Reforming Health

     As the debate on overhauling the nation's health-care system continues to be a political hot topic, complete with uncompromising bickering negotiations and partisan hubris, virtually everyone agrees on one point: There are not enough primary-care doctors to meet current needs, and the idea of providing health insurance to tens of millions more people would certainly threaten to overwhelm the already shaky system. The American Academy of Family Physicians predicts that, if current trends continue, the shortage of family doctors will reach 40,000 in a little more than 10 years, as allopathic medical schools send about half the needed number of graduates into primary medicine. The overall shortage of doctors may grow to 124,400 by 2025, according to a study by the Association of American Medical Colleges. And, the report warns, "if the nation moves rapidly towards universal health coverage," which would likely increase demand for primary care and reduce immediate access to specialists, the shortages "may be even more severe."

     The current solutions being discussed include easing the debt medical students accrue and amping up debt-repayment programs as incentive for those who choose primary care rather than higher paying specialties. As a medical student racking up an obscene amount of debt, I'm for it. However, I think there is another viable option being conspiciously overlooked; the inclusion of naturopathic physicians as primary care physicians in our health care model.

     Naturopathic physicians are primary care physicians. We attend four year, accredited medical schools, are trained and licensed to diagnose and treat patients from pediatric to geriatric, have prescribing privileges, and with additional education and licensure can deliver babies. In addition to the medical training received by our MD counterparts, naturopathic physicians also receive extensive training in botanical medicine, clinical nutrition, homeopathy, and structural adjustments. We focus on prevention to decrease the prevalence of chronic conditions such as diabetes, cardiovascular disease, and cancer. We facilitate healing by promoting and stimulating the body's immune system and removing barriers to health. Our interventions are less costly and less invasive and empower our patients to take control over their health and health care.

     As I mentioned in this post, naturopathic medicine is not defined by modalities but by six principals. These principals even further elucidate our effectiveness in primary care:

     The Healing Power of Nature - As naturopathic physicians, we work with our patients under the philosophy of a health-based model rather than a disease-based model. Under a disease-based model, the physician identifies a disease and prescribes a pharmaceutical or other intervention to remove the disease. Under a health-based model, illness is viewed as a suppression of the body's ability to counteract disease and by promoting a patient's health and wellness and removing barriers to healing, the body's immune system is supported and better able to remove the disease on its own or with fewer interventions. This model also decreases the likelihood of recurring disease and promotes the general health and vitality of the patient.

     First Do No Harm - As naturopathic medical students we study a wide range of treatment modalities, from homeopathy and clinical nutrition to pharmaceuticals and minor sugery. First do no harm exhorts us, as physicians, to choose the least invasive intervention for our patients. In a system where iatrogenic disease is the third leading cause of death in the United States, behind cardiovascular disease and cancer, I would say less invasive interventions that promote health are just what the (naturopathic) doctor ordered! Less invasive intervention also generally mean less costly.  In 2010, the United States spent $2.6 trillion on health care, over $8,000 per American. This is such an enormous amount of money, it’s difficult to grasp, but suffice it to say, the United States spends on health care alone what the 65 million people of France spend on everything: education, defense, the environment, scientific research, vacations, food, housing, cars, clothes and health care. In other words, our health care spending is the fifth largest economy in the world. And with this number only climbing it is becoming increasingly important to find less costly, yet effective solutions. Let's go ahead and chalk up another point for naturopathic medicine.

     Doctor As Teacher - Naturopathic physicians spend a large portion of each patient visit on patient education and counseling. In addition, our treatment style of less invasive and health promoting usually requires committment and active engagement from our patients. Taking a pharmaceutical or supplement alone simply won't do. This empowers our patients to be accountable for their health and health care and creates a positive atmosphere of change.

     Treat The Whole Person - I don't think it's any secret that we humans are complex creatures. So many variables are added, divided, sutracted, and multiplied to create who and what we are. Physical, mental, spiritual, emotional, genetic, environmental, social, and economic are only some of the many factors that contribute to pathology as well as well being. The most effective treatments (and physicians) are those that account for the multi-faceted way in which we live. Naturopathic physicians spend a great deal of time getting to know their patients in order to prescribe very individualized treatment plans and accomodate this idea. Not only does this make for more effective treatment but it also takes the doctor/patient relationship to a new level; creating a trusting and safe space that allows for optimum sharing and healing.

     Identify And Treat The Cause Not The Symptom - The naturopathic physician seeks to identify and remove the underlying causes of illness, rather than to merely eliminate or suppress symptoms and it is important to understand the difference. American society is enamored with the idea of the "quick fix." The $40 billions Americans spend each year on diet pills and supplements and gadgets seems to prove my point. However, these seemingly "quick fixes" often just negate symptoms somewhere downstream the physiological cascade and masks the underlying cause. This does not make for effective, long term health care. In fact, it does just the opposite: It turns patients into repeat customers as symptoms slowly return or new symptoms emerge. This type of dependence on the health care system isn't healthy, physically or financially, for anyone. In concert with the principals of Doctor as Teacher and Treating the Whole Person, naturopathic physicians aim to find the root cause of illness and symptoms and begin treatment there.

     Prevention - Naturopathic physicians emphasize the prevention of disease. This includes assessing risk factors, heredity and susceptibility to disease and making appropriate interventions in partnership with their patients to prevent illness. Our idea of prevention means so much more than vaccines and mammograms. Our goal is to increase and maintain health in an effort to help our patients live their best lives. This idea is immediately hindered when patients come to us with advanced chronic disease like obesity, diabetes, or carsiovascular disease. Don't misunderstand, we can, and will treat these things but a better model of health and health care would do its best to prevent these diseases before management and treament are necessary. I like to call this the "Smokey the Bear" principal because although well trained firefighters are vital, in battling forest fires and damage control in the aftermath, I think everyone can agree, people are better served by preventing those blazes in the first place. Naturopathic medicine is committed to prevention as this allows physicians to focus time and energy in more constructive ways.    

     With all that in mind, I would say as the urgent need for increased access to quality primary care physician increases, naturopathic physicians are a more than viable option, in fact we are necessary and uniquely trained to address this need. We are primary care. We should do primary care.

     So why is no one talking about this?

Cultivating the Practitioner

     My school year consists of three terms, each being three months long. Although I am only a little over half way through my second term I have quickly discovered a pattern. The first month of the term is nice as you're just getting into the swing of things, and you go to all your classes, and you feel motivated and invigorated. Then the second month hits you. And it's like a punch in the gut from someone you thought was your best friend. Suddenly, you're overwhelmed by exams and somehow you convince yourself that attending class is your "break time" from studying. As midterms approach, you begin to question every life choice you have ever made that has brought you to this point. Then, just as suddenly as it began, the second month is over. You enter the third month realizing that clearly you can conquor anything and actually look forward to finals week, even if only because it has become synonymous with Spring Break. That is where I am right now.

     Luckily, I'm quite good at picking fantastic friends and I owe much of the sanity I've retained to their unfailing support and cheer. Last night, as I was settling in for a movie night with one such friend, I ran across this poignant blog post written by another brilliant friend and was again reminded how blessed and grateful I am to have my village filled with such incredibly intelligent, provocative people.
    
     His post also caused me to reflect on something I've been meaning to blog about for a while now (blasted Second Month). I am taking a class entitled Cultivation of the Practitioner. When I first saw this course on my schedule I assumed it would cover subjects like motivational interviewing and the doctor/patient intereaction, and I suppose to some extent it has, albeit with a hippie healing twist I hadn't expected. What I hadn't expected was the intrapersonal component, where we delve into our deepest mental/emotional/spiritual recesses to see what we can find. The idea behind this is we cannot expect to heal our patients, physically or otherwise, if we ourselves are in a place of turmoil and uncertaintity. We must find a place of peace within ourselves before we can impart it to others. This doesn't necessarily mean we must be perfect or rid ourselves of every burden, we must simply be aware of our inner obstacles... as my professor so eloquently puts it, "know thy shit."

     That being said, I have really struggled with this class, which, of course, also has a lab component. Talking about my feelings and embarking on a path of emotional enlightenment is not my thing. It's not even anything close to my thing. I was even a little offended at what seemed to me, to be a bias towards emotionally driven living being a higher road. As I may have mentioned before, I was once described by a friend as a "hollow shell of a person" because of my lack of emotion-infused responses. This is not to say that I am completely emotionless. Of course I have emotions, everyone does. However, although I am aware of and acknowledge them, they are in no way my motivating force nor do they drive my decision making process. I'm much to practical and reasonable a person for that. I like things that are logical and make sense, two descriptives that can almost never be applied to emotions. So as you can imagine, being forced to dig deep and not only give my emotions the spotlight but also determine the source of those emotions can, for me, only be equated to nails on a chalkboard.
    
     In what can only be described as self-preservation, I have come to an agreement with this course and we have managed to coexist. I've managed to respect for the course for what it is and go with the flow. (Although yesterday, as we were sitting in a circle meditating and exchanging energy, I found myself alternating between nodding off and deciding what I would do if I won the MegaMillions.) I've even found myself looking forward to the class as a respite from the cerebral monotony that is medical school. It's become like a hug in the form of a class, which works out well because real life hugs often make me uncomfortable. If nothing else, it's given me a deeper understanding of myself and the source from which my motivation as a human being comes. By default, it has also provided me with an avenue for deeper connections with and understanding of those with whom I interact. It has enlightened me to different ways of living and perceiving the universe.

     As someone who self-describes as reasonable to a fault, I discovered something some time ago that has helped me cope when I can't seem to find a logical explanation for another's words or actions. The idea is that given my particular set of knowledge, experience, and opportunities, I am living my life the best way I know how. It would be unfair of me to assume otherwise of anyone else. We are all trying to do the best we can with what we have. Our vastly different backgrounds frequently guide us to make differing choices, which all too often lead to misunderstanding and judgement when viewed without context.

     Living in a city whose mantra is "Keep Portland Weird" has only solidified these thoughts. Portland is a place where every type of person can be found. The beauty of this is that Portland is not only accepting of both extremes and everything in between, it thrives on it. It has redefined, I suppose you could say "cultivated," my perspective on good and evil, better or worse, and brought clearly to the forefront the idea of different. There are an innummerable amount of paths to take in life, all equally sound... just different. And there is nothing wrong with that.