The End of Finals

This coming week I'll be taking my last formal exam at National (hopefully). The next two trimesters consist solely of clinic. It's another milestone -- they come quicker the closer one gets to graduation. I have mixed feelings about it. It's the end of an era. On the one hand, a few of my larger life goals have never seemed closer. This is an opportune moment to envelope myself in the task of creating the person and physician I want to be. It's always an exciting prospect - to feel as though NOW is the time to fully invest in those internal and external goals.

Flashback to the early days 

But something is holding me back. Somehow this doesn't feel like I think it should. It's tinted with with a touch of sadness. I've formed many connections and friendships with the people I've met here. They have been my teachers as much as any professor. From the people I've called my friends, I have learned some of the most important lessons. Lessons that are hard to teach and even harder to learn. In a way, they taught me to be stronger, to be discerning, and in a way -- autonomous. I learned the crucial role trust plays in interpersonal relationships, not just cerebrally, but experientially. It's an important understanding to apply to any form of clinical practice.

The conclusion of this trimester marks the end of my days spent on campus (for the most part). It means spending less time around many of the people I have come to know and relate with. I may not see them as much any more, probably not many of them at all after graduation. However, I will never forgot the important lessons I've learned from them. No doubt the resulting knowledge will continue to be a part of me and shape the person I am forever. So, while you're here, cherish the early years. Soak up the atmosphere of friendship before it all changes. 

Common Misconceptions

I like to keep a finger on the pulse, when it comes to mainstream medicine. Every now and again I'll lazily surf the first page of google searches related to the profession. I like to know which misconceptions are prevalent enough that potential patients may run into them. And I'm not just speaking of Chiropractic health care, I'm talking about the entire counter-movement to the stale paradigm much of mainstream medicine has found itself in. I'm speaking of NDs too, and all functional medicine docs.

Lately, I've been finding that there is a lot of confusion out there about what a doctor actually is. I agree, the nomenclature can be very misleading. Medicine has increasingly become conflated with health care, so much so that the two have practically become synonymous. So let me clear the muddied waters the best I can. There are a few different doctorate degrees that grant the recipient the right and abilities to care for patients' health. There are Medical Doctors (they sure scored big when they chose that name), Doctors of Osteopathy, Doctors of Chiropractic, Naturopathic Doctors, and an ever increasing number of various other doctorates.

2017-08-04_hmmThe main differences between these doctorates are entailed in their scope, philosophy, end goal, and the lens through which they view the treatment of pathology. MDs, DOs, and DCs are considered to be primary care physicians on a national level. DCs scope varies by state. Scope entails what treatment strategies and tools doctors are allowed to legal employ to treat their patients. A good example of this is the fact that DCs may prescribe pharmaceuticals in New Mexico, but not in other states. We may perform minor surgery in Oregon, but not elsewhere. The state-by-state scope can be a little confusing to understand at first, and has various implications on what these doctoral candidates may or may not be allowed to do while practicing their craft at their particular school.

I recently read a rather bombastic blog, lambasting the NUHS ND program, on the premise that such a program would be illegal because NDs aren't recognized by the state of Illinois. That would be like saying that learning about wolverines is illegal because they don't reside in the state of Illinois. They exist, just not in this particular state. Another erroneous point they posited was that all ND students in clinic are breaking the law because they're seeing and treating patients. That is akin to saying all nurses are breaking the law. ND students  are just that -- students. They themselves aren't seeing and treating patients; they are operating under the legal medical licenses of the various clinicians. It's a good thing to keep your eyes out for such misconceptions, folks. Know how you'll address the questions that may be posed to you. 

Patient Education

At Salvation Army, this week's community outreach topic was on deciphering food and supplement labels. The first challenge for my colleagues and I was determining which information was relevant to the average Joe. Our second challenge was finding a way to phrase everything succinctly, without unnecessary complexity. 

Another idyllic day at National

We accomplished this in a few different ways. First, we focused on a few basic, yet important distinctions. Total fat, versus saturated fat, versus trans fat, versus cholesterol. We talked about how carbohydrates are, in fact, sugar, and how the sugar to fiber ratio determines the glycemic load (in a nutshell). Our final main point was centered around serving size and how the nutrition label can often be misleading if not viewed in relation to the serving size.

We thought we had nailed that section, but were inundated with questions from basic nutrition to the meaning of life, and how nature versus nurture ties into how our bodies interact with our diet. But that, in and of itself, is a fantastic learning opportunity. I believe all doctors should give patient education seminars, and this is a valuable tool to hone our skills and approach to patient education. We have time to discover the common pitfalls and find ways to avoid them.

The supplement end of the talk was mainly focused on how to determine whether or not the supplement being bought is, at the very least, manufactured with some good practices. We decided that getting into the most bioavailable forms of vitamins and minerals, as well as optimal dosages would be extremely counterproductive. Instead we focused on looking for the USP label, which means the supplement's quality has been third party verified. We educated on what good manufacturing practices were, and how to find the GMP (Good Manufacturing Practice) label on a supplement. As far as dosage went, we merely emphasized the suggested use labeling above the nutrition facts. I'm excited to see where our lecture series takes us! 

The Academic Afterlife

Everyone keeps asking me how I feel, now that I'm in the twilight of my academic years. Am I excited? Where will I go? Who will I work for? Will I start my own practice? I never quite know how to respond.

On the one hand, I'm so sick of school and class that I could yell. Probably for a good 10 minutes. On the other hand, for the entirety of my adult life, I've been either in the military or school. Both are rather controlled, time-consuming ways of life. Both are quite a poor representation of "real" life. It's an alien world that is still quite mysterious to me. So the path forward may seem dark, uncertain, and scary, but I can't stay here.

My life at the moment

So, what will I be doing in 10 months time? I wish I knew for certain. It's something I definitely need to get dialed in. I keep saying that I'm going to shake some trees and see what falls out. But I haven't started shaking yet and time is really starting to run out. Perhaps I'm afraid of failure or rejection. Maybe I'm not quite sure what exactly it is I, uniquely, have to offer. I have everything I need to get started: a CV, a cover letter, even a business plan with financials. I just need to figure out how to present it all to potential employers or partners.

The pace of academic life does slow down the last year of school and I can see why. There's a lot of work that needs to be done to ensure a smooth transfer from school to life. Internet research into a practice just doesn't quite cut it when trying to assess whether or not it's the right fit or if there's opportunity for upwards mobility. More often than not, a face-to-face meeting is necessary to truly determine the proper fit. I'll keep you all posted on my strategies and what falls from the trees!

Community Outreach

There are many facets to pursuing a career as a physician, far beyond academia. That is why a physician's education is geared toward creating a well-rounded individual. For example, here at NUHS, one of our graduation requirements is community outreach. We are called to participate in an event or organization through which we can help our community and spread awareness about what we have to offer. At the Salvation Army clinic, we have our own approach to community outreach.

A quiet night of reflection on the lake

Since all the patients we see are inpatients for rehabilitation, we decided that the best, most effective way to positively impact our community is to create and deliver a lecture series to the residents. All the topics are designed to educate about one facet of health or another, whether it be diet, lifestyle or outlook. It's definitely been a unique challenge to learn how to boil down years of education and complex concepts into a succinct presentation that anyone can understand. It's rewarding, too. The attendees tend to be engaged and have plenty of follow-up questions that only seem to highlight my own ineptitude at simplifying some complex concepts. It's a truly fantastic experience.

While community outreach isn't going away, it is changing its form, which is unfortunate. Starting next trimester, the community outreach hours are being replaced with a quota. Interns will have to bring in x amount of new patients to the clinic as their outreach. While this does technically serve the community, it shifts the emphasis from the community as a whole to those who have insurance and can afford our services. I believe community outreach should be provided at no cost to the community as a whole. I suppose that, however things end up, students will be getting out and interacting with the community, which will always be a crucial aspect of our education.