Thorough Competency

Over the last three years of writing this blog and speaking with potential students, I have had many people express their fears about the unknown journey into naturopathic medicine. How difficult is the program? Since you learn so many things, is it possible to be effective at anything? Is it really harder than conventional medical school? Do you learn enough science? Is the art of medicine still taught?

I understand where these questions stem from as I certainly had many of them before entering the program. Although there is absolutely no substitute for experience, and everyone’s experience is different, one of my supervisors recently showed us five categories of competencies expected from naturopathic doctors by the American Association of Accredited Naturopathic Medical Colleges (AANMC). I found it interesting to see AANMC sum up everything we do into 5 areas and I thought I would share them with you.

Here is the Professional Competency Profile of a Naturopathic Doctor:

1. Naturopathic Medical Expert

• Integrate naturopathic philosophy, theory and principles with naturopathic medical knowledge in the care of patients and case management including the assessment, diagnostic and treatment phases.

• Develop, maintain and value a comprehensive knowledge base in naturopathic medicine.

• Conduct an assessment to formulate a naturopathic medical diagnosis.

• Effectively provide and manage patient care.

2. Naturopathic Manager

• Develop and maintain relationships in practice and the community consistent with the philosophy and principles of naturopathic medicine.

• Establish, develop and manage a practice.

• Exhibit strong personal management skills.

3. Naturopathic Professional

• Utilize knowledge of naturopathic history, principles and philosophy to guide professional engagement and development.

• Demonstrate ethics and integrity in professional practice and personal conduct.

• Serve the public through ethical practice, health promotion and disease prevention.

• Ensure professional competence through ongoing self-assessment and professional development.

4. Naturopathic Health Scholar

• Exemplify the principle of doctor as teacher in every patient and public interaction.

• Maintain and enhance professional competence through ongoing learning activities.

• Critically evaluate medical information.

• Educate patients, colleagues, other health-care providers and the public.

• Advance the practice of naturopathic medicine through the development, critical assessment and dissemination of research and information.

5. Naturopathic Health Advocate

• Promote the principles and philosophy of naturopathic medicine in advocating for sustainable, healthy environments and lifestyles for patients and society.

• Reflect a knowledge base that enables effective health advocacy.

• Influence others in accepting naturopathic medicine as an essential element in health promotion and disease prevention.

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New Beginnings

As I came in to the school this week I saw a sea of new faces excitedly awaiting their journey in naturopathic medical school. CCNM is now set to graduate the most students per year of all the accredited naturopathic colleges in North America. I clearly remember how exciting that first month of school was and how it was such a paradigm shift for many people depending on their background. Very soon though, it becomes a lot of stress and an unbelievable amount of work. Even with the added responsibility that comes with treating patients as an intern, I would not trade those 1st year students places for anything!

As the summer comes to a close, it is easy for me to nostalgically look backwards instead of looking forward to the new beginnings I have too. For me, this is the last September I will ever be in school as next year my wife and I will be busy preparing to set up our practice. Also, next Monday the 4th year interns begin a series of new classes (ethics/jurisprudence, practice management, in office procedures) that prepare us to write our final board exams and ultimately for practice. More importantly, the fall brings many new patients to the clinic who either felt better through the warm, sunny months or obligations and distractions delayed them from addressing their health concerns until now.

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Choosing the ND Generalist

Naturopathic Doctors in Canada (and the States where ND’s are a regulated practice) have worked hard to maintain a large scope of practice that includes extensive training in conventional biomedical sciences as well as alternative medical techniques. Until recently I have always wondered why someone would want to give up that freedom for a focused discipline that often requires the same years of post secondary schooling, like a registered dietitian or a chiropractor, when these modalities and corresponding scope of practice are already included within naturopathic medicine.

I realize that there are many good reasons (too many to write about here) why people choose to become a focused health care practitioner, not least of which is a positive personal experience with a certain health care professional or the goal of helping people with specific health concerns. Also, many students may not know their options including the fact that most just do not know what naturopathic doctors are trained to do. Although I am very proud of the ND’s scope of practice, and recognize the privilege to have my training, I now perceive one potential advantage to being a focused specialist... Might the patient’s problems be simpler?

This may not be the case at all but in the last month I have developed a small degree of wishful envy for practitioners who see patients that are presenting with concerns associated with a particular health focus, be it dietary, musculoskeletal problems or emotional issues. It just seems like it might not be as messy! Maybe that is part of the appeal?

In contrast, and without going into specific details, people visiting naturopathic doctors may have anything wrong with them - anything; and it may be somewhat illusive even to conventional medicine. Dr. Bernard Lown, MD writes in his book The Lost Art of Healing; Practicing Compassion in Medicine, “At present, about 25 percent of patients who visit an American doctor are successfully treated. The other 75 percent have problems that scientific medicine finds difficult to resolve. After being shuffled among a bevy of specialists and subjected to costly and invasive technologies, many patients, frustrated, turn away from conventional medicine.”

There is certainly an important place for every practitioner and every patient deserves the opportunity to be treated in the way that is best for them. Coincidentally, I am beginning to understand that with a large scope of practice comes the potential for patients with a greater degree of complicated health problems. This is the challenge of helping these people that puts those brief moments of wishful envy into perspective. Thank God I love reading because I certainly spend a lot of time researching for my patients! And, sometimes simple solutions do work even for the complicated problems.

If you or anyone you know is struggling with a health issue, do not wait until conventional medicine becomes frustrating to see a naturopathic doctor. It is important for ND’s to be able to work with conventional medicine where appropriate to the best benefit of the patient. It doesn’t matter how complicated your case might seem, ND’s will take the time investigate your concerns including asking the right questions and listening to your answers.

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Book Review 10

Confessions of an Rx Drug Pusher by Gwen Olsen.

As more provinces in Canada, and states in the U.S.A., grant naturopathic doctors prescription rights, and after seeing several patients after only 2 months in clinic with side effects from prescription medications, I decided to read another book on the topic of pharmaceutical drugs.

This book is an autobiographical account of how drugs, both pharmaceutical & recreational, have permeated society with nearly a complete disregard to their consequences. As a former pharmaceutical sales rep for 15 years, Gwen Olsen discloses enough inside knowledge about the pharmaceutical industry to put the broad spread dependence on prescription drugs, especially those for depression and other mental illness, into serious question. The book is very well referenced with an abundance of evidence including heart wrenching patient cases and scientific research.

As an autobiography, the author openly recounts the horrific events in her life, including messy family dysfunction and mental illnesses, that gave her a first hand experience on the receiving end of many of the medications she was trained to believe would help people. Her ultimate conversion to a traditional view of wholistic medicine, and occasional moments of over disclosure, may give some ardent Big Pharma believers an illegitimate excuse to discard the authors' perspective based on character weakness. However, the book still stands on its own as another beacon of light uncovering the damaged path left by years of unabated over prescribing and the lack of public safety with regards to medications.

Another book outlining some of the corruption in the pharmaceutical drug industry is, The Truth About Drug Companies by Marcia Angell, MD. This book, in contrast, is written from a MD's perspective in completely unemotional prose by the former editor in chief of the New England Journal of Medicine.

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Schooled by an MD!

I recently watched a debate on the effectiveness, safety and merits of complementary medicine. The panel included a medical doctor and a scientific sceptic on the con side, and two naturopathic doctors for the pro side. It was apparent to me early into the debate that the conventional medical community has a serious lack of understanding of what ND's actually do. ND's know what MD's do, and for the most part are familiar with the conventional medical school of thought, but so much of the time MD's really misunderstand what naturopathic doctors do.

There are some explanations for this. Certainly, there are some naturopathic doctors who muddy the waters and represent the profession in a way not typical of the profession as a whole. But, what makes naturopathic medicine most complicated is that the scope of practice is so large that some ND's may have an entirely talk-therapy based practice and on the other end of the extreme, some ND's may do primarily a sports medicine based practice.

One interesting point made by one of the naturopathic doctors was that, currently (because of the relatively few ND's by comparison), the largest population of doctors that practice natural medicines and therapies are actually medical doctors. This hit home when Dr. Lawrence Palevsky, MD came up from New York and gave a guest lecture on Pediatrics at CCNM earlier this week. It was fascinating to hear his perspective on the antecedents to conventional medical thought and its methodology for the treatment of childhood diseases. It was almost shocking to hear a Medical Doctor use every naturopathic tactic possible to avoid prescriptions of antibiotics, acetaminophen (Tylenol) and even present an informed choice on vaccines. I was reminded of the necessity of childhood fevers and shown, in tremendous detail, the great harm in handing out fever suppressing drugs like candy - and I learned this from a medical doctor! There is hope for much more integration of conventional and naturopathic medicine in the near future.

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“Eat food. Not too much. Mostly plants."
Michael Pollan - In Defense of Food

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The [CCNM] Hour

As an ND intern, I have the privilege to spend an hour visit with my patients. Initially, I thought this would allow ample time to ask all the pertinent questions, perform a relevant physical exam and ensure the proper care was provided for the patient by the end of the visit. Although this may be true in some straight forward cases, I have found that patients often see us as a last resort and have an extensive story and medical history to share. Furthermore, I think patients find some therapeutic value in just being able to freely tell me their story, in full, without me limiting their responses or cutting them off to one or two concerns per visit.

As such, I have already listened to (while carefully charting) some extremely complicated cases and the hour flies by before unearthing all the potential contributing factors to the person's current state. And, I still need to remember to at least take the person's blood pressure! However, when I review the patients case, I recognize the tremendous value of the information I gathered to point me towards treatment options and areas where I need to research. Furthermore, I have realized that most patients with complicated cases (that have stumped other health professionals) do not expect me to have an exact solution by the end of one hour. Although that would be nice, my assurance that a health improvement - at the very least - in the near future is possible is more important.

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