Archive for tag: scope of practice

Four Weeks to Go

I admit that I'm starting to reminisce already about my time here at NUHS. Here are just a few of my thoughts this week as things start to wind down and rev up for the next part of this adventure!

As each of the 10th trimester Interns complete their patient numbers and competencies, transition their patients to the Interns advancing from observation to the main clinic, and prepare for the next step beyond graduation (whether joining or opening a practice, continuing with another license or starting a family), I believe each one has taken the first step on a journey of helping others with minimally invasive therapies to become healthier.


Spring 2014 will see 11 new doctors of naturopathic medicine graduate from NUHS. These doctors will be prepared to help those with chronic illness determine the underlying cause of their disease, and where possible with the therapies that we are taught to utilize and our rigorous training on the human body and its functions, work together as teammates to return our patients to their basis for health.

This is a bittersweet time for many of us. Those of us who have developed close friendships over the past 4-5 years and fostered a sense of teamwork, cooperation, learning, teaching and accomplishment will be stepping out on our own. We will be making our way in the world as healer, educator, family, friend and human being. While we will be making our singular way, we know that we will have the support of our colleagues, loved ones and our patients.

Ultimately, the support of our patients is the driving force that allows us (motivates us) to take the next leap as we begin our journey in a profession with a scope that currently exists in only 18 states and territories along with the District of Columbia in the United States. This is both an exciting and scary time for many, especially the younger new docs who are stepping out into the working world for the first time. I continue to encourage my colleagues with the notion that they are very well educated, well trained new naturopathic doctors who are going to make a positive, healing impact upon their patients' lives. As long as that is their motivation and they manage their practice wisely, they will be rewarded with a full practice as word of their expertise spreads.

Until next week, most likely with a bit more reminiscing, enjoy the spring season and renewal of the sun's warmth!

High Force Intervention

This past week was a long and trying one for my entire family. We thought that we had lost my mom. Without the quick, assertive intervention of the paramedics, emergency room and intensive care unit staff back home in western North Carolina, my mother would have certainly died. With her permission, I am sharing this story, how high force intervention saved her life, and where naturopathic doctors fit into the care model, as I see it. The thoughts and opinions expressed here are mine and are the result of my thought process. This week's entry is a bit long and covers almost two weeks worth of events.

In my blog this week, I'll do my best to explain how high force intervention can be both a benefit and detriment under the proper conditions, as can any type of medicine. Mom has a history of asthma and heart disease and as a result was on a cocktail of 12 medications, without co-management between her various care providers. Before I move on, I want to make the point that each of these caregivers was honestly doing their best to care for her, yet no communication was occurring between the caregivers on Mom's many medications.

The story begins with my mother complaining of shortness of breath while one of my sisters was visiting. After prodding from my sister, my mom agreed to allow her to call 911. We are from a rural area, so we have volunteer responders who can arrive either in their personal vehicle or an ambulance. The first person to arrive saw my mom fighting for breath. By the time he had gathered his equipment, my mom was blue (cyanotic) and frothing at the mouth. He immediately began CPR on my mother as she was now in cardiac arrest. The ambulance arrived at this time, and within 90 seconds the paramedics were helping my mom breathe with a ventilator.

She was immediately transported to Mission St Joseph's hospital in Asheville, North Carolina, where the emergency room staff quickly and accurately stabilized her. She was moved to the intensive care unit shortly after being stabilized until her caregivers could be notified and they could figure out what was causing this episode. The quick, high force interventions of the first responders and ER staff saved my mother's life.

To keep a long story short, an interaction occurred between her many pharmaceuticals that caused a spasm in her diaphragm, the primary muscle that helps us breathe through expanding and contracting our lungs. Mom gradually lost her ability to get air, and thus oxygen to the point that she lost consciousness. As a result of taking many different medications without cross consultation among her specialist caregivers, Mom had a reaction that could have cost her life. At the same time, without high force intervention, such as her intubation and respirator at the emergency room, Mom could have lost her life. Again, I believe that each of these caregivers was doing their best with the toolkit available to them to help my mother be as healthy as she could be. This is what medical caregivers are trained to do, regardless of their specialty, field or modality.

Right now, Mom's medications have been reduced drastically, as after review and consultation together, her specialists determined that she didn't need as many medications as she was taking before the incident. She is feeling much better and is excited to have one caregiver managing all of her medications regardless of who prescribes them. She has a great rapport with her cardiologist who has been caring for her for over 15 years. Rest assured, I will be watching her meds more closely now as well.

My sister Kristie, Ladybug and Mom earlier this summer.

So, how does this relate to naturopathic medicine? This is where my opinion comes into play, so from this point in this week's post, I am sharing my viewpoint. I view my future role as a naturopathic doctor as a gatekeeper. By gatekeeper, I mean the role of the primary care doctor or central hub of care. If you imagine an ND as the hub of a wheel, with spokes moving from the hub out to various specialists such as endocrinologists, gynecologists, chiropractors, physical therapists, etc., the ND can take information from each of these specialists and incorporate that information into the 'whole picture' of the patient, their care and their health. Whether in a licensed or unlicensed state, the ND as the health gatekeeper, is trained to know and understand pharmaceuticals and how they interact not only with other pharmaceutical meds, but also with botanicals, supplements and anything administered to the patient. We are uniquely trained and qualified to act as our patients' gatekeeper for their health and lives.

In closing this week, we as NDs are not the ideal choice for high force intervention in most cases. With the exception of the states where NDs have prescribing authority in that state's scope of practice, we will not be involved in high force intervention (i.e. prescribing or removing pharmaceuticals in patient care or minor surgery/trauma etc.). We are trained more specifically for chronic lingering illnesses and our moderate methods typically don't have the overnight impact of a pharmaceutical. At the same time, our interventions are much gentler and have a much lower risk of a severe, life-threatening episode. I have a healthy respect for those who are trained and adept at taking a person on death's door and bringing them back time after time, day after day with the calm precision of highly trained professionals. At the same time, after my training here at NUHS, I'm convinced that not every situation requires pharmaceuticals upon an initial visit. Perhaps, as we grow as a profession and our allopathic colleagues become more aware of our training and effectiveness, we will see a greater amount of collaboration, communication and whole person care with NDs as the hub and gatekeeper of a patient's medical care.

I'm elated that my mother's caregivers have agreed to her wish of having a single doctor in charge of her medication list. This cooperation amongst caregivers is unique and I think indicative of the excellent care in western North Carolina as a whole. I'm happy Mom is still with our family and hope to have her with us for many years to come!