It's about the Zebras

As I'm hidden away studying in the air conditioned basement of a Toronto Public Library, I realize that 2 weeks of NPLEX review have already gone by.  This means that the Licensing and Board exams are looming that much closer.  Will I ever be able to remember all these details?  In my office, I could just look it up!

But, after this many years of studying and 12 months of internship, it's now really about the zebras.  There is a famous old saying in medicine, "when you hear hoof beats, think horses not zebras."  This translates to: when you have a list of signs and symptoms, think of the most likely diagnosis these point to first.  Well, this is true in practice but from the advice of practicing ND's I've listened too, not so on these upcoming exams.  I do realize that naturopathic medicine is still in the process of demonstrating to the majority of the public (and most conventional physicians) that naturopathic doctors are proficient primary care providers.  As such, our licensing boards are going to ensure that we have what it takes to catch those mysterious presentations of diseases.  Furthermore, many patients unfortunately only resort to an ND after they have been through an unhelpful ordeal in conventional medicine.

So, I do understand the necessity and therefore should not complain about being sentenced to studying inside during such beautiful weather.  However, I can say that I will be very happy on August 7th when this is all over...

The NPLEX II Saga Begins

Well it is finally here: the final mental marathon required to become a licensed ND.  My head already feels like I'm in need of a break after a 6 day NPLEX (Naturopathic Physicians Licensing Examinations) review course.  And I haven't even officially started studying yet!

Like any large and difficult task, I think half the battle is overcoming the intimidation and making a plan to break it down into smaller "digestible" components.  NPLEX II tests a naturopathic doctor's correct and safe utilization of the following components to prevent and treat disease in every organ system in the body: clinical nutrition, botanical medicine, physical medicine, physical and clinical diagnosis, lab diagnosis and imaging, pharmacology, psychology, emergency medicine, homeopathy, traditional Chinese medicine and acupuncture.  It is a tremendous scope of information!  So, for the next 10 weeks, new naturopathic graduates in Canada and the US will be reviewing and studying full time in order to be successful on NPLEX II this August.  Starting May 30th, I will be following a weekly objective schedule that breaks topics up by organ system and modality.  Of course, 8 hours of sleep, daily exercise, phosphatidylcholine and fish oil are just a few extra requirements necessary to survive the NPLEX II saga!

Well, with yet another blog post about survival, I realize that sometimes I take the risk over-informing prospective students.  Accordingly, I have periodically considered not disclosing information because some degree of naivety can be beneficial in undertaking a difficult task.  As such, in being candid with the extensive, somewhat unrelenting effort it takes to become a naturopathic doctor, my hope is not to discourage anyone from being an ND but to provide an opportunity for proactive students to become informed.  However, if for example only one or two of the naturopathic modalities are of interest to you, then maybe making all the extra effort to become a naturopathic doctor is not for you.  Keep in mind that there are practitioners who specialize in each of of the modalities that ND's are licensed to practice and maybe you would be better suited as an herbalist or registered dietitian or chiropractor or homeopath or psychologist or an acupuncturist.  At least now you can make a better informed choice.

Naturopathic Medicine Week 2011

May 9th - 15th is Naturopathic Medicine week in Canada.  If you are interested in learning the benefits of naturopathic medicine, take a look at these locations across Canada where Naturopathic Doctors will be giving free information seminars. 

This is a great opportunity for both prospective students and people who are suffering with health problems to go and get some questions answered.  Have a great week!

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.

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!

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.

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.