Office Hours with Angelique and Toby, episode 1. Released April 24, 2025. 37 minutes.

About this episode

In the first episode of Office Hours, Toby Daly and Angelique Britt, a newly licensed acupuncturist with more than two decades of nursing behind her, look at the state of the profession and the realities of opening a clinic. Angelique describes building her Massachusetts practice after getting her license in October 2024, through referrals, a local newspaper profile, radio ads, and insurance directories.

She also shares a hard early case: a patient whose severe pain after treatment turned out to be a serious infection that needed urgent care. Toby explains why he believes her Saam diagnosis was sound and why practitioners should charge for their best treatment rather than for outcomes. They talk about learning a sound system, reviewing cases with colleagues, and Toby's teacher Dr. Angela Wu, whose face and pulse reading let her see very large numbers of patients, compared with the more sustainable schedules they keep.

Topics

The state of the acupuncture profession
Opening a clinic in Massachusetts
A difficult first Saam case
Responsibility and outcomes: charging for your best treatment
Learning a system and reviewing cases with colleagues
Dr. Wu's clinical practice
How many patients a day is sustainable

Key terms

Saam acupuncture (舍岩): a Korean Buddhist monastic acupuncture tradition that treats imbalance on one channel system at a time, using combinations of the five transport points.

A note for listeners: this is a conversation between licensed practitioners, offered for education, not as medical advice. Patient details have been kept general to protect privacy.

Transcript

This transcript was generated automatically from the published audio and lightly edited for readability. It may contain errors in names and terms.

Toby: Hey Angelique. Welcome to our show Office Hours. We're going to discuss all things Chinese medicine. How are you doing? I'm

Angelique: H Toby. Doing pretty well. Thank you for asking. And how are you?

Toby: Everything's going pretty well with me, thanks. Okay. I want to get started with some numbers. Are you ready?

Angelique: I'm ready.

Toby: The numbers are 33,364, 1,300, and 1,000. What these numbers are in 2023, that was the number of active LACs we had in the US. 33,364. And that's the latest data we have is 2023. We're recording this in 2025, but we don't have any data up till then, anytime after 2023. And the other numbers I gave you were from four years prior to that, so starting in twenty nineteen, we were actually adding one thousand acupunctures per year, but losing thirteen hundred. That's on average for those four years. But we were having a net loss of three hundred acupunctures per year. It's even more grim for California where I'm practicing. The last five years, again starting in twenty three. So back to twenty eighteen for five years. California acupuncturist, we lost thirty-seven percent of our active acupuncturists. We've been having, you know, we lost our major journal, probably our second journal only to the journal of Chinese medicine, The Lantern in Australia that closed down. The school I did my master's degree in closed, the school I did my doctorate degree with. Close. So it seems like always went when I was first learning Chinese medicine, it seemed like such a expanding profession. And then based on the last couple of years it seems like a little bit contracting. I know you're a recent graduate of NESA and yeah. And you're a you're going to Taoist traditions yes for your doctorate. I am w I wonder if you have any sense about these what's good you're so much closer to these institutions than I am now. Any sense about them?

Angelique: I'm surprised by the numbers that you shared actually, because my sense was that I'm based in Massachusetts and it appears that the profession, at least here, seems to be growing. With Taoist Traditions being a smaller school, I think the cohorts are smaller. My doctoral program, I think there's 18 of us total, but I understand that might be large for a doctoral program. So yeah, I'm surprised to hear that. Who's collecting this data?

Toby: This was a PubMed article. What I'll do is I'll I'm gonna put the link to it in the comments for this clas for th this discussion we're having so people can look at the data themselves. But you know, it was a well established study. And then it look like I said, it looks like it's starting to trickle down to our journals and even our schools and things like that. At least on the West Coast here. Maybe that's a little bit different for the East Coast.

Angelique: Yeah, I'm not familiar with school closures out this way, but I honestly haven't paid that much attention, at least in this part. You know, when you're in school, you're kind of in it for the duration of the three years and then so on. So that's that's unfortunate to hear. I hope that's hope that's turning around since that's old older data. I guess.

Toby: Yeah. And then it seems like more and more you know it seems like more and more Americans getting more and more open to coming to acupuncture. I started a little over twenty years ago and it seemed like people were a little bit reluctant and now it seems like that resistance is gone. So, anyways, just a little bit concerning about I noticed this I read this article about that and I was just wondering what you felt on the ground. So that's great you're not really feeling anything on the ground. And same thing for with me in private practice, it seems like busier than ever. Anyway, so interesting. We'll watch on that. And then we'll see. Especially twenty three, maybe effect of COVID or something like that. Less people wanting to go to school. That's something. So we'll we'll let's see let's see where everything goes forward.

Angelique: Yeah. I hope it tips in the other direction, if this is the way we're trending. We're needed.

Toby: I love this Yes, I love this profession, so it made me a little bit nervous reading that. Okay. I know that you're a new practitioner. Mm-hmm. You just got your license and it's still a little warm from hanging it up at your office. Yes. How's that going being a brand new practitioner with her with your first office?

Angelique: It's been a very interesting process. I have I've been a nurse a long time. I've got over two decades of nursing experience. So taking care of patients isn't new to me, but certainly running my own business is new to me and Chinese medicine is new to me, practicing acupuncture and herbs and all of that. So it's been it's been a pretty large learning curve, but I'm getting there. I opened my clinic. I got my license in October of twenty four, and I opened my clinic in December, and it's now What where are we? Almost end of February. And I'm I've got a pretty steady trickle of patients coming in. I went from having six to twenty-sixth due to advertising in a local newspaper in the form of having actually someone come out and do an interview with me. And that article seemed to resonate with folks in my community. Forgive my post-cold resolution voice. And so folks have been coming, and I've been so grateful. I'm also Handling with insurance companies. And so that process is a bit arduous, but the approvals are coming in for that. And I have folks that are finding me on their directories. I actually had a phone call today from someone, a voicemail, asking about insurance coverage as they saw that I was a provider in their directory. So I think that's helpful, especially as a new person in a fairly saturated area with acupuncturists getting your name out there.

Toby: Yeah. I think that's fantastic. I think that's that's such a quick jump start. So I'm really happy about that. So besides the newspaper article about you and then insurance, anything else you're doing to let people know you're available?

Angelique: Yeah, I started out with word of mouth, essentially telling the network of nurses that I knew and friends and family and having them tell people. And that's where my small little initial cohort of patients started to show up. And I did a radio ad with a local radio station and they were great. I only had gotten one phone call, but I had heard I live in a small hilltown area in Massachusetts and I had heard other folks like through the grapevine that had heard my ad, but it didn't yield as much any it like nearly it didn't yield anything really. Like a phone call, but it was someone who was seeking an insurance plan I hadn't yet paneled with. So the newspaper is the way to go. New clinicians do it, grassroots.

Toby: This is so great. Ancient medicine, so we gotta use ancient modes of communication, newspaper and radio, right? Nineteen fifties strategies.

Angelique: Well, I found that the Google the Google SEO really with all of the things of starting a business, I was like, I don't have the bandwidth to learn one more skill. And so I have turfed that to maybe future advertising. And I've got classmates that have helped point me in the direction of maybe how to do that in the future. But for right now, I was like, I can do the grassroots thing. I can do the newspaper radio interviews and we'll save more of the tech stuff that has an additional, you know, books of learning for later on.

Toby: Yeah. But you'll see, right? I mean, especially you get some good clinical results early on with that first cohort of patients, right? Then that's really getting the ball going. I think the hardest part is getting it going. So you may not even need that the tech part.

Angelique: Yeah, it's super scary, you know, when you're on your own coming right out of school. I'm sure you remember, you know, you're used to having supervisors to consult with and sort of having that safety net that's there that's like both comforting and annoying, you know, like why do I have to check with them? Well, of course I have check with them and then that goes away and then you're on your own and you're standing there in front of your patient for the first time all by yourself and they've given you this highly complex presentation and you're like, my God, what do I do? And then you do something and it's hopeful. And it's building, you know, I'm still really in the new stages and still having a state of wonder every time a good result comes by. But that's kind of like the fun part.

Toby: It's so rewarding too, right? No team, it's just you, right? So success or failure, it's all you. It's on me. I remember that acutely getting started. I remember the first person, the first time someone gave me a check, I was just spelt like the biggest fraud ever, right? That I'd somehow trick them into paying me for something that I wasn't I wasn't, you know, qualified to do. You know, all that training years later, you know, so expensive and things like that, but I still felt like wow, it was just unbelievable that. Someone's paying me money for that. Yeah. So I remember that acutely.

Angelique: Thank you for saying that because same. It's like these people are giving me money and I'm like, really? But people are also getting better, which is fascinating and very rewarding.

Toby: Do you mind I know it was a little bit harrowing your first psalm acupuncture treatment? That's that's a tradition I practice in and that's how I met you at a at a workshop for the psalm acupuncture. I know you recently did your first psalm acupuncture treatment. It's is it is it still too fresh? You don't want to talk about it or are you okay discussing that?

Angelique: I was waiting for you to ask me about this. Boy. Not because I want to talk about it, but because I knew it was coming. Yeah. Let's see how I can present this to preserve confidentiality.

Toby: Yes, that's important. And let me preface this with one time I wrote a Journal of Chinese medicine article about a case of meteorologia that I just could not help anything I tried to do. And I ended up having to take that case to one of my teachers that solved it immediately within a couple of days. I think this is super valuable. I felt super vulnerable writing that journal article, but my hope was that somebody in the future, if they get into the same type of clinical thing, hopefully that will help.

Angelique: Mm.

Toby: So yeah, th in the in the spirit of that, yeah, if you don't mind talking about

Angelique: Okay, in the spirit of vulnerability, here we go. So yeah. This person came in mid sixties, pretty robust but complex, several complex health issues coupled with a lot of loss over the last year. And the main complaint was what they described as an idiopathic neuropathy. They actually described it as a genetic neuropathy and I kind of switched that in my own mind to idiopathic and I had sense

Toby: In helping colleagues.

Angelique: Been asking him to get the information from the doctor coming in for treatment for pain. He was having an electric shock like pain down the gallbladder channel and somewhat into the stomach channel. And it was intermittent and often it was shocking literally to him. And he was numbness in the bottom of his feet. So that was his primary complaint. And so we I had treated him, I think, for three weeks using TCM acupuncture. And wasn't really making a lot of movement. And there was some irregularity with when he came because of just issues that he had getting to the office due to the pain that he was having. And then he came in and I had I had mentioned to him some because I thought, you know, he seemed like the type of person that would, yeah, I was building enough, building enough of a rapport that I was feeling the courage, like, okay, I think I can do it with this guy. So I talked with him at length about it, and he was amenable and he's like, Yeah, we At first he actually wasn't and said, No, no, that doesn't that doesn't seem like a good thing to do. So I said, okay, fine. We carried on. And then the next time he came in, he said, No, we need to be more aggressive. Let's let's try that four needle thing you were talking about. So like, okay. And so based on his symptoms, which I can't, I goodness, I had my notes, I could tell you more details, but based on his symptoms, it was like a toss-up between a lung excess and a stomach excess. And because he had a lot of right, I remember a lot of rising symptoms, like he had some acid reflux, he had things going upwards. And it wasn't like he wasn't like a Sanjiao excess type person. So it wasn't like that flushing up. But I felt and he had flat VRs and trying to remember because some of his pathology was along the stomach channel, I was like, okay, we're gonna try to and he had high blood pressure. So I was like, let's let's see how this goes. And so I treated him on His left side, I think he was having more pain in his right side at the time and sent him home. But he got, he got up. And what he said actually after the treatment was, My feet feel like water balloons. And I was like, hmm, okay. I didn't quite know what to say to him about that. I said, Well, let's just let's see what happens. And then my so he goes home and I go about my the rest of my evening. He was my last patient of the day. And so I go home and go to sleep when I wake up in the morning. And I'd had some, I was In the process of learning that the Gmail was dumping emails into my spam from certain people and I hadn't quite realized that. So I was in the middle of a phone. Yeah. And so I was in the middle of a phone call and it was like two o'clock in the afternoon. And I was trying to troubleshoot. It was like, I don't know, some I think it was QuickBooks or something. I was on the phone and I just was clicking through my email because they were telling me to check my spam because they were trying to send me something. And I saw this email from this patient. Had emailed me like eleven thirty that night and was like, I am in excruciating pain. I can't sleep. And I'm thinking to myself, I'm like clutching my pearls, right? And like, my God. So I email him back real quick. So I'm on the phone, like, how you doing? And then as soon as I got off the phone, I called him. And he's like, Yeah, he's like, I've been, he's like, it is the worst pain I've ever experienced in my entire life. I am in so much pain. I was like, it is awful. And I was like, can you come back in? Cause I thought, God, I just I just messed him up real bad. Like I was, I was feeling awful. I panic emailed you. It was like, what do I do? My God. Because he didn't when we were on the table and I was looking at him, he looked calm. He looked good. He didn't have any of the weird blotchy that you're supposed to look for. He couldn't come in that day. So I said, Will you come in the next day? And he said, Yeah, I come in the next day. So he did and I was like, I'm not even gonna charge you. Like just I was so mortified. So he came in and he got on the table and he was in a different treatment room. And you know, he was talking about it and what was happening. And he said the pain, like he said, it was within like an hour or two of his getting home, the pain just intensified. Like it went like through like beyond 10 out of 10. And it was all through the night it was feeling like that. And like he was having different sensations in his feet. And to make a long story short, I got him on the table and I put my hands on his feet just to like, I don't know, make a connection. And I noticed when I touched him that his right the foot, his left foot was very hot, conversely to his right. And that wasn't the case the two days ago. And so I, you know, crank up my light and I'm I pull up his pant legs. And I noticed that he had, because I'm not a doctor, I couldn't diagnose, but symptoms consistent with a pretty raging cellulitis all the way up his legs. And what was interesting about that is that it was running up his spleen and his stomach channel primarily. And so I asked him, I was like, did you notice Do you notice anything about the color of your legs? And he sat up and he looked at he's like, he's like, no, I didn't really. And I was like, I want you to look at this. And I was showing him. And as I'm noticing, he's got more swelling on that side. So I'm like, you know, and he has a, he had a history of having osteomyitis and recurrent infections. One of the things that was happening is slow healing wounds. And so he was treating a wound on that toe that I had also been sort of. Paying attention to. He always had it wrapped very particularly. So he hadn't wanted me to unwrap it before. So I had assumed that might be the source of what the infection was. He I was like, you know, I really think it's I was like, okay. I was like, I think going with this going on, like you, you need to go to urgent care. And he's like, you're not going to treat me with acupuncture. And I was like, no, sir. I was like, I was like, I think you need to go to urgent care, like right now. And he was kind of dilly dallying. And I didn't want to scare him, but I just, you know, I was like, as a nurse and someone who cares about you, I think it's really important. That you be evaluated by a Western provider for this. And I sent him off to urgent care. And then it was four or five days I didn't hear from him. So there was like the panic part of me was like, God, did he die? And then there was the logical part of me that was like, he probably won't admit to the hospital. And he did. And he had a pretty severe cellulitis. It was caught before it went systemic. He had systemic, he'd had sepsis in the past from this kind of thing. And they had found some more osteomyelatus. So he got that treated. And since then I have heard from him periodically. Like he'll call the check in. He's having a little bit of stuff that's going on, is what he said. And he's waiting on insurance because I'm trying to panel with his insurance. So yeah, he's he's working through it right now. But that was that was a crazy experience, I'll tell you. Definitely made me a little gun shy. I was like, God, and then trying to figure out what happened, you know. What do you think happened?

Toby: I remember guaranteeing to you that not all cases would be like this, training Saam. Yeah. Just that stuff out of the gate. I think I think you and I went back and forth on this a little bit. And right away because you presented the case in much more detail to me. That I felt like you'd done the right thing with Saam and we thought I thought maybe something else was going on. And then I was emphasizing to you patients left to blame acupuncture for every single thing. Mm-hmm. And then attribute any beneficial things to their body just being fine, right? So I said just be cautious about that because you and I were discussing at that point if you needed to counterbalance that, you'd supplement stomach, is that right? And so we were we were talking about should you supplement lung? And then we really felt like it wasn't a wrong treatment once we discussed over and over again, especially this face responding well.

Angelique: Yeah, supplement stomach.

Toby: And that maybe something else was going on. So this was an extremely difficult case to navigate, especially as your first one. Yeah. Because we had two parallel things going on using a new system and then an und undiagnosed other pathogen that was virulent and just came to the surface of something like that. So yeah, again, my sense about that case, again, we never know be certain about anything in clinic, is that you diagnosed and treated correctly, and then just that infection was just raging there. So it just came to the force.

Angelique: Know what was wild though, Toby, is that it wasn't there. Like I didn't you know, I've I've got good assessment skills as a nurse, you know, and I hadn't raised the entirety of his pant legs to treat because you didn't have to, but his feet, there was no sign of infection that I saw or felt was touching him. You know, and then two days like that night, and then I saw him two days later, like it's almost like it brought it to the surface. You know, I think you mentioned that could happen that maybe that the acupuncture could actually have brought that to the surface. Is that right in my understanding correctly?

Toby: Yeah, it's definitely possible, right? But I think it's unlikely. I think that was just kind of a course of how everything was going for him. But you did a powerful intervention for him, but I still feel like your diagnosis was correct. So I think it's unlikely that needles actually caused that.

Angelique: Well, I know it didn't cause the infection. I just wonder if it, you know, moved the qi and the blood into those meridians so powerfully that maybe it brought his ability to sense the infection to the surface, you know, because of the neuropathy he was feeling. He didn't he wasn't able to fe have a lot of sensation in the extremities that we would consider like, you know, normal or what you're supposed to have there. He wasn't aware of it. I don't know. I've been mulling it like around in my mind even still to this day.

Toby: That's quite possible, right? That might have been protective for him. Like he could actually sense the pain sensation. Yeah. Yeah. So again, that's what I said. Two parallel tracks we're discussing right now, the pathology there. And then also is your was your SOM diagnosis correct? I feel like the SOM diagnosis is correct. So it's possible that yeah, you unmasked all that, especially by supplementing stomach, taking all that dampness off there so the patient can actually sense that.

Angelique: Yeah, wild first experience on my own.

Toby: I g I guarantee and you're finally you're embedded with school and everything like that out on your own. And this is your first presentation. So I guarantee it'll be easier. There'll be future cases that'll be more difficult than that, but at least you have a little bit of golden time now as a new practitioner. There's always a little something six months, nine months, everything will go pretty well. And then as long as you keep learning, you can keep extending that golden period. Otherwise if you if you stop learning then that you can't extend that.

Angelique: I don't know that it's possible to ever stop learning this medicine. I feel like it's bottomless.

Toby: Is it if you're bored in Chinese medicine, something's wrong with you. Yeah.

Angelique: Agreed. Goodness. Have you ever had case like that where things just went wildly sideways on you?

Toby: Yes, frequently, frequently happened.

Angelique: And how do you so for me, my impulse was, my god, I have to fix it. And I took all of the responsibility on myself and like didn't I wasn't even gonna charge this person. So like how do you because I know you that's not sustainable to do either. And I don't know that I would do that now as like that I've been not that I've been practicing forever by any means, but you know, now that I'm a couple of months in and I've seen enough patience on my own to kind of I'm starving to be like, Okay, this is how this is working. How do you handle it when things go super sideways?

Toby: Yeah, I think you have to you have to understand that the patient's paying you for your best possible treatment, right? So that's what you gave the best possible treatment. And like I said, it's impossible to say for sure, but you probably helped that patient and then for that patient could feel that before you know, again, major problems. There could have been even more infection before they actually felt it. So it's possible you really helped them, but still your intention is to help the patient as much as possible. And that's what you charge for. You can't charge for results. Like you can't give like a discount if everything miraculously or you can't charge extra if something miraculously moves forward and you can't charge you can't charge them for 10 treatments that they probably wouldn't need it and then like that. But also those difficult cases, right? You have to you have to just charge for your best possible intervention that you can do. So I think that's that's reasonable, especially in that case, right? You're so unsure about things and things like that, not charging for that. But going forward in the future, I think you just have to charge for this is the best possible intervention you can make, and you don't charge. Extra if it goes miraculous and you really can't charge less for if it's a little bit slower than expected because that there's just you don't have full control over that. You can't diagnose and treat perfectly every time, but you can get better and better as your career advances.

Angelique: Yeah. I feel that more now. Especially after spending the weekend in North Carolina at Taoist Traditions. One of the main themes that was like a thread that moved through the whole weekend was that we aren't we can't take the personal responsibility for the healing of the person for better or for worse. You know, that it's not our job to fix the people and it's not our job to put that on ourselves. You know, we work with them and we facilitate person's healing. I think that's important to remember, for better or worse. I tend to be very blameful of myself, you know, when things don't go well. So that was it was sort of a balm to my spirit.

Toby: Yeah, it's your responsibility to do your best. And then after that, you're free of that from my standpoint. And then yeah, you just work with that as best you can. And my teacher, Dr. Wu, she always anytime the patient complimented her, she had some amazing and miraculous things. She did a lot of infertility. So people that just had no chance of having a baby, you know, full nine months, natural birth, everything, a healthy baby and things like that. The patients would just effuse praise on my teacher, Dr. Wu, and she always responded the same way. Great job, body. Right to redirect to the patient's body that actually did everything, right? Of course we can have some influence, we can we can try and get it going the right direction, but the real miracles come from the body. And if acupuncture can do that. So yeah, I thought that was that was a nice way of sidestepping all that. And then also if everything's not going exactly how the patient would like, everything's not resolved immediately, you can't take full responsibility for that. So the healing and then the maybe slower treatments, you can't take full responsibility for that. Both instances, right? You just keep doing the best you can. And this is amazing medicine, but you can't will things to happen. You just have to do whatever your skill set is in that current moment when you meet that patient, just do the best you can with that. And then you it's it's all order, but do the best you can. Just let that let that go. Let those results unfold.

Angelique: Yeah. Be as present as possible and surrender. Right. But then I wonder, you know, too, like how you reconcile clinical thinking around that too, because you can't you want to be diagnosing and treating correctly. So it's like how, you know, parsing out the difference between like, is it my diagnosis and treatment? Is it the patient? Is it both? Because I remember in the course that I took with you that you had mentioned that like it's the system that works. That usually it's in paraphrasing, I'm not quoting directly, but like if the system works. And so often it's like the practitioner. How do you say it?

Toby: And that's sure what you mean.

Angelique: Talking about that with the Saam system, that like the system works. So usually if it's not working, it's usually because of like the error, not the error of the clinician, but it's usually not I'm not finding my words well in this moment.

Toby: I remember what you're saying. For the I really this is my experience with the SOLM system. Originally w when I learned it and I couldn't get clinical results, I would blame the system. And now I realize the system is so sound and can generate so many good clinical things. I mostly I blame myself, right? If I can't use the system properly.

Angelique: Hmm. That's what it was.

Toby: Yeah. So th that's a key thing too, right? Is if you get a good solid system, then it's really on you to do the best you can. And then as you work with that system more and more, it reveals like how powerful it can be when you when you have certain insights with the patient, right? Mm-hmm. So that's yeah, I'm just always trying to get a little bit deeper understanding of the patient in front of me and then see if I can match my understanding of the system together. It's difficult when you start and it gets a little bit better all the time as you go forward, but it's for at least for my case, it's never it's never close to just super clear. There's always a little bit of everything's a little bit unsure when you go to apply it in clinic. But the nice thing about having a good system, you can you can test your ideas and then hone your diagnostic skills over the years.

Angelique: And hopefully not have too many crazies on the way.

Toby: Right. Yeah. Right. But that's why especially like you presented your case, right? Because you I still don't feel like you cause that crisis from your acupuncture. So you got to learn about like the other factors that are going on besides the body, besides that acupuncture one. And then also, yeah, to learn how am I gonna apply this going forward, I have to consider all these other things too. So is like double, maybe even triple learning with one case. So sure.

Angelique: I'll never forget it. Tell you that.

Toby: Okay, great. And th thanks for sharing with everybody too. Okay, anything else you want to discuss?

Angelique: Did. You had mentioned once before that your teacher saw a hundred and fifty patients in a day and that you interned with her during this time. And so I'm curious how that was possible and how she did it and kind of person that she was. Yeah. To me. Is she still with us?

Toby: Yeah. She's semi-retired now. But yeah, it was she had pretty amazing. So I was mentioning before my teacher, Dr. Wu. So yeah, how she would do that is she you know, she's you know, she was several decades into her practice and she just honed everything to be she was a master face reader and master pulse reader. So between those two things, she would come in. Within a few seconds of looking at the patient's face, she has an idea and then checking pulse and then she's ready to go. So she was a good acupuncturist, but especially good at guiding the patient through things in their lives. So she would come in and within just a few seconds, say something really profound to the patient. And based on face reading and pulse reading, Dr. Wood would transform into anything that patient needed. So I was there for four years. The final day when I left. She allowed me to shadow her for the whole day. And it was absolutely amazing how she would just come into the room, transform into whatever the patient needed, and le you know, treat and then leave and then go on. It was like dizzying. She would come in, be so grammarly to some patients, right? Just nurturing and taking care of. And then so harsh, she'd be in the patient's face, yelling at them, whatever the patient needed to advance their health. She would just transform into that with her words, with her advice, with the needles and things like that. So it was a short period of time that she would be with the patient, but it was so intense and oftentimes, you know, really profound to the patient. So yeah, I saw a whole bunch of amazing things in that one day, but it was dizzying how yeah, how she was able to do that. And then just logistics of all that, she had a staff of 10 really well-trained people. So She'd put needles in, they'd be removed for her, check out, you know. So she would just come in, diagnose, treat, say something profound, move on to the next patient and round it around like that for an entire day. Yeah, it was exhausting. You know, those are long days, twelve, fourteen hour days. But yeah, you know, that's she'd honed herself to just be a pure instrument of diagnosis and treatment. Yeah. It was amazing to watch.

Angelique: That's incredible. Yeah, especially sitting over here when I have six patients in a day and I'm like, my God. This is because I aspire to some level of mastery. I don't I don't know that I would ever get to a hundred and fifty patients. I don't know that I don't know, man. I think about max patients per day and seven, eight, nine, ten.

Toby: Yeah. Well you'll see, right? You'll you'll see how everything goes. Soon, especially with your clinic starting to get up and going. So your problems now is not enough patients. And then for about a week and a half, you'll be happy, you'll have enough patients, and then soon you'll have too many patients and you'll have to manage it. So that'll be a new problem for you. If your problem now is not enough patients, you'll be golden for about a week and a half, and then it'll be too many patients.

Angelique: I'll be lucky to have that problem.

Toby: Yeah, yeah, yeah. But it was but that'll be new problems, right? And then sure. And then you have to need staff and you'll need, you know, so be new problems going forwards. Yeah, especially a successful clinician, right? People are gonna want to come see you, so you're gonna have to manage that somehow.

Angelique: How many patients do you see every day?

Toby: I had some health stuff, so I used to see up to thirty patients a day. And now I try to cap it at about sixteen. That's my real cap. I j I just got I think I'm gonna be a little bit over that tomorrow. Just I'm gonna be going out of town soon. I've got a patient I've been seeing for infertility, and then she's now coming to term and they're gonna induce soon. And so before doing that, she wants to come in for acupuncture. So we just l added that to the to the schedule tomorrow, right? So It was already sixteen, so I think that's seventeen. And then this is monastic tradition, so I always see monks. So I've got a really high level monk coming tomorrow too. So I think I'm at eighteen, but my theoretical limit's sixteen. I don't I don't want to do thirty patients a day anymore. I think it's a little bit too much for me. Yeah.

Angelique: I can see that.

Toby: What's the ideal number of days to see patients per week?

Angelique: Currently I'm working four days, but if I could, you know, paint the ideal picture, it'd probably be three.

Toby: Yeah. I really feel like that's ideal. That's Dr. Well, I was telling you those 150 patients a day. That's not like five days a week. She would see th patients three days a week. Because after seeing 150 patients a day transforming yourself into being all those amazing things, right? The last thing you want to do next morning is to see a patient and listen to their blues. Yeah, so I know a lot of successful clinicians. I think maximum they do is maybe four or something like that. Usually three, four, five, you could maybe manage it. But I know a lot of people that try and do more than that. And I think it's too hard on the system, right? Especially if you're really bringing yourself to the treatment. I think you have to have a little bit of rest. You have to have some time for self cultivation, some exercise, some not working at that intense level. In order to stay at that intense level, you have to come down sometimes too. For me, I match Dr. Wu's so I see patients just three days a week now.

Angelique: I like that. And that'll be something I can aspire to in the future. Once I've established myself and figure it out, go down to three days. That sounds very nice.

Toby: Yeah, I think i it's a really nice rhythm. But I think four days a week, I think that's fantastic for you right now. The thing you have as a new practitioner, the best thing you have is availability. Right. That you can offer to the patients availability. So I think that's fantastic to get started. But just you want to be in this for the long term, a couple of decades practice, right? So I think that's the way to do it. Hone down to I like three or four or something like that. But and then try and make them intense days, like Dr. Woodoo, twelve, fourteen hour days. Doesn't have to be like that. But if you can put everybody into three days or four days, that's much better than the having trickle in for five days or six days.

Angelique: Yeah, I can see the benefit of that. I worked, you know, when I worked in the hospital, I definitely felt better working longer shifts, less days per week. So that rationale also seems to fit here for that same reason. Because once you're there, you're there. You know, you're in the clinic, you're at the hospital, whatever, you're there. You might as well just stick it out. You're in that mode. Yeah, you're you got your practitioner hat on.

Toby: Energy's up and you down. Yes. Yeah. All right. I was gonna ask you one more question and then wrap it up for today. Is that okay? I know you just took your boards not too long ago. So I was gonna test if you still have some knowledge. Okay. Are you are you ready?

Angelique: Good to me.

Toby: Where is

Angelique: God.

Toby: Okay. Where is Huang Mun, urinary bladder fifty one?

Angelique: My god Toby.

Toby: First question, is there a urinary bladder fifty one? Do we have that point? Okay, okay, good. Okay, so that's that's good. Yeah. And where is it located?

Angelique: Think so. It's on the back somewhere. It's on the back. Low back. Outer bladder line.

Toby: Okay, good. Good. Can you be any more specific with any vertebrae?

Angelique: To do math. No. Yeah it

Toby: Okay. I want to make sure that you forgot these things as quickly as I did. So I wanted to ask you that. Thank you. I had to look it up. It's a T Okay.

Angelique: Okay. Thanks for that, Toby. Humbly. Right? Okay. Yeah. Is it are you sure?

Toby: No, I'm not sure about that. Okay.

Angelique: Yeah, I was like that feels high. I think it's lower. My god, do we have to pull out dead men?

Toby: It is lower. It's not it's not T one. I said T one and I apologize. It's L one. I'm sorry. Okay. Let's let's re let's recap this. There is a urinary bladder fifty one. Yes. At the outer UB shoe. Okay. I'm glad you I'm glad you forgot it immediately. Thank you. I think that's that's good use of your brain, right? Just jettison all that stuff you had to have for boards.

Angelique: All right. Put it back in the books where it belongs. We can look it up when you need it, right?

Toby: That's right. I looked it I looked it up and then said the wrong thing. So sorry about that.

Angelique: That's okay. I feel better about it.

Toby: I couldn't even remember after writing it down. So All right. Angelique, if you're up for it, let's continue our conversation going forward. And w we'll just continue discussing l like we were talking about before, our field itself, right? It's endless of things we can discuss. So let's meet again sometime soon and continue this discussion, all right?

Angelique: That sounds good to me. Are we gonna invite folks to put their suggestions and comments if they see this of what they'd like to hear about? Yeah.

Toby: Yeah, that would be great. If anyone does run across this and they want us to discuss something in the future, yeah, if they could put it any ideas they have in the comments, that would be great. And if you really enjoyed this discussion, you can like it. If you really didn't enjoy this discussion, Angelique and I promise we'll do much better next time. Everyone take care, okay?

Angelique: Matter time. All right. Bye everybody.