64 responses so far ↓

• 1 Suze // May 20, 2008 at 6:54 am

  I find this a strange topic, to say the least.

  I believe that if a client is not being helped by you, they will not come back. If you are helping a client, but they don’t realise it, they will not come back. If you are helping a client, and they realise it, then they are the only ones that will come back. So, why would you turn away someone that is being helped in some way by you?…

• 2 Burton Kent // May 20, 2008 at 8:52 am

  Simple. Some people are just unwilling or unable to have a good working relationship with you.

  A common problem is a patient is coerced into coming to you for treatment by a relative or friend. They have ONE visit, then leave saying “acupuncture doesn’t work.”

  Other patients repeatedly miss appointments, which disrespects your time. Then they wonder why they’re not getting good results.

  These are just two examples.

• 3 Christina Wolf // May 20, 2008 at 9:05 am

  Hi Burton!

  Yes, I have found this maxim to be true. People do have reasons for continuing treatment that may not be truly helping them get well–they are deeply identified with their pain or disease and subconsciously don’t want to let go, the practitioners who are treating them have become the patients’ social network. I remember in school the “lifers” coming to the student clinic–often they dictated treatment to such a degree that no only was it not a learning experience for the student, it wasn’t really beneficial to the patient.

  Certainly if what we are doing is not harmful to the patient and the patient wishes to continue acupuncture AND it’s even somewhat helpful to the patient, then I think it’s fine for that patient to come as long as they’d like.

  I don’t think these are the patients Burton is referring to–I think he is referring to the folks who (and I’ve had a few in my practice) want discounted treatment for a long-term problem but then won’t truly follow through with treatment recommendations, herbal protocols, etc. to get well.

  Here’s an example: in my own version of community clinic I used to charge $20 to $40 on a sliding scale. When I revised my clinic and changed the fee to a flat rate of $35, I received an angry email from a patient who could only afford $20 treatments. She’d come to me from another practitioner–to whom she’d also paid just $20–just when I was opening up my community clinic. Though she told me she was very ill and desperately needed treatment, she cancelled 50% of her treatments at the last minute and did not seem to be getting any real benfit from the treatments she did receive. In her email, she railed at me for changing the price and making acupuncture inaccessible to her. I had thought she might be upset and that she might leave my practice due to price, but had already decided that it was OK for her to go. Why? She was a drain on my practice! She took space that another patient would have liked to have, she did not value my services or the medicine enough to pay me what I needed OR to comply with treatment, so honestly, it wasn’t a good therapeutic relationship.

  My own therapist once said when you “fire” a patient or when a patient leaves your practice, that it’s probably good for everyone–you, your practice AND the patient.

  Big subject–we could probably write a book talking about this!

  Christina Wolf

• 4 K // May 20, 2008 at 9:30 am

  There’s a degree of truth to the maxim. I’ve definitely had a much larger percentage of low-cost patients (recieving an ongoing discount for one reason or another) who were problematic than full-cost. Problematic as defined by excessive neediness - multiple phone calls or emails/week and/or taking far more time than they should in the clinic, etc; persistantly negative attitude about ever getting better (and most everything else in life); general noncompliance with lifestyle recomendations and/or herbs; and/or obvious resentment over the price they were paying either for treatment or herbs. I read once that people value more what they pay more for, and there’s a definite degree of truth to this.

  Don’t get me wrong; it’s not everyone — I have a few people on the sliding scale who are wonderful and appreciative. But in my experience, it’s close to 50/50 with people paying less than full price whether they will be good to work with, vs maybe 10% of full price patients who wind up being difficult personalities. (And the days in the school clinic, which was the least expensive of all, had a *lot* of people who were either seriously belligerent or crazy or noncompliant. And yes, I’m aware economics and the economics of mental health is more complicated than I’ve described, but I think the value people give to the treatment is a part of it.)

  As to have I fired patients? Occassionally, yes. People whose attitudes were so out of line that it was affecting my treatment of either them or other patients. As to why? BECAUSE it was affecting my treatment of them and other patients.

• 5 Jared McCollum // May 20, 2008 at 10:15 am

  I charge $85 per visit but I used to have 5 appointments a week that I set aside to charge only $55 per visit. I had to discontinue this because I found out just how true this maxim is. The patients who were in need were 80% of the time more needy. I even had one patient cancel a visit 10 minutes after the appointment and then ask me to deliver her herbs to her home as she was too busy to come by the office.
  The opposite side is my patients that pay full price do not complain about my service, get better 10 times faster, refer far more, and regularly bring me gifts etc. showing me how grateful they are for the service.
  Do not be afraid to charge what you service is worth. I oftne see other acupuncturists who charge far too little and always struggle to build a practice. Patients are not shopping for a great deal, they are looking for the best. If they are shopping for a deal, trust me you do not want them as patients, and more often than not they do not want to get better or because of their attitude and choices in life are unable to.

• 6 Sidney Barthell // May 20, 2008 at 11:09 am

  Fabulous comments. We even talked about this in school. Although, back in the day, I knew a chiropractor with a client who was always one half hour late for her appointment. She seemed to enjoy disrupting his day. But he was clever, and unbeknownst to her, he just penciled her in his book a half hour later than the time she was appointed for. Worked like a charm! She was MAD when she found out he’d outsmarted her!

• 7 Lynn Jaffee // May 20, 2008 at 11:41 am

  I don’t think that I’ve ever had to fire a patient, but have found that the difficult ones just go away.

  When I have the occasional non-compliant patient, or those who chronically miss appointments, I mentally “fire” them, and it tends to take care of the problem.

  For those people who don’t value my time by showing up late, missing their appointments, or calling at the last minute to cancel, my schedule is suddenly very full, and can’t get them back in for a week or two. For those who have unreasonable expectations, I am honest about whether acupuncture, as they picture it, is able to help them.

  For the most part, this takes care of the problem, and I find that I have incredible patients that respect my time, this medicine, and get better as a result.

• 8 Andrea Beth Damsky, L.Ac. // May 20, 2008 at 12:18 pm

  Yes, I also agree that this maxim holds truth. However, I have deliberately dismissed only one patient, and with great satisfaction! He was very controlling, quick to anger, and bordering on verbally abusive, in addition to canceling appointments last-minute and complaining about how my hours didn’t suit his schedule. I sent his last herb refill to him by mail with a letter explaining why he was no longer welcome in my office, and offering to refer him to another acupuncturist along with a copy of his records, if he so desired. I never heard from him again, and I have been grateful.

  Lately I have been examining my own side of this relationship with my needy clients, and find I am often giving “too much”. I call this classic codependent caretaker behavior, and I find it leaves me feeling burned out, exhausted, and sometimes resentful. I think this would be a great topic to discuss in this forum.

• 9 J S // May 20, 2008 at 12:39 pm

  Hey Burton!

  Yes, I’ve had to let a few people ‘go’ over the years, but very few. One was a VERY aggressive woman who would yell and swear and could be quite insulting towards me. I did help her out alot, but it got to the point where her attitude and loudness were just too much for me. I finally suggested that perhaps she should see a physio therapist to finish off her treatments as I didn’t think that acupuncture was the answer. It was just easier to move her on that way, no one got their feelings hurt.

  Another person was this man who had come to me for what I was told was a sciatic issue. This guy was very difficult, very whiney etc. According to him, he pretty much had about 15 serious conditions… although he looked very healthy. I would try to be pleasant and ask him how he was doing and would get answers like “how the hell would I know!”.

  The final straw was when I had the stomach flu and had to cancel his appt. He was not happy about it at all. When I saw him for the re-book 2 days later and asked him how he was, his answer that time was “If I was any better, I’d be dead”. He then proceeded to tell me that “after I cancelled on him” he didn’t eat for 7 hours (type 2 diabetes was on that long list of disorders) and went into some sort of insulin problem and crashed his car into a field! While he was telling me about the crash, he kept saying “after you cancelled on me” as part of the story… sorry I had the flu, but what on earth did it have to do with him not eating??? I treated him that one last time and then suggested that his ‘health issues’ were out of my scope and referred him to a dr.

  The last guy that I let go is a guy who was very weird, a bit scary weird who showed too much interest in the fact that I have kids. At his last appt, my daughter (age 18) had dropped in after school and he zero’d right in on her. He then got into telling us that he used to kill people with his bare hands in his last life! When I asked him if he was a problem in this life, his face went beet red and his answer was “I can be”. He lives nearby and I’ve since heard through the school my son attends that he is of interest to the police with regards to children! I just don’t return his calls anymore.

  So, yes, there are times when you must let people go. One of my teachers, a Chinese Dr told me when I was doing my internship that we must never keep seeing people who drain us because we are needed to be there for so many others that we cannot give out our energy to negativity. I agree. Most people are pretty good though!

  Hope all is well.

• 10 Jared McCollum // May 20, 2008 at 12:44 pm

  I remember a patient who would come by the clinic and discuss treatment and how I could help her. She would monopolize my time and always question my credentials and experience. She finally booked an appointment but did not show up. when My secretary called back to reschedule but she insisted it was my fault on the missed appointment. All of this screamed a red flag so when she showed up for her first visit I told her that we were not suited as a healing pair as I was already concerned by her behavior. Needles to say that now that she was rejected she would stop at nothing to then become a patient, although I did not oblige her.

• 11 Dana // May 20, 2008 at 5:27 pm

  I fail to understand why so many people here are blaming patients with who pay lower fees for your own boundary issues. If you have patients that are constantly calling and demanding your attention, that is a result of your boundaries. Believe me, I’ve worked in a psychiatric hospital and no-one pulled this stuff on me for long because I didn’t send out any vibes telling them it is OK.

  The reason you all are finding it more likely that people who are paying reduced fees mis-behave is because few self respecting Americans would accept a sliding scale fee under the conditions you give. Most psychiatrically healthy folk would not want to be a charity case, especially if they are hard working people who truly take the effort to manage their money well. You’re not seeing the honest folk who honestly need a reduced rate because they won’t come to someone who thinks that they are less then because of their lower financial resources.

• 12 K // May 20, 2008 at 6:25 pm

  Dana,

  You have a point regarding boundary issues, and I have definitely had to work on that from time to time. But it’s funny how one woman can pay me $20 with as much grace as the ones who pay $80, while several who pay $40 act as though they’re entitled to have the world handed to them on a platter and make personal and snide remarks that sometimes include swearing. I think it might not just be my issues.

  Also, regarding, “someone who thinks that they are less then” - a wee bit judgemental there, are you? No one said anyone was “less than”, not that I noticed.

• 13 Suze // May 20, 2008 at 7:29 pm

  Love the comments!
  You have to ask yourself what your role is in your practice. If you are clear on this, then when people push the boundaries, you push back and no problem. They either accept what you offer and come back, or they don’t come back. It’s not about firing, just being clear on what they can expect from you as a health care worker.

  I worked with an acupuncturist, who when people were late, would just let them wait until he was comfortable and ready to see them. If they didn’t want to wait, that was not his problem, it was theirs. His only responsibility was to be available for them at their appointment time. They soon get it. Boundaries. I currently work with a practitioner who charges a fee if more than 2 appts are not canceled in sufficient time. If they don’t want to pay the fee, then they don’t come back. Boundaries. If someone is rude, you defend your respect. “If you insist on swearing at me, I’m not able to help you anymore”. Their choice. Boundaries. If people keep asking you for a discount, you must have given them some indication that you would change your mind, otherwise they would understand your ‘no’. If they continue “I’ve said before that i’m unable to give you a discount, and that won’t change”. Boundaries.

  In order to set these boundaries though, you have to be clear and most of all comfortable with being HONEST with yourself and others. You need to work out what your responsibilities are and to whom you have those responsibilities.

  The only instance where this doesn’t apply, I believe, is if you fear for your safety. As a counselor, I was helping a guy straight out of jail, who insisted on asking me about my personal life. I told him over 3 consults that the sessions weren’t about me and I wasn’t prepared to go into my personal life with him. He continued, so I referred him on and explained why. But again, I set my boundary, was honest with him, and then respected my responsibility to myself.

  Very interesting discussion…

• 14 Suze // May 20, 2008 at 8:30 pm

  Just wanted to add to my boundaries monologue… ;-D
  Perhaps it would pay to look at how you feel about those that you give a discount to in your practice. It would make sense that if you felt sorry for them, you may be giving way too much of yourself, which in turn prevents you from maintaining your boundaries. The client then has no idea of how much/little to expect and goes too far. Result : cheapies appear to be difficult clients. Whereas, when paid full price, you may want to present a more professional appearance to justify your price and therefore have less problems with setting boundaries….Result: full price clients are so respectful…just a thought….

• 15 Dennis // May 20, 2008 at 9:55 pm

  After 40 years I guess you could say I have seen and experienced a lot of patients. I agree that those who are the most price conscious are usually the biggest pains in the you-know-where, bar none. I gave up on the “free consultation” baloney a long time ago. The last one I got roped into, came to my office with notebook in hand, copied everything down I was foolish enough to burble out to them (yes, it was a man and wife team) and, after thanking me, left without spending a dime, never to be heard from or seen again. Who’s “fault” was this? Mine of course. A free consult may work for others but where does an Oriental practitioner go with it? One needs to know enough about the patient to make any kind of evaluation and then, naturally from the “evaluation” a diagnosis follows…. Otherwise you’re just telling them what? Yes I can help…..No I can’t help…..What?
  Sorry but a “free consultation” screams “needy” to me and very likely to any of the thousands of parasites mentioned by my colleagues above. If after I get to know a patient I can tell that they are truly in need I then may decide to give them a break…..not before…
  Another story btw…
  A few years ago I got a very nice elderly lady into my practice and at the time had a new assistant just hired. This assistant, who is still with me, decided on her own to give this elderly lady a “discount”, unasked for, because she was “obviously” in need…. you know she was “old”.. After getting to know the patient much better we discovered she lived in a multi million dollar home and had at least one ermine coat in storage which she had little need to wear any longer. …
  Needless to say I was NOT pleased to continue cutting this ladies fees because my sappy helper took “pity” upon her….
  Meanwhile, for those who “miss appointments” there is the “missed appointment fee” which will quickly cut loose the deadbeats. Just have them sign a form when they first come in stating that they will pay a fee for missed appointments and send it to them with a bill when they do so…..that’s usually enough to stop the problem cold. If they value you, they’ll be back.

• 16 Christina Wolf // May 21, 2008 at 8:47 am

  Great discussion! It’s about BOTH our own boundaries AND the poor behavior some patients exhibit. In my opinion, sending a bill when patients miss appointments, say “no” to unreasonable demands even though that patient might leave the practice, referring a patient on who is too demanding or not respectful of our boundaries, making late patients wait, etc. are not only ways we set boundaries but also ways of “firing” patients who we don’t want to keep in our practice.

  A word about offering discounts. I tried Lisa Roehdler’s (sp?) sliding scale one afternoon a week for two reasons: 1. I felt there were people who could use acupuncture out there who couldn’t afford my rates (which are what they are so I can make a modest living–BTW I am actively questioning whether acupuncture can provide me with the income me and my family need) and 2. I wanted to see more patients and supplement my income, capture that “end” of the market. Most of us can’t just switch to a full Community Acupuncture model–we’d go out of business, something we acupuncturists do all to frequently anyway. Most of the people who use my “discount” clinic are THRILLED and incredibly grateful that I offer it–most have gotten and continue to get well, and most are people I never would have treated any other way. Only a handful feel somehow cheated or less than by being in that clinic–so their option is to switch back to longer, more involved treatments. If people feel bad about themselves for using the “discounted” clinic, that’s their problem, not mine–and, no, I’m not going to de-value what I do by giving more for less (I get paid the same per hour regardless, I just give less time for less money–completely fair), I guess that’s my boundary :-).

  Few of us are going to get rich as acupuncturists, at least that’s been my experience, so why should we put up with baloney?

  C

• 17 K // May 21, 2008 at 9:11 am

  Suze - Thank you, those are great suggestions! I especially appreciate that you gave examples of dialogue. (Really, the words are often the toughest part.) Would you happen to be able to suggest a good book or website on that? Sometimes I’m great with boundaries, and other times I feel like the line is incredibly slippery and I’m not sure where and HOW to place it.

• 18 Burton Kent // May 21, 2008 at 11:30 am

  One good book on “boundaries” is When I Say No, I Feel Guilty. I’ve mentioned the healer personality type before - and from what I’ve seen, boundaries are often an issue for them. So I’m not surprised if boundaries are an issue for many practitioners.

• 19 Dana // May 21, 2008 at 6:02 pm

  K - Yes, I’m being judgmental. I’m judging that its wrong to broadcast that people who pay lower fees are the problem without considering that there may be other factors involved (like the practitioner’s un-examined issues with class.) Using the phrase “less than” instead of “problematic” is nitpicking at best. Less than, problematic, difficult, less desirable; these all really mean the same thing.

  Sometimes, judgement is needed. This is one of those time. Its time for our profession to wake up to the facts of class in American society.

• 20 Andy Wegman // May 21, 2008 at 9:48 pm

  Christina,

  (as a side note to the community clinic model mention…)

  I have come to know, that if it is suggested to most folks - implicitly or explicitly - that the treatment they are to receive in ‘community’-style is somehow inferior to/different than ‘private’-style treatment, the community clinic is likely to not flourish as it can otherwise.

  If I were the grateful pt. who could ‘only’ afford $35 once or twice a week, sure these treatments would be great, but I’d be left wondering, “am I getting the REAL treatments here? What would $80 get me here, I wonder?”

  No one wants to be a second-class patient.

  The community clinic model stands very well on its’ own - but it may be up to the practitioner to trust their community fully before full returns are given back.

• 21 Suze // May 22, 2008 at 3:39 am

  k, sorry, I really couldn’t recommend a particular book. My only other advice would be that learning to assert boundaries is a process. When choosing what to say, remember that it’s not you against the other person. You are simply letting them know the way things are (the first step is deciding what your boundaries are, the next is letting other people know what you have decided - people aren’t mind readers!). Once they have this information, it’s then up to them if they can respect that or if they need to go elsewhere. You are not responsible for their behaviour, just your own.

  Start out practicing “the words” on yourself or your family. With practice you’ll find the words that work for you, and remember sometimes different patients/people will need different words….

  In general, I see a HUGE distinction between “firing” and setting boundaries. Historically firing is rejecting, ejecting, getting rid of, removing, essentially something negative that you do to someone. By allowing a person the right to choose to comply with your boundaries or leave if they can’t, is entirely different. It shows them respect, even if they don’t seem to have shown you any, and allows them to make the ultimate choice in their relationship with you. Don’t forget that these people aren’t well (with whatever condition) and can at times feel victimised by their unwellness and the management of it by all and sundry.

• 22 Christina // May 22, 2008 at 8:41 am

  I think it’s interesting that I, and maybe others, who are willing to offer ANY discount seem to be getting told we’re just making people feel bad, and somehow I am “less than” (less noble perhaps?) than those who are willing to offer all community acupuncture, and if I just trusted my community enough that eventually my clinic would flourish that way.

  I’m glad, Andrew, that you are doing well with your community clinic and that it stands on its own–I have referred several people to you and will continue to do so. By the time I heard about this model, I already had a regular old practice that wasn’t quite serving everyone, so I decided to hybridize. I have a mortgage, a child to educate, an in-law who lives with us, etc.–no room for me to reduce my personal income, even for a short time, while I wait for my community to “give back”. And though I agree that some people may feel like they are getting less and wonder if the “community” style treatments are less effective, the truth is, as you know, the treatments are JUST AS EFFECTIVE, especially if the lower fee means people can come for a longer period of time.

  BTW, for all of you speaking about class out there, the folks who use my community clinic are largely white-collar professionals who feel overextended. The blue-collar working folks tend to pay me my full rate, gladly and in cash. I don’t think acupuncutrists are blind to class, I think we’re struggling to make ends meet just like everyone else. I also don’t think acupuncturists should have to sacrifice a decent personal income to do the work we do!

  Christina

• 23 Burton Kent // May 22, 2008 at 9:00 am

  Suz,

  Great distinction between firing and setting boundaries - thanks for that.

  Christina,

  Lisa has a really good paper/booklet written called “Love Your Micro business: Marketing a Community-Based Acupuncture Practice” in which she explains that when people don’t want to be a charity case. Rather than asking for a discount, they’d often rather not come at all.

  Lisa explains it better than I just did. The download link is here, but the file seems to be missing.

  I still HIGHLY recommend “The Remedy”, available from Lulu for either $8.15 for the ebook download, or $15.00 for the paperback.

• 24 Kelly McConville // May 23, 2008 at 9:32 am

  Kent - How do you handle missed appointments, or late cancels? This was difficult for me, however I have the patient acknowledge, at the initial appointment, my office policies. After 2 missed visits/late cancels, I will remind them that I will charge for the next late cancel/no show. This does “weed out” those patients who do not value your time, and frees you up to heal others who need your services.

• 25 Donna Greenberg // May 23, 2008 at 11:39 am

  This is a wonderful discussion. As a Five Element practitioner, I have found over the years that Wood types are problematic for me. I just don’t do well with hostility, pushiness, and difficulty in setting up and keeping appointments (on their part). Another type I have trouble with — but do treat — is Fire
  out of control — the type of person who is “in your face” all the time.

  Years ago, I was a writer/editor/public relations consultant and speaker, and I found that I had to project a lot of Fire energy, which left me drained. As an acupuncturist, I no longer project Fire (except in limited amounts),
  allowing my Earth energy to be more dominant. This tends to calm and ground people.

  I used to feel inadequate about not being comfortable with Wood types, but I concluded that not every patient is right for me, and it’s ok to either reject those types at the outset, or fire them later on, if things get unmanageable.

  As an Earth type, my big challenge is to avoid giving away too much of my time and care, which can leave me drained. So I pick and choose who I will give a longer appointment to.

  I have offered lower fees to people who I
  really like, and who are suffering a financial setback. Sometimes, these same people end up paying my normal fee ($90) once they are back on their feet.

  When my practice is full, I will probably offer a few discounted treatments per week; in the meantime, $50-60 is still better than not having the person come in at all. And I get excited about treating certain people, so it’s fulfilling to me, as well as valuable to the patient.

• 26 Honora // May 23, 2008 at 1:00 pm

  These issues are all interesting and I’d like to give a plug for an interesting and little known book on this subject by Nancy Bilello, who is both an RN and an acupuncturist in Denver. Her book is called Understanding The Difficult Patient and covers many things related to dealing with problem patients of all types as well as firing patients in a way that is both legal and compassionate.

• 27 Jeremy // May 23, 2008 at 4:30 pm

  Look fellow acupuncturists:

  All you discounting treatments and selling herbs for 15% above costs, screw it up for the rest of us.

  Granule formulas should be about 100% markup.

  If you get a bottle of pills for about $15, it should be sold for at least $25.

  Treatments should not go below $50 ever! In a big city, $75 or higher should be the norm. We do not practice emergency medicine. It is not a right to have acupuncture. If they are poor, they can go to a school clinic and get treated by interns. Us, in private practice, we have to make it so if they bitch and moan about our prices, then they go look for other acupuncturists that are cheaper, they can’t find one, because we all keep our prices high.

• 28 Jared McCollum // May 23, 2008 at 10:45 pm

  Jeremy,
  I would not have said it with such bravado, but I have to agree with you. I have meet many acupuncturist that complain that they can not make a living as an acupuncturist yet they charge only $50 or less per treatment. Patients are looking for far more than needles and cotton balls the service we provide in private treatments is well worth the cost of $80+ per session. This is especially true where I live in Canada. Health care is universal and paying for health care is very foreign for patients. The discount model not only does not work in Canada but devalues the service for other practitioners. When I meet and acupuncturist that is charging far to low a rate it has nothing to do with trying to help people out but everything to do with a lack of confidence in ones self and their clinical skills. I choose to serve my community by volunteering every week not by devaluing and professional service.

• 29 Jeremy // May 23, 2008 at 10:59 pm

  I charge $100 1st tx, and $75 for follow ups. My granule formulas are about 100% mark up. 20 grams or less is $8. 20-40 grams is $15 and over 40 grams is $18. It costs roughly $15 for 100 grams of granules. I take insurance, but am not on anyones list, and MUST be billed the remaining fee so I always get $75 or $100. If a patient says they cant afford my treatments, I make them promise to come twice a week and will try to get them to pay $60. I do have a few patients that pay $55 or $56. I inherited them from another acupuncturist and I got stuck. I try and make low payign patients coem twice a week.

  So I have a patient now, who claims they will only pay me $50 and they have insurance that pays $25. I told her I need to get the $25 back from the insurance. She told me she will only pay $50 if she gets the $25 reimbursement. Blue Shield mails to the patient not the provider. I told her that you MUST give me $75 and then you can get the $25 reimbursement.

  now I guarantee you that she is on the phone with every acupuncturist in the area that she can find that will beat my price. What if there was non? She’d be back to me. From what I understand, there isn’t anyone cheaper than me in the area, so she’ll be back.

  Don’t screw your fellow acupuncturist. Make people think our medicine is worth the money. Get good results and offer them friendly service and listen to their problems. That is what they are paying for sometimes. Human interaction. Thsi is not China. In The West, acupuncture has a spa mentality linked to it. Don’t think this is like China where you are working in a hospital with a labcoat and your personality doesn’t matter. Oh boy, it sure does! I got rid of my labcoat a while ago. What patients want is a healing/spa experience and to be able to have someone to talk to, since noone else, including their doctors, in their lfe will listen.

• 30 Lisa Rohleder // May 24, 2008 at 1:31 am

  Wow.

  Jeremy and Jared, thank you for your comments. Seriously. You guys have saved me so much time! What with the explosive growth of the community acupuncture movement, and the widespread interest among acupuncturists in issues of access and social justice, I think that people were starting to wonder if I was making YOU up. Sometimes when I’m teaching, I bring up the problems of naked greed and callous indifference to human suffering within the acupuncture profession, and I get these blank looks. Skeptical looks, even. And it’s hard, I never quite know what to say, because most acupuncturists are a little more circumspect about admitting that they don’t really care at all about patients except in terms of the income they represent. Now when I get those looks from students, I can just quote you! Additionally, your comments are a beautiful example of everything that motivates me.

  And Burton — that discussion I had proposed, about the issue of “acupuncturists deserve respect”? You still want to have it? I think your side of the argument just got a little harder to make.

• 31 Jared McCollum // May 24, 2008 at 9:50 am

  Lisa,
  Thank you for your comments they have confirmed for me what I have been thinking about community acupuncturists that they are holier than thou, judgmental hippies. I would assume someone with your intelligence and understanding of people, that you would have educated yourself before you we out and accused me of being a “greedy and callous”. Just because you feel you are some kind of Gandhi person out to solve the world’s problems does not give you the right to pass such careless judgement.
  I have read your book and like the ideas of community acupuncture. I even invested a lot of money and time in the idea early on in my practice but after almost a year of a dropping patient load and incredibly reduced income I listened to my patients and went back to private visits and charging $85 per visit. Within months I was up to seeing 50+ patients a week.
  I guess that your clinic name “working class” fits your community but I guess my community fits the clinic title 1st Class Acupuncture. Not every patient wants to lay next to a stranger, and not very treatment can be performed out in the open.
  Please Lisa, in the future think before you judge someone who loves his community and his patients love him. Just because I choose not to follow “YOUR” movement does not mean I am callous. It me I listened to my patients and not the ravings of a self-righteous hippy.

• 32 Andy Wegman // May 24, 2008 at 12:46 pm

  Jared,

  Are you for real? So your status quo is challenged and the best you can muster is crusty old name-calling?

  We are all colleagues here - perhaps you could do better to contain your childish ignorance and instead engage in some critical thinking and/or idea exchanging.

  It’s clear from your writing you have only a partial understanding of the Community Acupuncture biz/clinic model. Those with CA clinics aren’t underselling private clinics - not by a long shot, in fact.

  We are not only largely marketing to/treating a very different population than the $80/session clinics, but in doing so are increasing awareness of acupuncture in general - some larger clinics seeing hundreds of people a week - many times over . There have been MANY folks who come to our community clinic who have referred family/friends to L.Ac.’s all over the country, because of their positive outcomes here.

  It is only because these folks could afford to investigate acupuncture in the 1st place, that other L.Ac’s ‘got the business’ from these referrals. And you know what? These referrals will continue to roll out. To you and all sorts of other L.Ac.’s as well…

  Community acupuncturists aren’t ’screwing’ anyone (Jeremy). Take a second look and this may become easier to see.

• 33 Jeremy // May 24, 2008 at 2:02 pm

  This is medicine. This is not emergency medicine. If you believe in abundance or karma or whatever new in vogue term is used to describe, “It all works out” then your patients can find the $75 or $85 for treatment.

  Lisa you been had. You patients say they cant afford acupuncture, they beg for a $30 treatment, then they go out and buy a $200 par of shoes. They probably have HBO, Showtime and Tivo. Most people that claim to not have enough money are simply saying, “I have the money, but don’t think my money should go to acupuncture. I would rather spend it on other things.”

  There are exceptions, but for the most part that is how it is.

  Last time I checked I was living in America. The country that pretty much invented a beautiful system called Capitalism. Hmmm I love the smell of free market trade in the morning. Why don’t you go live in Cuba or somewhere. This is capitalism baby, and this is business first, healing second!

• 34 Jeremy // May 24, 2008 at 2:03 pm

  By the Way, I am an extremely effective acupuncturist and I have helped a lot of people. I just deserve to live a certain lifestyle in the process.

• 35 Sidney Barthell // May 24, 2008 at 4:20 pm

  What works for one doesn’t necessarily work for another. If both models can be effective, let them both live, eh? Community models for those who don’t mind getting treated dorm style, and private models for those who prefer the one on one. If we look to the Chinese for a model, and go way back, you can see that the Chinese incorporated differences. Like the polarity of yin yang with the five element theory, both of which come from a different perspective. Result? A bigger palette. Win win. IMHO.

• 36 Andy Wegman // May 24, 2008 at 6:36 pm

  Jeremy,

  Of course the community clinic set-up didn’t work for you. It can’t possibly as you obviously hold your nose above people who don’t have enough money to offer you.

  I’m very happy to know you have found a clinic model that’s fits your personality - and patients who appreciate what you do for them.

  Really, this is what we are all looking to do - along with making a living all the while, right?

  By the way, the community model is a shining example of free markets at work. A price is set, and the market responds. Very positively in many cities/towns across our country.

• 37 Jeremy // May 24, 2008 at 6:54 pm

  To be honest, I wasn’t really talking about the Community Clinic. I was talking about people in the “normal” acupuncture clinical setting, that charge too little. I am not against community acupuncture, as long as it is a comunity style, meaning, you get what you pay for. What I don’t like is if I am selling a bottle of herbs for $25, and the acupuncturist next door sells it for $15, when it costs $12 to buy.

  Like I said above, there are school clinics that charge as low as $20, so people can get acupuncture. A community clinic means a big room with all the patients together? If so, then it would make sense to charge less.

  But don’t ignore my other valid points. A lot of people CAN AFFORD acupuncture, but rather buy $200 shoes, or take hawaii vacations or pay $120 a month for the DirecTV Sports package.

• 38 Dana // May 24, 2008 at 7:26 pm

  Jeremy - No one has to beg Lisa to be treated for $30. She takes it gladly. In fact, $30 is on the high end of her sliding scale. And if I’m correct, her clinic pulled in something like 350k last year. If you want to be an exclusive, “1st class” (my god that phrase is telling) acupuncturist, that’s fine. But those of us who choose to be otherwise aren’t out to get you. And we aren’t suffering like Ghandi. I’ve met Lisa. No offense, but she’s not really a Ghandi type at all.

  I’m guessing Donna wouldn’t treat Jeremy. And I’m sure I won’t be in Jeremy’s clinic any time soon. His prices mean that I would spend a full half of my monthly salary on a month of treatments. That’s comically un-doable for me. I would have to become homeless. I’m thinking living in a cardboard box so I can receive acupuncture treatment isn’t really going to be all that good for my qi. I just wish I had a CA in my area so that I could see an acupuncturist who is truely happy with the $20 I can afford to pay for treatment.

• 39 Jeremy // May 24, 2008 at 7:33 pm

  Well if you can’t afford $75 then you are not good at the business side of acupuncture.

  Thanks for proving my point!

• 40 Jeremy // May 24, 2008 at 7:41 pm

  There is medical insurance.

  Also, there are low cost school clinics

  Furthermore, there are community clinics which I have already said, I am not against.

• 41 Burton Kent // May 24, 2008 at 8:02 pm

  Just wanted to say thanks for keeping it relatively civil, if a bit heated. The only moderation I have is on new comments to prevent spam.

  Please don’t abuse that - I don’t want to check my site later and be embarrassed by how my guests are behaving. So please be sure to avoid name-calling and keep it informative. Thank you.

• 42 Michael // May 24, 2008 at 11:40 pm

  I suspect our practices are indeed deep reflections of who we are, and how we work.

  In my own practice, I have a scale that slides down to what I would get from an insurance company. I don’t want anyone that can not afford insurance to be subsidizing those who can.

  I do have my ways of determining need. For example, if a potential patient walks in wearing $200 shoes, or their handbag would be half my monthly rent I’m not going to be offering a sliding scale treatment to them.

  Just the other day I had a woman come into my clinic asking for a treatment for a cold she was getting. She was from out of town, and just passing through. She balked at my usually fee, so I asked “what you do you usually pay your acupuncturist?” She told me and in an effort to help I said “ok, just pay me what you pay them.” Still not good enough for her. And in fact she was angry at me. I could not figure out what was going on between us. But, I knew that I was not going to treat her when I felt like my skill and experience was a commodity to bargain.

  When that sense of entitlement flares up, I’m getting pretty good at seeing it, and giving them an opportunity to shop those goods elsewhere.

• 43 Jon McCulloch // May 25, 2008 at 11:44 am

  Lisa, you say “I never quite know what to say, because most acupuncturists are a little more circumspect about admitting that they don’t really care at all about patients except in terms of the income they represent.”

  This is straw-man if ever I saw one. There are some very good arguments for concluding charging higher fees is actually to your patients’ benefit.

  I’m in marketing and I see this across ALL industries I work in: people will find money for what they want, but complain like hell about finding money for the things they need. Drive round any so-called “economically depressed” areas and count the number of satellite dishes, late-model cars, and umpty-hundred dollar pairs of trainers and hoodies. Then step into a bar and count the “poor” drinking beer and smoking cigarettes.

  Personally, I’m a rampant libertarian and capitalist, and if people want to screw up and even cut-short their lives with lack of education, focus, and bad choices, then good luck to them.

  There’s a big building with books in it in every town. You can borrow them for free. That’s the first step on the road to self-betterment. Anyone who’s “poor” in the western world and is reasonably fit and healthy, is poor by choice.

  – Jon

• 44 Lisa Rohleder // May 25, 2008 at 4:09 pm

  My response is on the CAN blog:
  http://www.communityacupuncturenetwork.org/blog/classism-and-marketing-conversation-part-two-ravings-self-righteous-hippie-or-cautionary-tales-

• 45 Lisa Rohleder // May 25, 2008 at 4:23 pm

  While I’m here — Jon, I never said my patients are “poor”. The point is that they are not poor. The point is that there are a lot of people who can’t afford acupuncture at market rates, because, let’s see: they are full-time students trying to” better themselves”; because they got laid off due to corporate downsizing; because they are trying to pay off huge medical bills due to having, say, a genetic autoimmune disorder; because they worked hard all their lives but their pension is still only $800 a month; because they are raising their grandchildren; because minimum wage is really, really low; or because they are starting their own business.

  I know all about pulling myself up by my bootstraps. I’ve done it and I’m a big fan of it. Lots of my patients are doing it. They still can’t afford acupuncture at market rates, because acupuncture at market rates is only accessible to rich people.

  There are lots of hardworking, committed, grateful, frugal people out there who make great patients. They’re just not rich. That’s my point.

• 46 Jeremy // May 25, 2008 at 4:24 pm

  Amen!
  A lot of acupuncturists think money is evil and that its noble to live like a peasant, driving a crappy car, struggling to pay bills, etc.
  They like the belief in abundance and self confidence that allows to live the proper doctor life. Maybe some acupuncturists don’t deserve the doctor life, to be honest. Not all acupuncturists are as good as some.

  I help my patients and strive to make lots of money. Yes, they can go hand in hand.

• 47 Dana // May 25, 2008 at 5:35 pm

  Jeremy - I’d like to let you know how very wrong you are about me. I took a year off to be an Americorps*VISTA worker, so that I could learn about the issues of class and poverty in my area. VISTA stands for volunteer in service to America. Its kinda like a state side peace corps. Its something that I felt strongly called to do and I’m really glad that I did because my VISTA work led me to learning about Community Acupuncture and thinking about how I can use my skills as an acupuncturist without falling into an elitist business model that felt wrong to me.

  I’m poor by choice. I’m not miserable here. I chose to spend a year doing this because I thought I could learn and its been a wonderfully rich experience.

  You may feel that I have a bit of Ghandi complex myself. If so, let me reassure you that right now, I’m having very the very un-saintly thought that I hope you feel like sh#t for your presumption that I’m a bad acupuncturist. I’m a great acupuncturist, as most of my very respectful and compliant working class patients will tell you. Not one of them pays me a cent. Its all non-cash economy. And I love it. When my term of service is over and I start up my full time acu-practice, I’m going to charge a reasonable fee for these same working class folk. The people who can’t afford even that will be glad to help out my practice in exchange for their treatments. I still probably won’t be rich in money, but I’m betting that I’ll be happier than I ever was doing upper-class modeled acupuncture - because it fits my calling better.

• 48 Jeremy // May 25, 2008 at 6:20 pm

  For the 3rd time, I am not against community acupuncture.

  There are school clinics where poor or cheap people can go. So people can get acupuncture for cheap. We don’t have to do it, it is already there.

  You don’t have to be an elitist to pay my prices, nor to use Blue Cross or Blue Shield or Workers Comp.

  Heres an example: A lady of a lower income was coming in to see the other acupuncturist in my clinic. She was paying $25 a session. That acupuncturist moved, and I inherited this patient. I told her $25 is too low. She said, “well my mom gave me soem money so I can probably afford $75 now.”

  She was in her late 40s. Not a kid. She then came once or twice a week for some time, paying $75 and loved every treatment. The universe provided for her.

  If someone can only afford $25, then they can go to the various school clinics around where I live, or be treated in a room with many other in the Community Clinic type setting. If they want 5 star service, from a 5 star acupuncturist, then I need to get a 5 star price. I didn’t live in China for 3 years, learn Mandarin, learn a
  Ba Gua acupuncture, learn all this extra stuff that goes far beyond what they taught me in acupuncture school, to not live an abundant life. I try and get paid what I deserve. The patients can come up with the money in some way, or they can go to a low cost community clinic.

• 49 Linda // May 26, 2008 at 12:50 am

  Jeremy, reading your posts you seem to live in a very small bubble. You write of insurance and school clinics to take care of people who can’t afford your prices. There is no acupuncture license in my state, so no insurance coverage, and the nearest school clinic is hundreds of miles away.

  I have no problem with spa type acupuncture clinics that charge high prices, and treat well off people, but it’s ridiculous to assume most people could find a way to afford your prices if they just tried. The universe is not going to give most minimum wage workers enough money to afford a proper course of treatment at your clinic.

  You seem out of touch with reality. Not everyone has insurance or a school clinic to go to, and why should someone who doesn’t have a lot of money only have access to students. Do you really think everyone who would benefit from acupuncture will have some miraculous family event that allows them to pay for it? You only treat people who make a lot of money, that’s your right, but please spare us the stories of someone’s mom giving them money or poor people with $200 shoes. Spare me the magical abundance stories, I live in the real world. In the real world many people are struggling to survive.

• 50 Jon McCulloch // May 26, 2008 at 6:40 am

  Lisa: “The point is that there are a lot of people who can’t afford acupuncture at market rates, because..”

  All these are specious reasons. People have money. They CAN afford market rates — that’s the point you’re choosing to miss.

  Mind you, and this is just my personal philosophy, as a businessman, it’s not my remit to act as a charity.

  If YOU want to, then that’s fine. I make no value-judgement because it’s not my place to.

  Similarly, you’re not really in a position to judge acupuncturists who want to make a lot of money. Personally, I think they’re making the right choice; Adam Smith and evolutionary science agrees with them.

  – Jon

• 51 Jon McCulloch // May 26, 2008 at 9:53 am

  Question: “why should someone who doesn’t have a lot of money only have access to students?”

  Ask the other question: why should someone who has no money demand free services from people?

  You CHOOSE to play the martyr and service cheapskate patients. Others CHOOSE not to. That’s what it comes down to (and remember poor people are poor because of the choices they’ve made).

  – Jon

• 52 Andrea Beth Damsky, L.Ac. // May 26, 2008 at 10:27 am

  I am drawn to serve all factions of my community. I have a cash practice and tried, for a while, setting aside certain hours each week for a community clinic. What I discovered, to my disappointment, was that it was exhausting for me to manage individualized treatments for 4-5 people at one time. Eventually, this clinic fizzled out. What I loved about it, was the community support and camaraderie that
  naturally evolved in this clinic - something I also witnessed and enjoyed when I interned at the local homeless clinic in San Diego.

  While I enjoy the quality of attention and focus I am able to offer in private appointments, I am getting restless listening to other people’s problems (good thing I didn’t become a therapist!) and wanting some change. And simplicity.

  I am looking for a better balance, one that truly addresses the needs of my patients, enables me to help several people at once, and is easy to do. I have observed over the years how significant a factor stress is in exacerbating and perpetuating many health conditions, so…

  I am just launching a community-style clinic that offers stress relief treatments only, using the NADA protocol. I am putting together marketing materials, (yes, Burton - marketing!) for local doctors who specialize in treating health conditions that are more well-known to be exacerbated by stress. If this flies, I may very well specialize in doing this and writing books. I like it - it’s simple and easy, and I can even take this show on the road, maybe into other doc’s offices. I’m very excited about this, and I’ll let you all know how it goes!

• 53 Emily // May 26, 2008 at 10:33 am

  Jon and Jeremy -
  What infuriates me most is the language you choose to use when describing working class patients. Poor, cheap, cheapskates. I wonder if any of your patients happened to stumble upon this thread, would they continue to seek treatment from you or have any respect for you at all?
  I have many friends who practice private room acupuncture. They choose to practice this way because they thoroughly enjoy the one-on-one experience, often utilizing bodywork, moxa, cups, nutritional counseling,etc,etc. I totally respect their practice, they are good at what they do, and they refer patients to me who are better suited to community acupuncture. They do NOT feel like those who cannot afford their services are cheapskates. There is a mutual respect between us.
  On the other hand, there are money-mongering acupuncturists who are obviously threatened by this model, and because of this fear resort to name calling, both of the practitioners of CA and the patients! Name calling of patients, to me, is totally unacceptable. What is so threatening about accessibility of acupuncture? If you have read The Remedy you know that CA taps into the “untouched” population. These are not your patients. So why are you so threatened?

  And if you are threatened now, watch out! The community model is spreading like wildfire.

  Community acupuncture is not charity. We do not promote free treatments. We rely on many small increments of payment. It is a beautiful way to practice, patients LOVE being in a room full of other people. It creates community amongst the patients. The qi is stronger. And more people are benefitting.

  And Jon,
  “You CHOOSE to play the martyr and service cheapskate patients. Others CHOOSE not to. That’s what it comes down to (and remember poor people are poor because of the choices they’ve made).”
  All I have to say about this is WOW! Holy Shit! Are you for real? This is the biggest piece of BS I have heard in a while. Good luck to you and your small little exclusive world. Do you kick homeless people too?

• 54 Linda // May 26, 2008 at 11:38 am

  I am going to say this first, I have no problem with people charging high spa prices and doing those long drawn out talk sessions, massage or other modalities. If enough people in your circle of life can afford you, more power to you and I’m happy they are getting treatment. Do your business how you wish as I will do mine.

  Jon, I’m no martyr, I insist on making a very good living and that is what my practice is growing into. I grew up working class which is not the case with most acupuncturists, which is why they actually believe everyone can afford their rates. It seems to them EVERYONE is at the high end of upper middle class and above. Working and lower middle class families in most cases cannot afford a useful course of treatment at $75. Calling them cheapskates is very insulting and ignorant. At best these people simply don’t exist to many acupuncturists.

  I don’t treat anyone for free. The idea that people who don’t earn high salaries demand free services is another load of garbage. The guy out there fixing your telephone on the pole does not view himself as a charity case, he pays me as much as he can afford and still care for his kids. He deserves respect. He matters as much as the higher paid people he works for.

  I recently started a community practice after a long absencse from acupuncture treatment. I was frustrated that the people I knew couldn’t afford my services. Now I have people from all walks of life in the treatment room, and this benefits all acupuncturists because it gets the word out that our medicine works. I rely on the medicine instead of all the talking and end up making the same amount of money or more as someone charging $75 and up.

  Community acupuncture is not charity. Like many of you I do charity work outside my normal practice. Working class and lower middle class don’t need or want charity. They pay me! What happens when acupuncture is opened up to the world of people who can’t afford market rates is that they come and receive acupuncture, and our medicine grows. We won’t grow only treating the upper middle class, that’s why people say an area is saturated. No area is saturated if you open it up to all incomes of WORKING people, these people aren’t charity cases. They work hard and they proudly pay for what they receive. So many acupuncturists are out of touch with the real world.

• 55 Linda // May 26, 2008 at 1:09 pm

  I think you have a great idea Andrea Beth. Treating stress will help out with so many conditions. NADA is probably the most important tool in my treatment arsenal. I use auricular acupuncture as a stand alone treatment for many conditions, I find it extremely effective, and NADA is at the base of all my auricular treatments. Good luck!

• 56 Jeremy // May 26, 2008 at 1:37 pm

  Linda you are beyond reason, and frankly, I don’t your attitude. This is draining trying to reason with you.

  You keep saying wealthy peopel paying spa prices.

  LISTEN: I CHARGE DOCTOR PRICES!!!

  Get it through your head!!! I do medicine and charge medical prices, and my prices are cheap compared to most doctors.

  WE DO MEDICINE! WE ARE DOCTORS!

  Why should only Western Doctors who don’t always cure people and give them tons of drugs make money and not us.

  We get it Lisa, you want to be poor. It makes you feel good! You like dealing with the poor. They are your people. That is great! That is your thing. You have every right and keep on keepin on.

  But for the rest of us that are logical beings, that are in touch with reality, we see ourselves as medical practitioners and charge medical prices.

  You selfishness undermines the medicine and it is because of peopel liek you, that allow Chiropractors to be called doctors and us to not be treated as so.

  You may make yourself feel good, but you ruin it for the rest of us.

• 57 Jeremy // May 26, 2008 at 1:41 pm

  Going to get a medical check up or dentist or chiropractor to Linda is high spa prices.

• 58 Jeremy // May 26, 2008 at 1:43 pm

  “Working and lower middle class families in most cases cannot afford a useful course of treatment at $75″

  We get these people all the time.

  I’m done! Your pissing me off!

• 59 Jon McCulloch // May 26, 2008 at 1:47 pm

  Jeremy,

  I’m not an acupuncturist or a doctor of any kind. So I’m curious about your statement, “Why should only Western Doctors who don’t always cure people and give them tons of drugs make money and not us?”

  Are you suggesting accupuncturists ALWAYS cure people? That’s an extraordinary claim and one I think is not true.

  I also don’t think Lisa and people “like” her ruin it for you at all (and we’re all pretty much alike anyway — our differences are far smaller than our similarities).

  There is ALWAYS someone out there willing to pay top-dollar. Our job as business men and women is to make sure they find us and decide we’re the ones they want to give their money to.

  In my own industry it’s easy to find a copywriter or marketer who’ll ask only $20 an hour. It affects my business not one whit, not an iota. In fact, it does me a favour by weeding out the scumbags and cheapskate clients for me. Moreover, it gives me a great line to use in my marketing: “there’s a reason these copywriters charge only $20 an hour… they know their own value and price accordingly”.

  – Jon

• 60 Jeremy // May 26, 2008 at 3:13 pm

  No Jon not what I meant.

  All I am saying is that I consider myself a doctor of herbs and acupuncture. I should be paid as a medical practitioner. Would you go to a Western Doctor that drove a 1995 Ford Fiat and rented a studio apartment? It doesn’t make sense.

  Western doctors sometimes do nothing but mask symptoms, and they get top dollar. I try my best to create a deep healing for my patients, I don’t see why I shouldn’t be paid a reasonable medical fee such as $75. How the patients come up with the money is none of my business. I just know, that they do. Sometimes insurance helps them pay.

  It is this attitude that Linda has and th elike, that we are here to help heal the world by giving and giving and not taking what we deserve, that screw it up.

  Chiropractors do far less involved treatments and are considered doctors and can see 12 or more patients an hour! They make lots of money and are treated as a doctor, even though they are far from being actual doctors. Why? They have the proper business sense and are taught business in Chiropractic school.

  Acupuncture could be like that, but not with the attitude most acupuncturists in this country currently have.

  In life, you get what you pay for. The consumer knows this too.

• 61 Jon McCulloch // May 26, 2008 at 3:24 pm

  Jeremy,

  You’re spot on with the economics; from my view, anyway. Just because doctors (of ANY kind) have a skill it doesn’t mean anyone is “entitled” to their time or efforts, no more than they are with any professional. A doctor gets his skills by hard work, learning, and self-investment. Damned right they’re entitled to make a handsome profit.

  It was just the other comment I queried.

  – Jon

• 62 d // May 26, 2008 at 4:37 pm

  wow, this is the most reactive, defensive and judgemental blog I’ve read to date on CA clinics versus private clincs.
  at the end of the day does it really matter who is doing what? do what makes you happy.
  and if someone is undercutting you by selling herbs at a lower price, I’m sure you will find the money somewhere to make up for it. after all, I thought the universe provided…

• 63 Burton Kent // May 27, 2008 at 9:11 am

  Thanks, everyone. I’m closing the comments on this. If you’d like to continue the discussion, please read Lisa’s Ravings of a Self-Righteous Hippie.

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