The trimester is coming to a close, and I can honestly say it's
flown by. We're all scrambling to meet deadlines in the clinic:
this many of this, that many of that. It hardly seems that about 12
weeks ago we were terrified we'd be horrible at this. Truth be
told, I didn't think anything about deadlines and numbers and
paperwork (OK, well I did think about paperwork a little bit).
That's probably why I'm scrambling now.
The last couple of weeks have been discussions about who is
transitioning to the other clinic, and some talks about where we'll
end up. Half of our crew is moving to the other clinic. It's
unlikely that I'll see them very often. Perhaps we'll have seminars
or training sessions of some sort, or get together outside of
school (although we don't do that now). But in a few weeks, there
will be another big transition for all of us. Some of us have been
together, nearly every day, for about 3 years. This will be
something really new.
Newness. It reminds me of my theory about Maslow's Hierarchy
from last week. Incidentally, I've been working some more on that,
but I'll spare you all the details. I had the pleasure to discuss
it with two of my fellow interns today, the concept of new ideas.
We were talking about my theory, and about other theories -- things
in medicine and science that seem to have been left behind. We were
discussing the idea that there are no new ideas.
Image by http://mladavid.deviantart.com
Mark Twain said:
"There is no such thing as a new
idea. It is impossible. We simply take a lot of old ideas and put
them into a sort of mental kaleidoscope. We give them a turn and
they make new and curious combinations. We keep on turning and
making new combinations indefinitely, but they are the same old
pieces of colored glass that have been in use through all the
I grew up not far from good ol' Mark Twain's stomping grounds,
but between you and me, his writing always made me crazy. No matter
how much I tried, I couldn't understand the dialect he wrote. I'm
not sure that I agree with Mark; it seems we're discovering new
things all the time. From god particles to medicines, we strive and
learn how to change, adapt, and understand the world around us.
If the last 12 weeks in the clinic have taught me anything, it's
that we have no standard approach to treating anything. We have to
be willing to come up with new ideas, or at the very least, new
applications for old ideas. For every patient that comes in, even
if they have the "same" diagnosis, what works for each one of them
is likely to be something completely different.
I'm fairly certain that our discussion today came to the
conclusion that there has to be something new. There has to be a
pursuit of Science that crosses boundaries into new territories,
that bypasses the need for a randomized controlled trial of
everything, and simply embraces discovery for the sake of
discovery, and implementation for the benefit of the whole. Perhaps
we're all idealists. I see no problem with that. Being idealistic
just promotes my love of the field and my hope for making a
Neil deGrasse Tyson, in his series "Cosmos" said:
"To make this journey, we'll
need imagination, but imagination alone is not enough because the
reality of nature is far more wondrous than anything we can
OK, Neil. I'll take that one to heart. The greatest theories
come from crazy idealists.
I wish you all many great new discoveries. May your kaleidoscope
always look just a little bit different.
Have you ever stared at something so long that it looks
completely different? I do this with words. I think that's a new
level of zoning out. Sometimes when I do this, it completely
changes my perspective. Not all that often, mind you, but it does.
Lately, I've been getting hit with a lot, that's been altering my
I've been spending a lot of time in downtown St. Petersburg.
It's not as if I haven't lived here for 8+ years, and it's not as
if I haven't been downtown nearly a million times. Because of
friends living downtown, I'm seeing parts of it that I've never
seen before. I'm always amazed at what exists, right under my nose
-- but I just haven't taken the time to see it. So now, it's
starting to look completely different.
Like many downtowns across the country, ours has had its
moments. There were department stores downtown, factories, big
business. I've always wanted to research some of the buildings
downtown, especially the Studebaker Building, which I used to drive by
nearly every day when I lived on the other side of town. And then
there's the nation's first open-air post office, which, honestly --
these pictures don't do justice. The inside of the post office
reminds me of old time banks and Westerns -- loaded with
beautifully stained wood and remembrances of teller windows. Some
of these buildings have been standing for a long, long time --
constructed not long after the turn of the century, which for this
area is nearly ancient.
Also, like many downtowns, St. Pete seems to constantly undergo
some form of revival. New places move in; old ones move out. Things
get rebuilt or renovated, torn down, and new life comes in to
change the look and feel of it all. The more time I spend down
there, the more I like it. There are old bars and restaurants,
beautiful scenery, and the old stately architecture. I've posted
pictures of the banyan trees, the Dali and Mahaffey Theater, the
Pier, and a few of the marina as well. I'm running out of time to
explore here -- at least while I'm still at school. I've set a
loose goal for myself, of visiting every building between Beach
Drive and 34th street on Central Avenue. I wonder how close to that
I can get with this crazy schedule.
We're in Week 10, which means midterms are over here at
National, and I'm looking at finals for Western States. I can't
believe how quickly things have passed. I keep going back and forth
about jobs and locations and being excited about being out in
practice and clinic and a million other things. I was forwarded a
list of job openings all over the country, towards the end of last
week. I couldn't help but look -- thinking that it was all very
premature, and yet I'm being told that I SHOULD be looking right
now. I'm still thinking it might be a little presumptuous.
And of course, this week I have to turn in a sample business
plan. It's hard to anticipate things like that when you have no
idea where you'll be. Of course, I could go anywhere. The question
becomes where, and when, and how, and why. We've all talked about
setting up our own practices -- well, most of us have. Some, I
think, are planning on joining practices and others might just
associate for a short period of time. When I thought I had a clear
plan before, now I'm not so sure. Life sometimes gets in the way of
plans. John Lennon said something like, "Life is what happens when
you're busy making plans." For right now, I'm only making immediate
plans, with the rest in the background.
Maybe I just need a change in perspective.
The marketing presentation is over. I'm really glad. I was
sweating it big-time. I put a lot of work into it -- the design and
layout of the logo, the tagline, all the wording for the sample
brochure -- all of it. Even though it made last week's schedule
pretty intense with all of the other activities, now it's done and
I can watch my classmates do theirs (and enjoy them), and also
focus on other things.
So the plan for my future practice is to
be both multi-disciplinary and integrated -- where the
practitioners not only work together, but complement each other in
abilities to provide a larger scope of practice. The basic premise
is that in order to take care of the whole person, we have to
approach the whole person. So we'll have everything integrated into
the practice from seminars, movement classes, and functional
medicine to counseling, acupuncture, and herbal medicine. My idea
is to have five practitioners to start with: Chiropractic,
Naturopathic, Acupuncture, Massage, and Behavioral Medicine. I'd
like to also have an herbal compounding pharmacy on site -- in
addition to a number of nutraceuticals available.
I've also entertained some ways to expand down the road. The
addition of hyperbarics, a medicinal and natural foods café, and
inpatient care seem more than logical. I realize that they're big
and potentially lofty ambitions, BUT I think with the right team of
practitioners, we can definitely do it. Anybody want to help?
This week I have a few things due: notes from my head-to-toe
practical; my community resources listing and BETS research (I'm
working on Alzheimer's and choline -- or hoping to); and on Friday
I have my functional rehab practical. I'm so glad I'm going early
with that one as well. That REALLY frees up my week 14. There's
nothing like having a little bit of extra time to study for things
The Master's is going well. This last week it was tough to get
everything done because of the exams, presentation, and practical.
I was scrambling to get it all done by midnight on Sunday (all of
my Master's work is due by midnight Sunday). As it was, I was
falling asleep finishing the last assignment. It could have gone
better, but that's what happens when you're falling asleep
answering questions. The topics for last week were mostly gut
immunity -- which I find fascinating. I'd really like to figure out
all of the possible permutations of gut disruption -- beyond gluten
and casein, microbes, etc. Did you know that 70% of the immune
system is located in the gut? Even inhalants are partially mediated
in the gut. If you're really interested in learning more about this
-- try the Textbook for Functional Medicine -- chapter 28. While
some of the physiology is a little tedious, putting the pieces
together is pretty fascinating.
Well, that's all from me. I've registered for next tri -- except
for electives. I'm trying to decide whether to take acupuncture or
not. The jury is still out.
Have a great week everybody. Good luck with studying, projects,
and whatever else is going on. This Friday we have the Turkey Bowl.
How was your week last week? Has everybody recovered from
Halloween? Now we're in the home stretch. It's the start of Week 11
-- time to start thinking about finals and projects and
All I can think about right now is the MARKETING PROJECT! I know
I've mentioned it before -- but to reiterate... We're tasked with
developing a business plan including start-up costs, developing a
marketing calendar, business cards, logo, brochures, website, etc.
It's a LOT of work (and worth a lot of the class). In addition to
all of that, we have to do research on the location where we're
hoping to practice, what type of demographics are there, and
whether we think the area can support our type of
As of right this second, I'm looking at Portland, Oregon. I've
been drawn to the Pacific Northwest for quite a while. I miss the
seasons (but not so much the cold), and everything I've heard about
Portland and surrounding areas, is absolutely amazing. There are
other reasons, of course. One of the biggest ones is the liberal
scope of practice allowed in Oregon -- including obstetrics and
minor surgery (with additional certification of course). The
broader the scope for me -- the better; it's how I intend to
So, in my research adventures, I've found things like: how many
chiropractors are in the area, what the per capita income is, what
the average salary for chiropractors is in the area/state; and what
types of practices are in the area. What I've noticed is that there
seem to be two types of DCs in the area: single practices with
maybe some physical or massage therapy, and single or group
practices focusing on sports medicine. There are a couple of
multi-disciplinary practices, but not many. There are a lot of
sports medicine chiropractic physicians. This is great for me,
because I have no interest in working with sports medicine. And for
those of you that might be thinking about relocating to the
Portland area -- it looks like there's some pretty stiff
I've had to spend a fair amount of time thinking about what all
my practice will offer, what I'm willing to take on as far as
scope, and how many other practitioners I'd like to work with me.
This has the potential to become HUGE. I have always intended to
have a multi-disciplinary practice. The more research I do, the
more practitioners that I want to bring in -- not just
Chiropractic, but Naturopathic, Traditional Chinese Medicine and
Acupuncture, Massage Therapy, and Behavioral Medicine.
At the outset, I'm feeling like we need about 8-10 practitioners
to create the best, most effective type of practice. As wonderful
as these ideas are, the logistics of setting something like this
up, are daunting/enormous. And honestly, this is the kind of thing
that I absolutely hate. You can ask any of my classmates or
professors for my response when we talk about money and billing and
other business management type stuff. The first thing I say is
"Can't I hire someone for that?" They always cringe, tell me that I
need to know it, and keep going.
I feel fairly safe in saying, that this project will probably be
the extent (for the most part) of my forays into business
management. I am learning a ton, but I also acknowledge that my
talents lie elsewhere. First, I'll draw up the budget for equipment
like massage and flexion-distraction tables, band aids, acupuncture
needles, alcohol wipes, cotton balls, phlebotomy equipment, basic
physical therapy equipment, herbs and supplements, office
equipment, waiting room chairs, and silk plants. Then, I'll factor
in things like electricity and Internet service. Yes, I'm in WAY
over my head. I never thought I'd be doing something like this --
just practicing medicine. It takes a lot more than I'd ever
Maybe I should start looking for that business manager
Have an AMAZING week, everybody. I'll let you know how it
It's November! What? Did the time change work for you? I ended
up staying up even later.
This week is the calm before the next storm. We have one more,
big round of exams and projects due next week--including the
Marketing project. This is the culmination of all of my
mind-ramblings of the last couple of months, and the chance to pull
some pie-in-the-sky ideas into my project.
Last week we had a speaker in Marketing that had been on the
show "Shark Tank." Unfortunately, I took pictures for everyone else
and not myself. He spoke about what it was like to start up a
business, some of the struggles associated with it, and some of his
experiences since his business started. I'll go ahead and give a
shout out to him (and his brothers) who own Nardo's Naturals. They
make natural skin care products and they're centered here in St.
The geek botanical person in me was intrigued by some of the
ingredients they use in their products--lots of essential oils and
coconut oil. You absolutely cannot lose with those. And of course
it just reminded me how much I want to include natural products in
my future clinic--which brings me back to the Marketing
When the speaker last week asked us what we wanted our future
practice to be like, I opened my mouth and said something like: "I
want a multi-disciplinary practice with Functional Medicine,
Chiropractic, Naturopathic, Acupuncture, Physical and Massage
Therapy, Well-being classes, and an Herbal and Compounding
Pharmacy." I think his eyes nearly fell out of his head. Big
ambitions, I suppose. I'm not sure what will be more difficult,
setting up the practice, or finding the right people to work with
me. Either way, these plans will be coming together in paper,
brochure, website, and business card form--in the next 10 days.
Boy, I sure have my work cut out for me. I don't have anything
finalized, except the ideas, which have been floating around in my
head for quite a while. When I get it all done, I'll share it with
you guys. I have no idea where all it will go.
I hope everybody had a Happy and Safe Halloween. On Wednesday of
last week, MoPal (Motion Palpation) hosted a Halloween potluck. We
had some great costumes. My tri's very own Lexxi (dressed as Ms.
Pacman) and Dave (dressed as Walter White from "Breaking Bad")
stole the show and won best costumes. This is where the pictures
for this week hail from. It was nice to see so many people get
together and be festive.
I, for one, am glad that most of the candy is gone. No more
temptation. I have a small handful left. I'll feed it to the kids
and make them run around the neighborhood about 80 times--and then
brush their teeth. We have a few weeks to behave ourselves before
Thanksgiving--which really should be renamed to something that
involves "gluttonous intake of food and falling asleep on the
couch." It looks, though, like we might actually have a Fall/Winter
here this year. The temperature has been erratic and sometimes cold
and sometimes hot--but it's more acting like it's trying on the
cold for size. Layer. That's my recommendation. Today I'm wearing
flip-flops and a sweater. Go figure. That's Florida.
Have an amazing week everyone. May your feet be warm, and your
sleep be plentiful. Remember to take a little bit of time out for
yourself this week. It's important.
• After the DC Degree
• Botanical Medicine
• 1 Year at National
• Marketing Project
• First Week in Student Clinic
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