seminar” - Team up with other local merchants or government agencies to host a free seminars on your area of expertise. If your talent or expertise helps others, you could partner with the local fire or police department to host an educational or awareness seminar, which will increase your chances of getting a lot of publicity.

15. Collect Business Cards from Local Businesses- Go around to local businesses and offer to sponsor a rotating business card drawing to give away their service (meal, dry cleaners, massage, acupuncture) once a month to one customer. One month the prize is a free meal, the next month free massage, the next free dry cleaning, etc. Every business has a bowl to collect the business cards, which are all pooled once per month. You get to keep the business cards and once you have them in electronic format you’ll share them with every business that participates. Before you know it you’ll have hundreds and thousands of business cards you can all use for direct mailings in your local market.

16. Chocolate Shoes – Still trying to get in the door to meet some MDs? This idea takes some brass, but I like it. Buy a dozen chocolate feet (there are a few companies who make these… try http://chocolatelady.com) and have them boxed beautifully. Send them with your presentation folder and a well written but spirited cover letter to 12 local specialists in the area where you want referrals (gynecology, orthopedics, pediatrics, etc.) Your letter can start with something like “Still trying to get our foot in the door.” Some doctors won’t like your approach, but others may just be impressed/amused enough to give you a call.

17. Sponsor a Half Court Shot - Ask the local high school in your target area if you can sponsor a half court shot contest during the high school basketball game’s half-time show. Award the winner gift certificates to the local movies or dinner for two at a local restaurant. Ask the movie theatre and restaurants to help you offset the cost (or go together with another clinic or two). Get this one in the paper!

18. Got a family member or friend who owns a gas station? - Offer free acupuncture treatments with a fill-up instead of a car wash. Create a large banner to put up at the gas station. This should create some buzz!

19. 6-by-10 – have a heard time doing your cold (or warm) calls? Make a deal with yourself to have six calls done before 10 AM. That’s 36 calls if you do it two days a week for three weeks! If two or three of those calls create a business opportunity for you, it was well worth the time and effort. Some of these calls could be about one or more of the above ideas, some to MD offices, some to inactive patients, some to people you met at a party who asked about acupuncture, or whatever. I guarantee that by the 36th call, you will experience less fear and loathing. Here’s a tip… have a script written and in front of you in advance so the jitters don’t make you forget what you want to say. And remember, your pitch must start and end with what’s in it for them. Here’s another tip… if you cannot get through the gatekeeper, try to make an appointment to meet and “court” the gatekeeper. Invite them to lunch!

20. Start The Acupuncture "Kiwanis" club in your community. In other words, a group of acupuncturists (or alternative therapists if you need a larger membership). Meet once per month for breakfast or a beer and figure out a project to help your community as a group.

Perhaps you are more creative than me and can think up a lot more great promotions. Give it a try. Make a list of 20 more creative promotions and work them down to a short list. Then move out and make something happen. We don't want to let others define who we are and what we can do!!!