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!

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.

Quote of the Month

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

Abigail Charlson

Book Review 11

Hippocrates' Shadow. Secretes from the house of Medicine by David H. Newman, M.D.

Anyone who is currently, or plans to practice, as a health care provider should read this book.  With that said, I would not recommend this book to everyone (even though my caution may inadvertently assist in perpetuating some of the medical secrets and pseudo axioms the author illuminates) as the author boldly presents some issues of huge magnitude with the potential to shake an ardent believers trust in western medicine.

However, for those in the healthcare field, this book exposes the history behind "schools of thought" in medicine and the steps that lead to many common assumptions about the practice of medicine.  The author, who practiced as an emergency medicine doctor, runs a clinical research program and teaches at Columbia University, boldly asks if certain segments of medical education is spent teaching material that is incorrect.

The book has a great layout as most chapters begins with an ER room scenario that leads to a discussion.  A thought provoking read that is a must for health care providers.

Lasting Impressions

Over the last few months I have had several patients preemptively express a similar sentiment about the use of supplements.  In these particular cases, after the patients’ have told me their concerns and reasons for coming to the clinic, they finish with a caveat that goes something like, “Now I don’t want to be sent home with 10 different supplements to take.”

I can certainly understand the intrigue many practitioners have with supplementation and the excitement that goes along with knowing which vitamin, mineral or co-factor is required for a person’s biochemistry to function optimally - nutrition in the form of supplementation is a very powerful thing.  However, this alone is not a legitimate reason to send a patient home with 10 different supplements.  As a patient, if taking that many supplements was your desire, it is not necessarily wrong (and I have several patients who have self prescribed more than 10 supplements) but it is not indicated or reasonable for most people.

I wonder if this impression also comes from an early model of naturopathic medicine where naturopaths were associated with a health food store and correspondingly sold supplements. Being confronted with this made me realize that there is a lot of power in a mental association.  For example, when you think of agriculture, do you still think of the little red barn?  This positive association connects what we eat to a small, caring farm where healthy animals run on open fields and come into a warm little red barn at night.  Although this is unfortunately seldom true anymore, the association benefits particular brands that continue to advertise something of the sort. 

When you think of a naturopathic doctor, what do you think of?  It is interesting how the naturopathic profession still feels the obligation to prove its legitimacy to the conventional medical community as well as the general public despite helping hundreds of thousands of people every year.  Although most ND's do not over-prescribe supplements, sometimes naturopathic medicine is growing so fast that not all ND's have embraced the role of a primary care doctor and these particular practitioners choose to practice in a more exclusive and specialized way.  This diversity can be a strength and is not necessarily a bad thing.

To help you chose an ND, most naturopathic clinics have a website that explains the practitioner's philosophy and services (I wish MD's had a website to explain their philosophy) so you can see if you are a good fit.  Remember that NDs are trained as primary care doctors who follow a therapeutic order and utilize diet, nutrition, herbs, physical medicine, lifestyle counseling and acupuncture individualized to each patient's needs.

NYGH Health & Wellness Fair

Yesterday I volunteered for our school at the North York General Hospital (NYGH) annual Health and Wellness Fair.  With the two establishments being in such a close proximity (directly across the street from each other), it was very interesting to see the range of responses to our booth.  Those who came through the fair were mostly employees of the hospital, although an occasional patient stopped by to ask questions.

I was somewhat taken aback by some of the stern looks, harsh comments and being brushed off by a small group of first year Residents.  I could not help but wonder if they thought we were a bunch of x-hippies cleaned up to look like business people instead of effective primary care doctors!  Over the course of the day, I realized that the naturopathic profession needs to remember how strange and foreign our world of quinoa, medicinal plants, and acupuncture, etc., etc., is to the average person whose medical doctor fixes all their health problems.

It is important to remember that the sample populations we are accustomed to seeing are not necessarily representative of the general consensus of the community.  The people that come to the RSNC clinic, or from my experience preceptoring in private practices, have already overcome many obstacles and boundaries to being a patient of naturopathic medicine.  If you are reading this blog, you also have already overcome many more barriers - even in terms of awareness - to understanding naturopathic medicine than the general population.  As such, there is a great need for the naturopathic profession to be culturally relevant when explaining our perspective of health to the general population and an attempt must be made to try to put ourselves in their position (and try to see things from their perspective).

There were some encouraging moments too at the fair and it was great to initiate awareness of how naturopathic medicine can help many health concerns. I should also consider the fact that we were invited to attend the NYGH Health and Wellness Fair another indication that integrative medicine is not so far into the future.

Village on a Diet

I wonder if twenty years ago we would have predicted that in 2011 people would be so fascinated with a television show about one of life's most basic physiological processes - losing weight?!  Village on a Diet has fascinated me by its simplicity.  Yet, despite a basic premise, the solutions for the town of Taylor, British Columbia are a matter of life and death for many of its citizens.

Change is difficult, especially lifestyle changes, and we can see this resistance in many of the people on the show.  What makes matters worse is a bombardment of advertising giving people the impression that they need to "ask their doctor" for something they can take that will make their life better, instead of what they need to change. 

Although the experts sent into Taylor seem to make up an effective team (despite the "suck-it-up" military style work-outs which may be required to get their weight loss goal in one month), it is very unfortunate that a naturopathic doctor was not part of the group to ensure long term diet and lifestyle changes.  This is important because living a longer, healthier life is not quite as simple as "eat less and move more" - although this formula certainly does contribute to weight loss in the short term (and many people have a serious food excess combined with a movement deficiency).  What is most important though is addressing the multifaceted root causes of obesity (beyond calories in and calories out).

The show does have many positives, and I have to say, I do love the community approach; that's a first for a weight loss show.  Finally, I realize that having a psychologist on the team was a great addition and I hope that her added help is enough to compensate for the physical shock some of the participants undoubtedly endured.  I hope this show is an indication that the general population is becoming aware that quick fixes and fad diets are not a long term solution.

Quote of the Month

"To teach is to learn twice." 

Joseph Joubert

The naturopathic Godfather

Today I met the Godfather of postmodern naturopathic medicine.  Dr. Joseph Pizzorno is an elder in the naturopathic community who graduated in the mid 1970's when there was only one naturopathic school in North America.  According to him, CAM is popular culture now in comparison to the persecution it suffered when he first started practicing.  He is currently the president of Bastyr University and also the author of the Textbook of Natural Medicine. 

So today, Dr. Pizzorno gave a presentation to CCNM students and staff about intestinal permeability.  As I am not a particular fan of this textbook, I was undecided on whether to attend.  However, who can miss the chance to see someone with such a reputation!  And, I have to say that the lecture was very educational and, as to be expected from someone with his number of white hairs, some controversial statements were made that only many years of experience could allow him to say.

Maybe the gray hairs creeping up on my head will help me after all!!

Blood, urine & no tears.

Today I finished my last official shift at the Gamma Dynacare Lab inside the Robert Schad Naturopathic Clinic (CCNM's teaching clinic).  Fourth year interns are required to fulfill a mininmum amount of clinical hours in the lab and also obtain a minimum number of patient blood draws, urinalysis and other tests.  Additionally, we complete a very thorough one-on-one verbal assignment that assesses our knowledge (learned in lab diagnosis theory classes) of the correct indications for ordering labs.  This learning experience was one of my favourite so far at CCNM.  It is not often that students get the opportunity to learn in a practical one-on-one teaching environment and I did not take the privilege for granted. 

Naturopathic doctors are trained to use lab diagnosis to investigate or support a clinical suspicion.  Additionally, many patients are now requesting disease risk assessment tests that can be performed with a "simple" blood test.  What is exciting is that many tests are now becoming available at point of care.  This means that soon a finger prick (instead of a more invasive blood draw into a vein), saliva or urine will be able to test most hormones and disease risk factors right in your doctors office.