The Qi of Good Strategy
— Joseph Walker, III, MD, DABMA
When you step into the treatment room, strategy is already at work. Not the kind printed in a 200-page spiral-bound instructional manual, but the quiet, focused kind that lives in your head and hands. You begin by identifying the diagnosis — not merely an ICD code, but the deeper question: What is the core obstacle standing between this patient and better health?”
It could be unrelenting low back pain, but the real challenge is the fear of movement. It may be post-stroke spasticity, but the actual barrier is the patient’s loss of confidence in their ability to recover. Strategy begins with seeing clearly.
Richard Rumelt, in Good Strategy / Bad Strategy, calls this the “kernel” — a three-part process: diagnose the challenge, craft a guiding policy, and take coherent, coordinated actions. It’s as accurate for one patient in front of you as it is for an organization or an entire profession. Without a clear diagnosis, you can’t choose the right points or the right conversation. Without a guiding policy, you’re just improvising. Without coherent actions, your treatment plan is a disconnected list of good intentions.
In medicine, and especially in medical acupuncture, bad strategy is easy to spot. It looks like trying to treat everything at once, relying on the comfort of routine, or mistaking broad intentions (“I’ll just do a NADA or 4 Gates protocol”) for an actual plan tailored to the moment. Good strategy requires the discipline to choose — to commit to one approach over others, at least for now — and the courage to adjust when the results tell you to.
This isn’t just about technique. It’s about presence. A strategic treatment is mindful: every point selected, every needle manipulated, every minute spent is part of a coherent whole aimed at overcoming the central obstacle. That is how, visit by visit, you move someone from a stuck state toward movement, from pain toward relief, from fragmentation toward integration.
Now imagine scaling that process up — from one patient to our entire field.
Medical acupuncture in North America is a small but diverse community. Physicians, dentists, veterinarians, physical therapists, and other licensed practitioners all bring acupuncture or acupuncture-related skills into their work. Each discipline sees through a slightly different lens — neuroanatomy, orthopedics, rehabilitation, traditional medicine, systems biology — and each has techniques the others can learn from. Too often, our strategies for the field are vague aspirations: “Grow the profession,” “Increase public awareness,” “Support members.” These are goals, not strategy.
A good collective strategy for medical acupuncture starts the same way as for an individual patient: with a clear-eyed diagnosis. What is the real obstacle? Is it the lack of new trainees? Fragmented credentialing standards? Limited reimbursement? The public perception that acupuncture is “alternative” instead of integral? The answer may differ depending on your perspective, but until we name the central challenge, our actions will remain scattered.
From there, we need a guiding policy — a shared approach that says, in effect, “Given our resources, our position, and our obstacles, here is the way forward.” That policy might focus on building cross-disciplinary alliances, amplifying evidence-based outcomes, and mentoring the next generation. Then come the coherent actions: targeted recruitment at medical schools, collaborative research projects with other health professions, advocacy for inclusive reimbursement codes, and interprofessional training programs. Each step coordinated, each step reinforcing the others.
When you work this way — diagnosis, guiding policy, coherent actions — you’re not just helping your patients; you’re helping shape the future of medicine. The patient in front of you benefits from your strategic clarity. The profession benefits from our collective clarity. And the health care system benefits when we show, through results and relationships, that medical acupuncture belongs at the table.
The exact process that can heal a single shoulder can help heal an entire system. The needle is just a tool — the strategy is what moves the qi.
