Integrating an acupuncturist’s perspective to product development

I was walking home from a long shift at one of the three acupuncture clinics I was working at in Williamsburg. As I headed down to the subway, a brightly colored sign with bold text taped to some scaffolding caught my eye. It read “your vagina deserves better.” My first thought was “YES, she does!” and then I wondered, “who & what is Tia!?" After a quick Instagram search, while waiting for the subway, I found @asktia, the Instagram handle for the app soon to be IRL clinic coming to Flatiron in NYC.

I scrolled through posts — “imagine your PCP talks to your acupuncturist to collaborate on your care plan, “ or “yes, your diet and repeat UTIs might just be connected” to “sex-positive health care where you run the show” and other female empowered, body positive and pro-choice messages. Was this femtech/health startup with a cycle tracking, female health problem-solving app real? I immediately searched for an email address and sent a hopeful message expressing my admiration and newfound dream to work as the acupuncturist at the very 1st Tia clinic.

Fast forward 6 months later, I found myself in a meeting room at a coworking space with Chief Medical Officer at the time, Dr. Stephanie McClellan, and CPOO, Felicity Yost. Together we brainstormed how to incorporate the integrative +Traditional Chinese Medicine (TCM) medicine lens into the UHR while I googled meanings to tech acronyms under the table. It was my first time working with anyone other than small- business- owning -acupuncturists and I found myself temporarily swapping out words like Qi, Yin and Yang for more easily accessible phases like blood circulation, fluid balance, and energy levels. I was relieved, however, to find a team that was so open, fascinated, and hungry for this alternative way of thinking.

As evidence-based medicine, acupuncture and TCM have long been recognized for their non-invasive, side effect free and long-lasting stress relieving and health boosting benefits. The research on acupuncture for female-specific health concerns is ever-growing. Acupuncture and herbal medicine have successfully offered life-changing solutions to those plagued with chronically painful periods, hormonally influenced emotional roller coasters, fertility woes, and so on. Tia, and the creative minds building both the clinic and the UHR from the ground up, we're eager to find ways to weave TCM + whole-body health into their approach to care.

This concept of whole-body health is at the very core of Chinese and integrative medicine. It’s nearly impossible, or at least very unlikely, for an acupuncturist to ask a patient about their inability to fall to sleep at night and not inquire about their bowel movements, frequency of headaches, or preference for warm or cold beverages. Figuring out how to merge together this, oftentimes stream of consciousness/ connect the dots style of thinking into a cohesive document is where the fun started.

Dr. McClellan, who had spent her career studying the effect of stress on female brains and convincing her medical colleagues that women were not just “small men” already tended to a more holistic and natural approach. She had been recommending acupuncture to her patients for the past 20 years even though I was the first to give her acupuncture. My task wasn’t to figure out how to convince them of acupuncture’s long list of benefits, something I was accustomed to doing, it was how to incorporate the ideology behind it  The first few questions I saw at the top of an intake asked, “were you born vaginally or cesarean?” and “Did your mother have a difficult pregnancy?” This type of thinking — looking at one’s innate constitution and how that informs overall health is embedded within TCM.

Some of the concerns I had noticed in UHR’s at previous acupuncture clinics at which I worked included:

1. Either the questionnaire was so extensive and detailed that the patient’s first appointment was almost two hours or
2. it was simply a space to free write your chief complaint.

Both versions worked- patients benefited and symptoms improved from the acupuncture they received at either clinic, but they both were catered to a very specific model. As with most things, there is a sweet spot between the two- a UHR where you could get into the nitty-gritty without having to read and/or transcribe a novel. To do this, we had to see where our typical intake questions overlapped.

We collaborated to explore the various ways we thought about female health. We had the more commonly asked questions about the menstrual cycle like, “Is your cycle regular? How many days do you bleed for? Do you experience pain with your cycle?" And then dove into the more qualitative, nit-picky TCM style question, “what color is your blood?” “Do you experience clots?” “Does your period start and stop?” We expanded questions about sleep to go beyond, “How many hours do you sleep each night? and “What time do you go to bed? To include, “Do you have a hard time falling and/or staying to sleep? Do you experience night sweats? What about dream disturbed sleep?” We blended our approaches to patient inquiry to find where we aligned, what was missing, and what was necessary

What Chinese and integrative medicine brings to the table that is often missing in Western medicine clinics + hospitals is the idea that symptoms, or the branch, arises due to an underlying concern, the root. This idea is fundamental in TCM. Rather than giving a pill for this and a pill for that, this root/branch thinking enables us to dig deeper and figure out the why of how it all started. And what’s more affirming in this type of thinking is not only seeing longer-lasting solutions to what was once a chronic ailment, but the fact that asking patients these questions, incorporating them into the UHR enables them to make the connections. What we have found is that Tia patients are actively invested in their health and they are tired of going to specialist after specialist who say that the pain will eventually go away, that their chronic bloating doesn't sound that abnormal, or that their irregular bleeding seems to be normal their body. The Tia patient wants more answers. They are curious and intuitive and while they’ve been taught to ignore the signs their body is telling, sometimes screaming at them, they have come to us ready to listen, ready to learn.

Working with the team to layer this type of thinking into the UHR did, as expected, posed a concern in terms of length. What I found, and still find to be a challenge when bringing together health and tech is all of the “ifs, buts and it depends,” of a patient's story. While tech thrives on clean, bullet point answers and organized layouts, my note-taking often leads me on a winding journey of writing outside the lines. I expected to incorporate at least some open text for a patient to “free write” a specific answer but soon found that not only is this inefficient space-wise, but also, makes it harder for another practitioner to make sense of it all. In order to honor the need to allow flexibility in response, I was introduced to the idea of “conditional logic”.

Conditional logic allowed us to include the possibilities of the “if’s, but’s and it depends” into a relatively concise questionnaire. While I can’t credit this simple idea with being the secret to condensing dozens of textbooks of theory and years of clinical questioning into something a bit more approachable, it certainly helped.

The underlying theme in this whole process was efficient collaboration — finding a balance between honoring a patient’s unique health journey while at the same time, making it digestible for practitioners of varying backgrounds. It is through creating the right kind of layered questions that leads not only a practitioner but also the patient, to the underlying root.