Accompaniment
on excellent traits and virtuous circles
After a patient gets treated in POCA Tech’s student clinic, they receive an email linking to a survey, asking for feedback. Last week we got this response:
Please rate your experience with this student acupuncturist.
Needling skills excellent
Communication excellent
Overall excellent
How likely are you to seek treatment from this student again?
very likely
What were the strengths of the student acupuncturist?
(This intern) is attentive, aware, sharp as sh*t, compassionate with a grounded, down-to-earth humor, all excellent traits for an acupuncturist.
And a human being.
How could this student improve as an acupuncturist?
maybe offer pizza?!?
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The intern promised to work on their pizza skills, but this post is actually not about pizza (sorry!) it’s about the concept of accompaniment.
Dr. Paul Farmer, one of the founders of the global health organization Partners in Health, wrote an essay, "How Liberation Theology Can Inform Public Health", about applying key concepts of liberation theology to medicine. He listed three: Preferential Option for the Poor, Structural Violence and Accompaniment.
Here’s how he describes accompaniment: “The power of this simple idea, a staple in liberation theology, came to me in contemplating patients facing both poverty and chronic disease. They missed appointments, didn’t fill prescriptions, didn’t “comply” with our counsel. And this was true in every country in which I’ve worked. But when we began working with community-health workers to take care to patients, the outcomes we all sought were much more likely to happen. Instead of asking “why don’t patients comply with our treatments?” we began to ask, “How can we accompany our patients on the road to cure or wellness or a life with less suffering due to disease?”
This is what we’re trying to teach POCA Tech students to do. Accompaniment is the most important skill for a community acupuncturist. It’s the core of our praxis.
Most of what I know about acupuncture equals what I learned while I was trying, as best I could, to accompany my patients with chronic illnesses. It did not match the acupuncture textbooks. I learned that you can’t control what acupuncture does in the body once you put the needles in; regardless of how hard you try, your treatment might get mind-blowing results or none at all. Attempting to micromanage either your patients or acupuncture itself usually results in frustration for everybody.
Progress with acupuncture tends to look like incremental improvements that build on each other over time. First someone’s sleep gets a little better, then their energy gets a little better, then maybe they can move a little more easily which means they can get a little bit of exercise, and a little bit of exercise helps them sleep better — that’s an example of a virtuous circle, and it just keeps going like that. Acupuncture catalyzes and supports any number of virtuous circles. Sure, there are miracle treatments — every now and then there’s the one-off that fixes everything at once. But mostly it’s about hanging in there with people, trying to feed the virtuous circles. (If you’d like to read more about “systematic incrementalism” and chronic pain, check out Atul Gawande’s great article “The Heroism of Incremental Care”.)
Accompaniment is kind of pedestrian — in a good way — literally like walking a path. I learned that it was productive to focus on how I, rather than my patients, show up in clinic. It was useful for me to work on becoming a consistent, attentive, grounded, and hopeful version of myself. There was leverage to be gained by making the clinic as easy as possible for my patients to use. The rest of it was out of my hands. Everything I could work on required self-discipline and patience; none of it was rocket science.
Melissa Poulin, a POCA Tech alum, wrote in her Substack: “… I know, from my experience as both a patient and a practitioner in community acupuncture, that peaceful accompaniment is often the only thing that helps us bear our suffering. When nothing else relieves sadness or anxiety or chronic pain, it can be healing just to have someone acknowledge how much it sucks, and be willing to try to make you a little more comfortable, if only for an hour or two.”
This weekend at POCA Tech we’re going to be talking about the concept of the practitioner persona, or who you need to be in clinic in order to provide accompaniment to all kinds of people who are traveling all kinds of roads. One of the hidden perks of doing that kind of work is, in my experience, that you can also become a stabilizing presence to yourself. Spending time embodying the excellent traits of awareness, compassion, groundedness and humor while you’re at work is like getting a break from the stressful aspects of your own personality. Even when you’re working hard, it’s restorative and nourishing. Not unlike a long walk in the woods. Or pizza.