Conversations with Dilip Babu M.D., Part One
on integrative medicine and becoming an acupuncturist
Recently I had coffee with my friend Dilip, who’s a POCA Tech Board member and a part-time WCA acupunk (Hillsdale, Wednesday afternoons). Outside of our world, Dilip is trained in Internal Medicine, Hospice and Palliative Medicine, and Medical Oncology, so his day job is working as a physician. I thought I’d try to turn our conversation into a newsletter (or two).
Me: Talking to you gives me a reality check about the economic horrors of the US healthcare system outside of WCA’s little bubble, where we not only have a sliding scale but sort of gleefully ignore it, you know what I mean?
Dilip: One of the first things I thought when I was introduced to WCA was, how are these people getting away with this?
Me: Speaking of that, just to recap: you were introduced to WCA by a friend in 2021, and not long after that you started volunteering at the front desk at Cully. I remember somebody saying to me, have you met the new volunteer? He’s really nice, I think he works in healthcare or something and he’s interested in POCA Tech? By the time we actually sat down to talk about school, somebody had finally asked directly about your day job and you said,
Dilip: "I’m an oncologist" -- which I was at the time, although I now work as a hospice doctor.
Me: I was like, okay, this is a new one for us.
Dilip: I had the chance to observe some acupuncture back in med school, and I’d been interested ever since.
Me: Fun fact, in Oregon it’s legal for M.D.s to practice acupuncture with no additional training whatsoever (though the Oregon Medical Board doesn’t encourage it). So I was like, you can’t spend three years on POCA Tech’s program after practicing as a physician for more than a decade and also teaching in a medical school. Just, no.
POCA Tech is designed to take laypeople and turn them into practitioners and you’re way down that road already, we’ll have to figure something else out! POCA Tech is fundamentally about a path to licensure and you don’t need that. Then it dawned on me that the process of figuring something else out was actually a really cool opportunity for the school. How would we train people if licensure wasn’t a factor? What do we think is most important, what’s the core of what we would teach if regulatory agencies weren’t involved at all? So I pitched you a proposal: want to try something wildly experimental and help the school learn something that it couldn’t learn any other way? And then we’ll talk about how it goes? And you said yes.
So: tell me about becoming an acupuncturist.
Dilip: When I started taking classes at POCA Tech, I was bringing a biomedicalized frame to acupuncture. I was coming to it with a lot of backstory. It’s like, when I lived in Tokyo after living in New York, I would approach a new place thinking in analogies, like “this is the Central Park of Tokyo”. It was hard to actually see Tokyo; everything was in reference to the other model.
I’ve also studied Ayuveda, and one thing I learned from that experience was, if you have a heart attack go to the hospital. Biomedicine does some things really well. I think of these systems of medicine as being complementary, not better or worse. I really think it’s about integrative medicine, not alternative medicine.
Allopathic medicine understands illness in terms of diagnostic categories or disease entities that sort of exist in the ether, separate from a specific human being. Whereas Ayurveda and acupuncture look at illness and health in a more embodied way. Like, the way you as an individual might embody an imbalance is different than one of these abstract biomedical disease entities.
And then the diagnostic categories get turned into billing codes. It’s a very short road from the philosophy of allopathic medicine to the economic reality. If you don’t have a billing code for it, it doesn’t exist. There’s this idea of disease as a thing separate from people, and then it’s imposed on the individual patient.
Sometimes the abstract category fits what the patient is experiencing pretty well, so you take it from there and proceed with the “standard of care” treatment pathway. The problem is that sometimes the abstract category doesn’t quite fit, in which case you might end up blaming the patient. And if things really aren’t working, that’s when patients get labeled “noncompliant” or some other stigmatizing language like that.
Me: Unfortunately acupuncturists have sort of adopted their own version of that into our professional culture, which we try really hard to not do at POCA Tech. Which makes me think of something you wrote, that we used as documentation in our last accreditation review. Reflecting on your experience as a student, you said:
My previous training concentrated primarily on the diagnosis, pathophysiology and management of disease entities both common and rare, with some attention paid to social determinants of health. While the curriculum at PTI does include these topics—presented from the perspective of acupuncture—several other subjects are covered with which I had previously only become familiar through my own reading. Some of these include trauma-informed care and the financing of healthcare in the United States.
And there’s the whole thing about holding space, right?
Dilip: Right. I didn’t learn explicitly about holding space when I was in medical school — I learned by watching other physicians do it. So as soon as I heard it at POCA Tech I was like, I get it! I wonder how my learning might have been different as an MD if I’d had that introduction while I was in school. But that skill was very transferable to practicing as an acupuncturist, and it’s a lot of what I do in clinic.
I try to see how trauma informed I can be. It’s really fun to pay a lot of attention to how I blanket people, for example. And I try to concentrate my attention at the point of the needle and when I insert it I think, now my body and this person’s body are connected. I don’t get that in my biomedical day job.
Me: This is something it’s useful for us to reflect on, that a lot of what makes a good practitioner is the same no matter what kind of medicine you’re practicing.
Another thing you pointed out to us early on was how educational it was for students to spend time at WCA’s front desk, that it was actually an important aspect of clinical education. To quote your reflections again:
I would like to highlight one uniquely educational component of the curriculum at PTI: students are given the opportunity to learn and master every patient-facing role in the clinical space. Over the course of multiple rotations, time is devoted to work as a front-desk receptionist and scheduler, observer (essentially an assistant to the main clinic provider), and student intern acupuncturist. I have benefited greatly from these rotations as they have afforded me an understanding of the patient care experience that is multi-dimensional. By interacting with patients from various different angles, so to speak, I have come to know them in a richer, more well-rounded way than before.
It’s been really valuable for us to see our little world from your perspective.
Dilip: Working at WCA is a lot like waiting tables. I don’t mean that as an insult. When I used to wait tables I was also holding space, but without any training. It’s like, who’s half baked and who’s fully cooked? And who needs attention, right now?
What I like about working at WCA is, it’s very much what you see is what you get. Nobody ever says, I paid $20 for this?!?
It’s like, this is a diner, here are the eggs. One treatment isn’t supposed to change your life. I don’t believe in that. And I like diners!
To be continued 7/17
Shameless plug of the day: Dilip kindly offered to teach a class to POCA Tech students, which we subsequently turned into a CEU: Oncology and Palliative Care for Acupuncturists. It’s great! Please check it out if you need CEUs!