WALKING THE CHARTS
A man was once given a small corner of a vast garden to tend. He cared for it well—weeding, seeding and watering the land with love and attention. Over time, his modest corner of the garden flourished, teeming with abundant life. Under the man’s hand, lush greenery, vibrant flowers and rich scents filled the small parcel of land, to the blessing and delight of all who entered or saw it.
Since the man had proven himself capable of caring well for that which he was given, he received more of the garden to tend, expanding the size of his corner to include some of the adjoining land. He welcomed the new responsibility with gratitude, seeing the challenge as an opportunity to bring more life and beauty into the world. He cultivated his larger corner of the garden with the same great passion and respect, and before long, his corner grew again and then again, steadily over time.
Great was the beauty and the blessing he brought into the world. His life’s work inspired many to attain greatness and magnificence with their own part of the vast garden. Through his example, the man helped many find peace, joy and fulfillment through making their own land a unique and glorious expression of who they are.
Not far away, another man was also given a small corner of the great garden to tend. He resented it and felt that he was badly done by. To him, it was unfair. He felt he should be given a different area, one that was already great and beautiful, not the sparse one he had. He did everything he could to resist how things were. Grumbling, he did the minimum required to keep alive what little plant life there was. He complained a lot to his neighbors, speaking of little else but what was wrong with his lot of land and his lot in life. Under his faltering, undisciplined hand, the land that was his to keep languished, becoming overgrown with weeds, which choked the life from the flowers and other plants. Eventually even the weeds became dried and brown, withering in the breeze and sun.
One day he came to his corner of the garden to find that much of it was gone, given to others to tend. What remained of his was tiny, just a few yards across. Seeing this, he became still more angry and resentful, complaining all the louder of how badly life was treating him. He inspired only discord, discontent and joylessness in those listened to him and took in his words. The result of his life was greater darkness, ignorance and ugliness. The garden had no more beauty for his presence.
This simple and obviously metaphorical story illuminates several principles of life. Without naming each one, we see the basic teaching is that if we welcome and care well for that which we already have in our creative field of responsibility, life will give us more.
In a healthcare practice, this idea takes form as caring for people well, to your highest vision of what that means. It means making care as least as important as cure, compassion at least as important as correction. It means giving all the people you contact through your practice the beautiful gift of who you are. The result of this is that your practice will grow, steadily if not quickly. And you will earn a fine reputation as a practitioner and as a person—something beyond price or measure, something hard won and easily lost. If you care well for the patients you have, stay concerned more with the depth and fineness of care you provide than with just “getting more of them in the door,” letting your practice be filled with the finest qualities of who you are, then you need not worry that your practice will grow strong and full.
One practical expression of this principle is a process I refer to as “walking the charts.” This is one of the most important habits I have developed over the twelve years I have been in practice. I know that if “the book is thin,” meaning that I have many gaps in my clinic appointment book, it is because I have not walked the charts recently enough. After I do walk the charts, the book is soon full again. It is that simple. This process is a way to care for people well, the way I would like to be treated. It is a way to improve my clinical skills and outcomes. It is the most effective way I minimize attrition—patients who fade from my active list onto the inactive list. Losing patients through attrition can easily nullify new patient gains. And constantly working with mostly new patients can be tiring. Finally, walking the charts is deeply satisfying and spiritually nourishing. It affords me the opportunity of helping a patient heal, even though they are not physically present. And since no one is healed alone, this process is a profound form of self- care and nourishment. It feels really good.
Walking the charts requires a little preparation. It is important to block off a chunk of time—at least 30-60 minutes—to do it. This is not something you squeeze in between patients or over lunch. It feels best to set aside one to two hours at each sitting, or “walk.” All you need is your desk, your patient charts, your clinical reference and appointment books, and a phone. By the way, this is not something you can job out to your staff. I tried that, and it does not work. This is between you, the patient, and Universal Intelligence, or Source.
The first step is to sit down and center yourself. Take a moment to breathe deeply, relax your body, quiet your heart, and bring your attention mindfully to the moment. Begin with stillness, gratitude and ease. Open yourself upward in thanks to Life for bringing you to this moment, and for all that is present in your world. Calm up.
Next, pull out the first patient’s chart from the “A” section. Let’s say the patient’s name is Sharon Anderson. Bring her to mind. Look at the notes from her last visit. See if she is in your appointment book. If appropriate, call her. Examples of when it would be fitting to call include: if you treated her for a cold or other acute condition in the last few days; if she just had her first treatment with you; if she has not been in recently or does not have her next appointment scheduled. Let her know, if you speak with her or leave a message, that you are just checking in to see how she is doing.
I do not mention scheduling the next appointment on the message machine, or to her until the end of the conversation, if at all. If I speak with her, and she had not been in to see me in some time, generally she will say something like, “Oh, I’ve been meaning to call you for an appointment.” Patients usually get it that I would like them to return just by the fact that I called. It is important that the patient understands that I am not calling just so they will come in again. I am genuinely interested in how they are doing and feeling, and answering any questions they may have. My clear intention is to care for them in the way I would want to be cared for. Patients deeply appreciate these calls. It is a tangible expression of caring that they value and remember.
If a patient has not been in to see me for a while, and I leave a message when I call, I will do so three times before deactivating that patient’s chart. I just let them go after leaving them three messages, once each time I walk the charts.
As a teacher of mine often said, “You can serve only on the basis of response, not need.” This could, and perhaps will, the subject of a whole other article. It will suffice for now to state that people must be open to receive that which you offer—be willing to be helped—for you to help them. You need only concern yourself with patients where there is a pattern of response to your services. Be unconcerned with unresponsive patients. You cannot help them anyway, so let them go.
Finally, I write in the chart what happened—date, left a message or spoke with her, and pertinent details. If this was the third message left, I deactivate the patient’s chart by placing the pages in a storage folder, to be filed in our storage room.
The next step in walking the charts is to prepare fully for that patient’s next visit. In this example, I review Sharon’s chart to see if I am completely prepared for when she comes in again. If there is research to do, I do it. If I need to re-evaluate my assessment, or create or modify her treatment plan, I do it. For example, I may wish to change her herbal formula, or look up point combinations to consider for her next visits, or make notes on questions I want to ask, or consult with a mentor or colleague on the case. Whatever needs to be done, I do it right then.
The result of this step is that I am quite confident when Sharon arrives in the office again. She will most likely feel it, and share that confidence in me. I will be at ease in my readiness, which helps her be at ease too. My clinical results will be optimal, since I gave myself time to think about her case. And I will not be “winging it,” which does not feel good or work well, and produces fatigue by the middle of the treatment day. As my first acupuncture teacher often said, “Make good preparation. Then you can do your best work.” This step helps take care of the rational/analytical thought that complements the intuitive sensing that happens spontaneously in the treatment room.
The walk ends with taking a moment to silently bless the patient. You can think of this as sending them good Qi, offering them positive thoughts or intentions for healing, or whatever words you would like to use. Whether or not I have called and spoken with Sharon, I take a moment to use my capacity, which each of us is born with, to bless this person. It is to seek and see in her the highest and finest qualities she has, to actively seek and find what is right in her, and acknowledge it within myself. This is my favorite part of walking the charts, because it always produces an immediate feeling of peace and well-being—the feeling that I am doing what I came on earth to do, fulfilling my deepest purpose: to love and be a blessing to all those in my world.
That completes the process for the first patient. With gratitude and satisfaction, I return Sharon’s chart to the cabinet, and pull the next. I continue this process until I have gone through all my patients, or until I run out of time. Working with a single chart may take a minute or an hour, perhaps more if I am preparing for their “report of findings” visit. I take my time, knowing that in this process, as much as in any other area of my life, quality, not quantity, is everything.
I have tried rushing through them (that’s “running the charts”), and it does not work. I do not get as much out of it, patients sense I am rushed on the phone, and the book does not fill up the way it should. I walk my charts at least once a month, ideally twice. If I let it go longer than that, attrition invariably results, and the practice suffers. I am then like the man who let his garden decay, only to see it shrink in size and vitality.
I have mentioned a few times that after I walk the charts, the book fills up. I need to emphasize that that happens whether or not I talk to any patients or even leave any messages. I have spent an hour or two working the process, not make a single call, and the next day come in to find 15 messages on the machine, some from patients who have not been in for months or years. Life is about energy. If the energy you express is right, then all right things come to you.
Like the wise man of passion and integrity who cared well for his corner of the garden and saw it grow in beauty and then in size, so too is walking the charts a remarkable way to care well for those in your creative field of service. Do it, and watch your garden grow and flourish, to the delight and blessing of all those who enter or see it.
Summary of the Steps in Walking the Charts:
1. Center yourself
2. Call the patient if appropriate
3. Treatment planning for the next visits 4. Silently bless them
ABOUT THE AUTHOR
Michael Gaeta is an acupuncturist, nutritionist and bodywork therapist who began his New York practice in 1990. A graduate and past faculty member of the New York College of Health Professions, Michael is Past President of the Acupuncture Society of New York (asny.org). He presents seminars, including “Love, Serve and Succeed” at schools and conferences throughout the US. Michael is also a pianist and composer. His passion is to give, love and serve through teaching, hands-on therapies and music.