Tim's Blog

Hi, everyone!

The first official week of Student Clinic is in the books and it was a full one! I was able to see five patients the first week and the time flew! Of course, it seemed as much time was spent with paperwork as with the patients, yet this is a necessary part of the patient visit to ensure that those who see a patient after me know exactly what I talked about with the patient. 

First a little background on student clinic here at NUHS. During 8th trimester, ND students are interns in Student Clinic. In other words, we only see students and their families during 8th trimester. This is to prepare us for seeing the general public in 9th and 10th trimesters. We are allowed and even encouraged to recruit our patients from the student population here on campus, as recruiting patients is part of building a practice once we graduate. When a patient doesn't request a specific intern, the patient is assigned based upon an objective alphabetical rotation. In other words, we have plenty of patients to see and help in Student Clinic even with minimal recruiting efforts. 

The week kicked off with a new patient visit, which typically is supposed to take about 90 minutes. Of course, a brand new intern with a new patient, new file, fresh paperwork and a steep learning curve means that 90 minutes is an attainable goal, yet often is one that is not met with a first visit. Take that first visit and follow it immediately with a patient who is returning for a follow-up visit and you have the recipe for a full day! Now, since our Student Clinic hours are Monday, Wednesday and Thursday from 1pm to 7pm, multiply that by 3 and add all patient file paperwork that must be completed before leaving at the end of the day! Whoa! :) 

Thank goodness, our ND clinicians are around to give us a helping hand, guidance and solid suggestions when we "err off course" just a bit! Without their short bits of advice and a finger pointed in the proper direction, I'm certain 10 interns would have been scurrying in all directions. :) A quick shout out to our clinicians in the ND clinic and their patience, guidance and sense of humor! 

The rubber is meeting the road and it's time to apply everything that has been learned (or absorbed) for the previous three years. I'm honored and grateful that others trust their well being to me in Student Clinic at NUHS. I'm grateful that we have the strong clinicians to guide us during our internship!

Hi, everyone! All of us here at NUHS are back from break and getting into the rhythm of classes or clinic schedules. In my case, I have finally started the final lap here at NUHS and have entered Student Clinic. 

But first a little about this past break and my trip back home to the beautiful mountains of western North Carolina. I've included a pic from one of my favorite hilltops behind the "homestead" back in WNC. 

During my trip back home I was able to catch up with my family and friends, spend some quality time together and relax just a bit. I hiked a few miles on the Appalachian Trail that is very near my home at Sam's Gap in North Carolina and the views were spectacular! I caught a few odd looks from those who had been on the trail for awhile (guess they were wondering where my gear was), but all in all had a nice chat with one hiker as they descended from the trail to get a few supplies at a little store nearby the trail. Amazing how we traipsed all over the woods as kids never worrying about supplies, hiking poles, packs, etc., yet as an adult, I was concerned about hiking a few ridges that I had covered many times as a kid. All in all, a great trip and I'm thankful for my family and friends back home, catching up while seemingly not missing a beat, and leaving with a sense of love and fulfillment.

Now, back to school. I'm entering Student Clinic this trimester as an intern who will be working with students currently attending NUHS and their families. The cohort entering Student Clinic this trimester is, I believe, the largest cohort yet for our naturopathic medical school and the groups following are even larger! This first week is going to kick off with a bang, as my appointment schedule is booked for the week with students completing their "freshmen physicals." A freshman physical is a complete head-to-toe physical and naturopathic intake that typically takes about two hours, after some practice. I believe most of us will take somewhere between two and three hours for our first couple of intakes until we get our time management skills improved. :)

Well, with that I suppose it's time to get the shirts pressed, the slacks creased, the intern's white coat spotless, and step into the role of the student healer. A big welcome to all of our first trimester students in the professional programs and our undergraduate students! Until I graduate, I'll do my best to share life in the clinic over the coming year--stories of my time there as well as insight into other interns' journeys here at NUHS! 

Talk to you next week!

As spring approaches, I like to watch for the early signs of warmer weather. The flowers sprouting from the earth, the trees as they begin to bud, and the sandhill cranes as they migrate back north over our campus--the surefire sign that spring is finally here... or nearby anyway! 

Part of becoming a doctor is to learn to observe our patients before we ever palpate, percuss or test motion. We observe the patient's patterns of movement, any visible signs of distress. As we begin our intake, or conversation, with the patient, we observe how they communicate, their story. As we begin the examination, we observe the patient's skin, hair and nails looking for any sign of illness or injury. 

This is where our dermatology class helps with our examinations. As we progress through the program, dermatology is interspersed throughout the curriculum, introducing us to various conditions presented on patients' skin and other visible areas. We are introduced to macules, papules, nodules, patches and furuncles from the early days of our program until it finally culminates in the dermatology course in eighth trimester. 

By the time we are finished with this class, we will be able to know the pathologies that are associated with acrochordons (skin tags), eczemas, contact dermatitis, boils, papules, etc. Each class, now that we are in the clinical sciences portion of our studies, puts together all the pieces of our basic science 'data driven' classes. We are applying the principles into larger concepts and drawing conclusions based upon clues that we can see, examine and test, just as any good healer would do. 

Speaking of signs, the sun is coming up and I have another presentation to do! Eighth trimester is full of presentations, papers, cases, etc., as I have mentioned ad nauseum the past few weeks. 

Here is a picture of some of the tulips on campus sprouting through a dusting of snow we received this weekend. They present an excellent lesson in perseverance! 

Until next week, may your journey be light and you keep a happy heart with a big smile!

This week we had what I believe to be a unique experience among the naturopathic medical schools. We had a medical emergency during a follow-up visit with one of our simulated patients. I'm not aware of any other naturopathic med school that offers this intense experience for their students.

Dr. Ezra Cohen has set up our clinical training rooms with microphones, cameras and recording equipment to help us review and better understand our encounters with each simulated patient. These video records help both us, as students, and our faculty gain a better understanding of strengths and weaknesses of our interaction with our patients. Dr. Cohen warned us at the beginning of the trimester that we would have a simulated emergency at some point during the trimester. He also warned us that the cameras would be rolling to document the experience. The cameras were rolling, so to speak, as our follow-up visit began.

The follow-up visit started quietly. Our patient was an elderly female who had presented for persistent headaches. My team of naturopathic and chiropractic interns had completed the first office visit and initial intake with her the week before. We had come up with a good treatment plan for her that involved increased water intake, diet modification, a relaxing botanical tincture for the evening, along with some acupuncture and massage for her neck and shoulders to help with the headaches. This treatment plan was developed based upon many interactions with prescription drugs that our herbal tincture may or may not have along with our patient's daily activities, posture and goals for healing.

Well, as we were about 10 minutes into the follow-up visit with our patient, she started complaining of having difficulty breathing. As our patient began to clutch her chest and let us know she was dizzy, one of my team of Interns stepped beside the patient in her chair to steady her. Just as she was about to say another word, she grabbed her chest in a clenched hand and started to slump over in her chair! 

Another Intern stepped to her opposite side and as she slumped the two interns supported her and carried her to the examination table in the room, where they placed her in a "face-up" position lying down. I immediately exited the room to let Dr. Cohen know that we had an unconscious patient, who had clutched her chest while complaining of shortness of breath. I explained that I believed our patient was having a myocardial infarction (a heart attack) and asked Dr. Cohen to immediately call 9-1-1 (simulated, of course). 

Dr. Cohen called right away and I returned to the room. Upon my return, my teammates had started taking the patient's vital signs, were supporting her on the table to secure her from falling and both were talking to the patient to let her know that she was safe with her caregivers, emergency responders were on the way, and that her emergency contact had been notified. During this entire time our patient was alive, yet unconscious. After about five minutes, Dr. Cohen entered the examination room to declare the exercise complete.

Our team described what we would share with the emergency responders such as the patient's vital signs (with any differences before and after the incident), when they last ate, and current prescription drugs as well as a description of the patient's words, actions and the entire incident. This information is vital to the emergency responders' ability to care for a patient in an emergency situation.

Our patient suddenly "woke up" and was fine. She gave each of us excellent feedback on how the situation was recognized, handled by each Intern, and relayed to the first responders. Our simulated patients do an excellent job overall of discerning our actions, efforts and performances as Interns.

Thanks to Dr. Cohen and his efforts to ensure we are exposed to as many ailments, pathologies, life situations, and emergencies as possible, I feel that we will be better caregivers to our patients. After all, doctors (regardless of modality or specialty) are caregivers and as soon as we forget that we are dealing with a whole human being, then our capacity to be a "caregiver" diminishes. I am thankful for our professors at NUHS who teach us to be caregivers and not just a lens to focus on one pathology.

A bit of a short entry this week everyone. Suffice to say that I'm only four weeks into this trimester and I'm spent. After three years of classroom instruction, I'm tired of sitting in class and listening. Fifteen weeks of intensity followed by two weeks of absolute nothing, repeated 12 times and three more cycles of this before graduation. I revel in the lab time we have between our simulated patients, physical therapeutics lab and observation in the clinic.

Yet, each time that I feel that I have had enough and I'm ready to pack things in and return to the banking world, an unexpected event occurs that rattles me back to the reasons I entered this field.  

We had a simulated patient this week who presented with a chief complaint of depression. My lab partner (a chiropractic student) and I proceeded to take the case asking the usual questions and we noticed that the patient really wanted to talk. So, at that point, without any signal from each other, we simply started a conversation with our patient. We used phrases such as "Can you tell me a little more about this situation?" or "How does that make you feel?" Once we had the flow of conversation, we were able to hear the patient's history, understand where she was coming from, and determine the timeline of her depression, her history of medications, successes, failures, and how she feels in the present moment.

After the session, the simulated patient has the opportunity to give the students verbal feedback for about five minutes. She told us that she had never had students who were more genuinely empathetic and covered so much ground in the 45 minutes of the initial intake. All with a simple conversation. The relief I felt was profound!

I was coming directly from taking a quiz in the previous class that I was convinced I was ready for but ended up missing a couple of questions (not bad, a couple), yet I was ready to ace it! I was feeling like my best effort just wasn't up to par. Then immediately walking into a room with a patient who is presenting with depression and being able to make them feel heard, valued and optimistic that we could help her (without making any promises to her) reminded me that was why I am becoming a doctor - to help others regardless of the confidence, regardless of "having a bad day," to trust my training and my ability as a human being to connect with other human beings, and to get to the root cause of the illness, and next, working from that root cause to get the best outcome possible for the patient. That's a pretty good feeling! 

Finally, I did a lot of work on the Gathering this weekend. I spent some hours building a slide show for the video display in our bookstore window. The slide show will display information on the Gathering, the symbols of the Gathering, its history and the speakers for this year. 

I was also able to complete one of the wreaths for display during the event on the stand I showed you last week. This wreath is for Dr. Gerald Farnsworth (one of our oldest surviving pioneer NDs who was part of the startup of NCNM) to place on the stand during the opening ceremony. That's right! The wreath has a big "E" woven into it and the "E" stands for Elder, and I'm grateful for the Elders of our profession who paved the way and built the model of connecting with other human beings. A noble reason for being a doctor, and more so, to simply be a good person.