It's Graduation Time!

The graduating class of 2011 is done!!  It seems absolutely unbelievable...I'm sure the reality of being finished internship will quickly set in as I begin to prepare for NPLEX and board exams, but right now I'm basking in the accomplishment.  And what a journey this has been...filled with a lot of ups and downs, the appearance of gray hairs and the skills to help improve health care in Canada.

One thing I was not prepared for this last month was saying goodbye and transferring the care of many patients I have got to know very well over the past year.  Although I'm sure their new intern will work as hard as I did, there was a sadness in not continuing along their health journey with them.  Well, I do not want to end on a note of sadness as this is a time for celebration.  So, congratulations to all the naturopathic medical students in North America who will be graduating this spring.  I wish everyone the greatest success.

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Real Health Care in Canada

With only 2 weeks remaining in my clinical internship, and the timing of this federal election, I was paying greater attention to the politics of the profession and the vital role naturopathic doctors have in changing the course of "health care" in Canada.  I put, "health care" in quotations because what our politicians have not yet been made aware of is that healthy people are not the ones being taken care of in Canada.  Rather, our conventional medical system is in fact a disease care system of medicine.

I realize this is my bias, but I would like to see naturopathic doctors (ND's) be the primary care gate-keepers of the health care system since we have the widest scope of practice of any health care provider (and subsequently the greatest number of therapeutic tools).  When necessary, ND's would also know when and which specialist would be best for the patient to be referred to within the conventional and complementary health care systems.  I believe this would revolutionize Canada's health care system which is in a state of patient care deterioration and financial crisis.

Most people feel like they are too busy to write or ask their local member of parliament about what health care truly means to them or to let them know about the benefits of naturopathic medicine.  But, we can all quite easily talk to our friends, mention our vision for a true health care system on Facebook or Twitter.  Many small actions will build into a large movement!

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Individual Medicine

One of the challenges in naturopathic medicine is treating every person individually.  This entails pulling together treatment ideas and prescribed changes from a host of resources and, in some respects, I often feel like I am reinventing the wheel with each patient.  For the clinician, this is a recipe for a lot of work and at the end of the day, it can be difficult to separate the "office" from home life as the realization of this responsibility sets in.

This is a sharp contrast to conventional medicine which has an established algorithm or standard of care for most medical diagnoses.  I can't say for sure, but, when an MD leaves the office, it might possibly be easier for them to believe that they have done all they were trained to do for their patients and no one could expect more of them.

And, the conventional treatment protocols do seem to work for a percentage of the population.  However, the majority of patients that come to naturopathic medicine have not been successfully treated with conventional approaches and they are in need of something to address the root of their problems.  At times I wish there were more standards of care algorithms for ND's but, then I also hope that as our medicine continues to be supported by science that practitioners never utilize a canned approach.

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OSCE time of year again

I would not ever want to be in the third year's shoes during the OSCE's (Objective Structured Clinical Examination).  I can clearly remember my experience last year and seeing the faces of some of the people after their exams, I feel their pain!  (My post last year stated that it was almost fun, but even after a year of seeing patients, it would take a lot of adrenalin for it to feel fun). 

One of my colleagues in 4th year took it upon herself to organize several mock OSCE's, which we nicknamed the "Moski's", in order to better prepare students for this important test.  Now, even the 2nd years do an OSCE that tests their physical and clinical diagnosis skills before they enter 3rd year.  I was happy to teach at each event and was impressed with the level of confidence some people have developed.

The OSCE's ensure a standard of safety in Primary Care and as stressful as it is having your every word and move scrutinized, they are a necessity in order to make ND's the best primary care doctors they can be.

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CCNM Growing Pains

The fact that school at the Canadian College of Naturopathic Medicine (CCNM) is very difficult is something I've written about several times before.  It has been argued by some students at CCNM (who have other medical degrees) that the diversity of material in the naturopathic program adds an additional challenge on top of the tremendous course load making it one of the most difficult medical programs.  Additionally, although CCNM is over 30 years old, it still growing to an ever expanding profession.  Furthermore, to accommodate a January enrollment, CCNM has long days of class packed into one of the shortest school years of all the accredited colleges.  So, as I've written before, this can be a recipe for exhaustion and burn-out. 

At first, the thought of burn-out at a 'holistic' school may seem ironic but it certainly happens.  Then, I thought this would change after getting into clinic.  But after treating patients for almost a year, I realized that it can still be very easy to take home an exceptional amount of stress.  Stress and burn-out is common place in well established schools too.  I subscribe to Medscape (which sends me a weekly email about the latest topics in conventional medicine along with blog posts from students and professors) and see there too that conventional medical students also frequently complain about the unrelenting difficulty of their programs.  One thing I notice though, is that they do not blame their school.

In contrast, at CCNM, the school administration and curriculum seems to take the brunt of the blame from students; and it may be warranted in some cases.  Yes, there are a lot of tedious requirements and it is difficult for the curriculum to address every naturopathic perspective in depth.  However, I can't help but wonder if some of the the students have taken the school's willingness to change as a sign of weakness instead of a sign of consideration for the students?  And, have some students perceived the never-ending onslaught of rules and requirements as an attempt to needlessly evaluate them instead of an effort to maintain credibility in a growing field?  Maybe this will be much in the same way as some people who did not appreciate their parents until leaving the nest.  While growing up they had perceptions of endless tasks and rules to adhere too, parents not allowing enough of this activity or that, and not until looking back did they realize their parents actually knew what was really best for them.

I think the naturopathic program should be longer and not streamlined into focused training on one modality.  From my experience, being able to use whatever is best and most indicated for patients, not being religiously stuck on one modality, is the ultimate difference a naturopathic doctor can offer.  I believe this is an advantage ND's have over any other primary care doctor.  The naturopathic profession is growing at a tremendous rate and CCNM grows correspondingly.  Ultimately, graduating from CCNM is no easy feat and will be something I remember for the rest of my life...seven weeks to go!

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From Green to Transparency

One of the most powerful agents for change happens each time we buy a product - we vote with our dollars by supporting companies.  Over the past year I have noticed an explosion in the number of companies vying for customers by jumping on the "green" bandwagon.  The increased awareness and urgency of environmental issues has created public pressure on companies to make more environmentally conscious products. But are they?

Products in the grocery store, clothing manufacturers, many vehicles claiming to have best fuel economy in their class, even Coca cola is coming out with a 30% plant based plastic bottle.  My first inspiration for writing this post actually came from watching the Canadian Association of Petroleum Producers TV advertisement that made it sound like they leave no environmental impact at the oil sands in northern Alberta, and yet it doesn't take much searching to find out that the water available to surrounding native populations is not drinkable due to heavy metals and toxic hydrochemicals.

Many companies may claim to be green, but if they were truly transparent we would see that unfortunately money is their prime motivation, not real environmental protection.  So, be skeptical!  If a product claim doesn't make sense, it is probably not as green as it sounds.  Even if what the label or TV commercial says is true, what is the company not telling you?  As consumers continue to choose true green products, and these companies become successful, this will raise the bar for those companies who still believe that they can't make a profit without cutting corners.

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Quote of the Month

"Human nature is about the only nature some people experience."

Abigail Charlson

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