Archive for tag: patients

Main Clinic

Hello to everyone! I hope you enjoyed your summer and are ready for what appears to be a great fall season!

I was able to relax a bit, recharge, hike some trails back home, and be the first person at the top of Mt. Mitchell (highest point east of the Mississippi at 6,683 feet) for sunrise one morning during a hike. The view was incredibly beautiful and being able to sit, think about the past few years of school, the challenges, rewards and decisions to come while watching the sun rise over the southern Appalachians was one of the more peaceful moments of the past few years of my life.


At the same time during the break, I caught up on some personal reading that I had put off for over two years as well as some reorganizing, consolidating and reducing for the inevitable move in about 8 months.

Now, for the homestretch in clinic!

Here is how the Naturopathic Clinic is currently structured:

  • 6th Trimester - Observation
  • 7th Trimester - Hydrotherapy Shift
  • 8th, 9th, 10th Trimesters - Main Clinic

Previously, 8th Trimester interns could only see other students, not the general public. This left many students with seeing a new intern every four months as ONLY 8th trimester students could see other students. So, when an Intern moved to 9th trimester, they would transition the student patient to a rising 8th trimester intern.

Now, students and the general public have the opportunity to see interns beginning in 8th trimester, and, if the condition warrants, remain with that intern for up to a full year. This helps to build rapport and trust with the patient as well as helps the Intern with seeing a resolution to more ailments than was previously possible.

Finally, the most appealing aspect to this new structure, in my opinion, is that now our naturopathic medicine students are spending half of their education in a clinical setting! Again, in my opinion, nothing trumps experience and "hands on" training when learning a new skill!

Time to get back to the books! Talk to you next week!

Another Trimester in the Books

This morning, I sit at my spot by Lake Janse and watch my classmates walk into their last few exams as I do a small walkthrough of my last final for the trimester, Minor Surgery.

I think of all the preparation, stress, notes, charts, diagrams, decision trees, memorizing, practicals, dissecting, adjusting lab...ahhh!  Adjusting?!?! I'm going to be a ND, why in the world do I need to know how to adjust somebody?!?! This was something I heard, and even said, early in my education here at NUHS, a historically chiropractic school.

Well, as things turned out, adjusting was highly important for me to remember in my first trimester as an intern. Three of my patients required manual adjustments along with physiotherapeutic treatments (ultrasound, etc.) and soft tissue (i.e. muscle, tendon, etc.) manipulation. As a result, I was forced both to remember and to go back to dig through old notes on modalities I thought I would rarely, if ever, use in my practice.

The extensive therapy that these patients each needed to return them to a basis for health included physical medicine, part of the naturopathic therapeutic order, as well as some supplements and analgesics specific to their needs.

My patients, through their needs, visits and therapies, helped me to complete my physical medicine and manipulation requirements for graduation in my first trimester in clinic! These are modalities that are typically completed much later in the naturopathic internship. My physical medicine patients this trimester have taught me a number of invaluable lessons.

  1. Pay attention in the early manual adjusting classes here at NUHS.
  2. Keep your notes and procedures from the early manual adjusting classes.
  3. Work with a chiropractic student when studying for adjusting practicals (and offer to study with the chiros for Botanical Medicine classes, where ND students are more engaged).
  4. Mostly, in your early career here at NUHS, remind yourself to be prepared for ANY patient that walks through the door. You may not know the specifics, yet you can get a good foothold on the complaint and be prepared to take it on if you apply a "big picture" view, even when the classes are information specific.

My experience with the physical medicine aspect of our training here has given me a bit to think about over this coming break and in the coming months. I am now considering, considering mind you, pursuing a chiropractic degree upon completing my naturopathic training here at NUHS. I feel that having both degrees will give me a more complete tool kit to offer patients as a Natural Medicine Primary Care Provider. Of course, time and financial resources are considerations in that "consideration."

2013-08-19_tim _president

Finally, I feel it's important to mention that this past week was President Joseph Stiefel's first graduation ceremony at NUHS. I enjoy sharing a "Good Morning" and short conversation with Dr. Stiefel as we pass on his walk from his home to his office each morning. In the photo, each of us is getting a "dry run" on the graduation portrait--his for about 200 graduate photos at the ceremony and mine for roughly 8 months from now. I enjoyed seeing him speak to our graduates and their families and am proud to have Dr. Stiefel as our new President. (Small trivia fact: Dr. Stiefel's wife, Dr. Holly Furlong, was the very first blogger for NUHS.)

So, with only two trimesters to go (or possibly more if I return for the chiropractic doctorate), I am looking back at what I have learned, what I need to brush up on and explore new skills for my future practice. This is what I will think about when traipsing over the mountain trails back home over the next two weeks. Until then, may the rest of your summer be relaxing, fulfilling, and help you make the decisions you need to guide your future in the proper direction for you.

Simulated Emergency Clinical Encounter

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.