Tobydaly1: April 10, 2020, 10:26pm
1. I really miss acupuncture. I especially miss the immediate clinical feedback. I realize now, how incredibly
helpful that feedback has been in guiding my herbal prescriptions, nutritional recommendations, etc
2. They’re awkward. I can’t see any way of getting around this.
3. Some patients will refuse to do them. I didn’t see that coming. Several of my patients just flat out will not let
me know what is going on with them in a video format.
4. Anything that puts me in my normal clinical rhythm helps. For example, I started washing my hands before
and after the video appointments. Weirdly, this put me in a more comfortable clinical flow.
How’s it going at your clinic?
George_Mandler: April 10, 2020, 11:39pm
I miss Sa’am!
Clinic seemed hard.
The pandemic arrived.
Clinic is even harder.
In retrospect pre-pandemic Clinic was easy.
Tobydaly1 #3April 11, 2020, 12:02am
Nice to hear from you George! How are you doing?
rappeports: April 11, 2020, 1:59am
HI Toby, I was thinking g about you tonight as I deeply missed my needles today. I did online consults with a
couple, two women who I’ve been treating for awhile for some emotional issues using Saam and this morning they
had to put their dog to sleep. They were bereft and I felt kind of lost without my needles. I feel confident in my
ability to support my patients in these types of emotional situations with acupuncture, but I felt kind of
overwhelmed without that tool. Despite this, I just wrote them herbs prescriptions which I think will be really
helpful, however I’m not certain that I left them this afternoon with he same level of groundedness that I am
accustomed to after providing acupuncture following a devastating loss. I wonder with all of the death around us, if15/01/2024, 16:22Four Observations From Three Weeks of Video Appointments – Qiological Community
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this is preparation to what we may be experiencing soon – more times that we will need to help people through loss
without our needles.
George_Mandler: April 11, 2020, 11:51am
I have been doing minimal consults – tops 6 per week at the moment. I’ve only seen 3 early Covid cases myself as
where I live it seems physical distancing is working very well.
I miss Sa’am. Clinic was much easier with Sa’am for sure. (However I am glad to not be washing my hands
because they were raw a month ago).
I too find the video awkward and unsettling – I am much more comfortable with a patient physically present rather
than looking at them through a Zoom window. But adapt we must.
In my consults I stress to my patients how important it is to be as accurate as possible because important diagnostic
tools are not available. At the end of sessions i go over my notes with them to make sure I understand their
experience. However I still need to improve in this area as I missed some important information in a session
yesterday and needed to email for clarification.
I also find that tongues can change dramatically with light/shadows and need to be careful to make sure what I see
is what I am really seeing. In addition, I had “Night Shift” on my Macbook 24/7 and just realized it removed all
yellow hues,Yikes that can mess up a tongue diagnosis!
Stay present. Trust. Adapt. Be. Love.
sweiz: April 11, 2020, 12:55pm
Hi Toby! It’s so good to hear from you and so nice of you to check in.
I agree with George and Sally. I miss Saam and I miss the physical closeness. I realize there is so much information
coming in subliminally as I interact with people in person that I miss. I also realize how much touch and seeing is
important for me; touching feet, hands. legs, belly, pulse…feeling how much tension is there, dryness, laxness,
fullness, temperature in different parts of the body, cracked heels, bunions. I have to rely heavily on questioning
and it really strikes me how difficult it is to get accurate information from people’s subjective experience! Many
people are not very embodied and they just don’t know or don’t know how to answer. Thirst, appetite, sweat,
urination, bowels, body temp…all so important but somehow, without the physical proximity, the information
seems harder to get or rely on.
At the same time, I’ve been surprised at the way I can make a personal connection over zoom.
Another thing is that a bunch of Covid cases have come to me. I feel I need to seem them right away and check on
them an hour after they have had herbs and the next day. I feel much less in control of my time. It reminds me of
when Zoe was a baby and I was at the mercy of her needs. There is something beautiful about this direct
responsiveness but its also scattering for my focus, which I see now, relies heavily on predictable structure.
It’s good to hear other’s experience. Thanks15/01/2024, 16:22Four Observations From Three Weeks of Video Appointments – Qiological Community
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Tobydaly1: April 11, 2020, 5:14pm
Thanks so much for this Sally. I have the same feeling, as soon as this lets up I think we’re gonna have quite a
backlog of qi to counterbalance.
Also, thanks so much for this year’s Shen Nong conference. Perfect timing.
Tobydaly1: April 11, 2020, 5:19pm
Thanks George. Great idea to go over your notes at the end with your patient. I’m going to start doing this. Also,
I’ll check my camera settings.
Take extra good care,
T
Tobydaly1: April 11, 2020, 5:35pm
Hi Sharon,
You know I don’t always trust my patients to tell me the truth. I’m having such a hard time being forced to take
everyone at their word!
One of my suspected COVID cases is a nurse with asthma who developed a cough. I checked on her every day and
she started to get irritated! Feels like I’m completely re-learning how to practice…
KristinWisgirda: April 11, 2020, 5:36pm
Yes! to everything said above.
I also miss the container of the clinic and treatment space that is devoted to attending to what is happening with the
body. During video and calls, patients are distracted by the life going on around them. My focus isn’t quite the
same either, as much as I try. The technology itself is distracting as well. Looking at the screen during a call makes
it look like your gaze is averted.
Having to direct patients to self evaluate things like skin temperature and moisture has created a few nice moments
of patients acknowledging their felt experience in a way they might not have asked them before. Still, it can be had
to know how much to trust this information. Mostly I am frustrated with how little information I have to go on.15/01/2024, 16:22Four Observations From Three Weeks of Video Appointments – Qiological Community
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PS “Telemedicine” is my new least-favorite word.
Tobydaly1: April 11, 2020, 7:03pm
Same. I started calling them “video appointments” but would be very interested if anyone can recommend a
different term.
sweiz #12April 11, 2020, 10:23pm
Pixal Practice
Video Vibes
Distance Diagnosis
“Look Ma, No Hands!”
michaelmax: April 12, 2020, 12:17am
George_Mandler:
Stay present. Trust. Adapt. Be. Love.
Ahhhh… yes. Thank you George for this potent reminder.
KristinWisgirda:
“Telemedicine” is my new least-favorite word.
I’m a computer guy. I’m fine with tech. I’m 1/3 Borg. And I HATE “telemedicine”
I don’t have a better term. I wish I did. I keep trying. Love Sharon’s “Look Ma, No Hands!” that kind of
playfulness is so needed right now.
I’ve had a handful of patients with the tele-blah blah blah. One C-19 early stage, one new patient with migraines,
and a few regulars for herbs or they just needed to connect.
This new “gold rush” to the Internet that we told to do…
It reminds of when I was a kid. When I was a kid dogs ran free in the neighborhood. And there was that one dog…
the one always chased cars. There was a running joke about “what is that dawg gonna do when it catches the car?”
I feel like this rush to the internet is just like that. What are we going to do… really… going to do when we get
online?15/01/2024, 16:22Four Observations From Three Weeks of Video Appointments – Qiological Community
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I think it is a potent opportunity. But unless we know… really know… like in our bones know… what we are
bringing to the video encounter that will be of service. Then we might as well be selling used cars.
For me in this moment getting clear on what I bring to my patients both with needles and without… what is the
jing, the essence of my work? Asking this question, and then asking it again, and again. Seeing if I can refine out
some sense of what I can with an authentic and settled heart say I offer online. That has been my recent inquiry.
I’m getting close to something that feels like an answer.
I think about how acupuncture in my limited understanding of it works. It puts people in touch with innate
resources they did not know they had. For me, this is the essence of what skillfully placed needles do.
And I’ve found over the years I’ve at times been able to engage with patients in a way that I can get a sense of
resources they have, but they are not in touch with. Often I can reflect these back to the patient in the course of
conversation. Often enough it lands for them. And it helps me to clarify my diagnosis. And it can profoundly shift
them, even without a needle.
So what can I do online?
First– be there if they simply need a human to talk to who will listen them into their own solutions.
Second- Be more attentive to how a slight shift in lifestyle or habit can work like an acupuncture treatment to put
people more in touch with a particular organ or channel. For example, for my patient with an excess of taiyin
spleen dampness, give him the “practice” of not eating a few select damp producing foods. Frame it as his attention
to eating habits is the treatment.
Or the GB excess patient who rages at her mother, and has that excess wood back flow onto her lungs and cause
asthma. Her “treatment” is to attend to again and again set that boundary with mom, and find a way to do it without
anger. I frame it as “practice.”
In short, I’m using my Saam thinking. I’m using my herbal thinking (and using herbs when I can). But I’m asking
people to do something for their own wellbeing based on a small repeatable action in life that acts as a kind of
tonification for the weak system.
Of course, I’d prefer using needles. But I am taking my Saam infused way of seeing the world, and asking people
to live into what could be a solution.
Daniel #14April 12, 2020, 6:10pm
“TeleMedicine” triggers a nausea response for me.
michaelmax: April 12, 2020, 7:13pm
Tele medicine… the red headed stepchild of healing 15/01/2024, 16:22Four Observations From Three Weeks of Video Appointments – Qiological Community
https://forum.qiological.com/t/four-observations-from-three-weeks-of-video-appointments/978/print6/9
But seriously. Can we find a term we like. Something that rings a “YES” in us? If we, we can really make a
difference. As I suspect many of us hate that tele-whatever we find ourselves using.
Daniel: April 14, 2020, 1:55pm
Maybe this will be of use . . . . https://oneworldindialogue.com/online-aliveness/?fbclid=IwAR23LGUIuF-
VZe0pnZrNjHF872TCHFaPHM7JxXiZC4w-Qh9Ha-WoSiBTb58
KristinWisgirda #17April 14, 2020, 2:42pm
Thanks @Daniel! There are lots of offerings on virtual consulting out there. This one seems to focus on the
quality of the experience which is appealing.
We are all lamenting about how deprived of information we feel with these new formats. There are areas where we
can improve the experience including insisting on good lighting and minimizing distractions.
Being slow on the uptake and easily overwhelmed by the video experience, I am going to start asking for patients
to send tongue pictures ahead of time, as well as pictures of their face. I’m not a sophisticated face diagnostician
but there is still lots to see. Puffiness, skin quality/moisture, lips quality/moisture, color, acne and rashes,
tension/expression and the eyes. I am hoping that viewing the patient ahead of time might clue me into problem
areas that I might not think to address and guide my questioning. A few minutes of contemplating the patient before
the call begins might help me create a space more conducive to treatment.
How are others improving the quality of their virtual consults?
Daniel: April 14, 2020, 3:11pm
As of yet, I am not doing any virtual consults. For one, I am not an herbalist. I only do acupuncture/moxibustion as
well as of course, the full and insightful assessments we do of our patients and consequent advice / sharing /
suggestions / recommendations around lifestyle / life-philosophy / perspective.
I find the whole notion of ‘telemedicine’ largely disingenuous and am very leary of it.
I do think, particularly given Sa’Am as we are doing it here and the insights it generates, there is potential for a
very productive and useful consultation through online means – not really as a series of sessions but as a one or
two-time consultation. And i am continuing to think about that a lot. But I do NOT think it would be the same thing
as an acupuncture treatment at all.
I know and have heard many times – the notion, the idea – that you can treat with words just as you can treat with
needles – and that the two together, in resonance – are very powerful. I do think and have witnessed the latter for
sure. As for the former – treating with words having the same potential as treating with needles – i think its a great
idea – but in reality – I think the equivalence is highly unlikely (except possibly at a level of mastery none of us yet
has).15/01/2024, 16:22Four Observations From Three Weeks of Video Appointments – Qiological Community
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KristinWisgirda: April 14, 2020, 3:28pm
I’m glad to be having this conversation. Thank you all.
Daniel:
I find the whole notion of ‘telemedicine’ largely disingenuous and am very leary of it.
Me too. I am trying to make the best of the situation to continue to provide care for my patients but it feels yucky.
I’m not sure if yucky means abandon it all together or find another way that has integrity to it.
Daniel:
treating with words having the same potential as treating with needles – i think its a great idea – but in reality – I
think the equivalence is highly unlikely (except possibly at a level of mastery none of us yet has).
I have experienced profound healing personally through audio recordings but that seems beyond my skill level to
provide.
I believe T mentioned that his teacher has ditched the needles and treats people by having tea with them.
laurelt: April 14, 2020, 4:30pm
Thanks everyone for weighing in. I’m doing a handful of herbal consults every week. I miss everything mentioned
including the all the intangible energy dynamics of being with someone. I think the ways I naturally from rapport
are quite nonverbal, so I’m having to relearn that as well.
My folks have a wide range of comfort with video, and I think many don’t see the point if they can’t have
acupuncture. A lot of folks can no longer pay me. I have offered self-acupuncture and self-moxa, but most people
aren’t interested. I’m honestly not that interested either–so I appreciated your thoughts, Michael. I think if I offer
anything more than herbs it needs to be something I’m excited about. So far I don’t know what that would be. I
have been enjoying calling some of my regular folks who disappeared just to see how they’re doing. I’m not
getting paid, but it feels good to maintain the simple human connection with them.
I agree about the need for humor–if I can’t laugh I don’t want to be part of your pandemic.
Daniel: April 14, 2020, 8:58pm
I’ll share a couple of relevant stories from my clinic here . . . . we all, of course, come at Chinese Medicine from
distinct and different angles, depending on our influences and our predilections. My general perspective is that in15/01/2024, 16:22Four Observations From Three Weeks of Video Appointments – Qiological Community
https://forum.qiological.com/t/four-observations-from-three-weeks-of-video-appointments/978/print8/9
Chinese Medical Health, a person fills their being fully and moderately with themselves. Nothing is too much or
too little. Everything is in correct proportion and responses to anything on ‘the outside’ are proportionate and
appropriate. A fully healthy person would also be in authentic contact with who they are – at all depths and levels
and fully engaged with the process of becoming who they must become. Sooooooo, with that in mind, what I am
always looking for is . . . . what is showing up that is too much, too little, inappropriate, disproportionate . . . and
consequently, interfering, obstructing and compromising in some way, the person’s ability to connect with and
engage with the process of becoming. Then of course, we have the frameworks – whether it’s the hexagrams of the
I Ching, Yin and Yang, the Five Phases, the Six Levels . . . to help us identify these issues. In my experience,
nothing rivals the power of a well chosen and implemented acupuncture treatment in getting things moving and
removing obstructions. But in clinic and certainly in a virtual online context, there is certainly a lot we can say to
help the patient understand where the situation is too much, too little, inappropriate, disproportionate, etc. I would
think a powerful video consultation would be along those lines – and I do feel the Sa’Am framework in particular,
really has tremendous potential to hone in on the most important issues. I have not done any online consults yet,
but I am doing a lot of thinking about how they might go. I’ll share a couple of examples from live clinic . . . . . . .
Daniel: April 14, 2020, 9:13pm
Here is an exceptional case from clinic from two years back that highlights the power of the word , as opposed to
the power of the needle . . . .I’d been seeing this retired policewoman for about 8 sessions of acupuncture. I
happened to know her and her ex-husband personally – and the psychologist she was seeing (small town, what can I
say?!). She was coming to me for a wicked case of sciatic pain. Usually, of course, sciatica responds very well to
acupuncture. I did 8 weekly treatments and there was NO RESPONSE – and she even had so many classic
palpatory signs, I was just tremendously surprised there was no durable response to treatment. She’d been through
a nasty and hostile divorce and a lot of counselling around that. On our 8th session, I asked her what she and her
psychologist had been working on . . . . .(with my usual perspective being, from a Chinese Medicine perspective –
to see if I could identify what, if anything, was missing, out of place or inappropriate) . . . . she told me, if I recall
correctly, they had focused on two areas . . . (1) what she would make sure to avoid in any future possible
relationship partner so as not to repeat the problem and (2) what her needs were in a relationship. The missing
piece was radically obvious to me . . . with her psychologist, she had never looked into the contributions SHE had
made to the relationship malfunctions – it was like the therapy was blame (the other) and need (what I need) based
but completely avoided self-responsibility!!! (I was a little horrified!). Anyway – I just came right out with it and
said, ‘well, here is what is missing, here is what you have not looked into . . . I suggest you look deeply into your
role in the relationship dysfunction and take responsibility for it’. Two days later she called me and in a state of
total joy, told me her sciatic pain of one year had completely disappeared, completely!! and months later, again, she
called to say it had never returned!!! Just that single insight at the right time, turned out to be the game changer – it
was a spectacular illustration to me of what we CAN do with words!!
michaelmax: May 17, 2020, 10:44am
Daniel:15/01/2024, 16:22Four Observations From Three Weeks of Video Appointments – Qiological Community
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The missing piece was radically obvious to me . .
These are curious moments for me in our practice. We are not psychotherapists, we are not trying to “counsel”
them into resolving their psychological issues.
But… because we have the perspective we do, and because we are looking at them through the lens and prisms of
Chinese medicine, we sometimes ask penetrating questions that do in turn create change.
Words can be powerful. What’s more, the bodymind responds when connected with, be it needles, herbs, words,
habits, insights, poetry, music… there are many ways to connect. It can be surprising.