Welcome Baby Blogger!

My readers may have noticed that it has been a number of weeks since I have posted.  No, I haven't been slacking off, nor have I been scared away by the heated arguments of earlier this year.  There has been something else brewing in the life of this blogger!

My husband Jason and I are pleased to announce the arrival of our beautiful daughter on March 22nd, 2012.  Baby Krumbeck was 6 lbs 15 oz, 20.5 inches long after a relatively short, wonderful natural birth.

For privacy reasons I won't be posting pictures of her face or announcing her full name.  If you know me personally feel free to friend me on Facebook to see more cute-as-a-button pics.

So, there may be another break from blogging for a while.  I'm due to graduate this June, then studying for the boards takes priority until mid-August.  Jason and I will be moving east and I plan on opening a private practice in Montana in late 2012 or early 2013.  I'll let you know the progress as we get a little closer.

For now, back to burping, feeding and changing!

In Health,

Erika

Why should I see a naturopathic physician?

I've been writing a lot about the philosophy of naturopathic medicine because I want the general public (and especially my own future patients) to understand the vast difference in approach between conventional and naturopathic medicine.  This is another reason why I wrote a post on what ND's are not - naturopathic physicians are not simply doctors who prescribe natural things instead of synthetic ones.  Our entire curriculum and practice is centered around a philosophy of treating the whole person, addressing the cause of illness and allowing the body to restore health naturally.  It is this fundamental philosophical difference which directs our treatment approach.

So why should you see a naturopathic physician? 

To understand the difference between naturopathic medicine and conventional medicine, let's first look at the conventional medical model:

• Disease is equated to pathology and disability 
• Healing is removing pathology, suppressing symptoms and decreasing disability 
• Therapies are mostly used AFTER the appearance of symptoms (retroactive care)

Conventional medicine excels at treating patients within this model.  In fact, I will unashamedly say that natural treatments are vastly inferior to conventional treatments for suppressing symptoms, and often for removing pathology.

What conventional medicine doesn't address is health. 

Naturopathic physicians recognize that good health is more than a mere absence of symptoms.  We also recognize that healing and creating health is a process that goes beyond simply removing pathology.  I like to use this diagram of a staircase or ladder to describe the stages of health and illness:

On a gradient of health, most patients come to their doctor when they are at least 2/3rds of the way "down" the ladder - when they reach the point of having symptoms of a problem.  The issue with the conventional model is that the treatments are aimed at merely getting patients off of that step, not restoring health.  Many patients spend their entire lives at the "dysfunction" stage of ladder, fully medicated in order to suppress their symptoms, but completely unaware that they are only one step away from symptoms and disease progression.

Similarly, most patients not aware of the potential for restoration!  I have seen countless patients now, who after months of naturopathic treatment proclaimed "I never knew I could feel this good!"

This is why naturopathic medicine has an entirely different approach.  Naturopathic physicians are experts in adding health, not removing symptoms.  We focus on optimizing the body's own healing process in order to reach a point of complete restoration.

So why see a naturopathic physician?  Please don't come to see us to remove your disease.  Rather, come to see us to regain your life!

How do I find a well-trained naturopathic physician?

Despite my many blog posts about our educational level, I realize that there is still some misinformation about naturopathic physicians.  Many people want access to naturopathic medicine and well-trained naturopathic physicians, but it is still a little confusing as to who's who.  Here's my guide to finding a legitimate naturopathic doctor and supporting our profession:

1) Check out the American Association of Naturopathic Physicians (AANP) website: www.naturopathic.org.  Click on the link "find a naturopathic doctor near you".  This is the quickest and easiest way to find a licensed naturopathic physician.  All ND's listed on the AANP website have graduated from 4-year medical schools.

2) The AANP maintains an up-to-date list of which states license naturopathic physicians.  Why is this important? In unlicensed states any person can call themselves a "naturopath" regardless of their training.  Are you in an unlicensed state? Be extremely cautious when interacting with someone who claims to be a naturopath or naturopathic doctor.  Always ask where they received their training (it should be from one of 6 schools: Bastyr, Boucher, Bridgeport, Canadian College of Naturopathic Medicine, National College of Natural Medicine, or Southwest College of Naturopathic Medicine).  Note that there are many "diploma mill" type colleges that offer "Naturopathic Doctor" degrees.  These are typically online or distance learning courses, and these graduates can only call themselves "doctor" in unlicensed states.  These graduates have not had hands-on coursework (like a cadaver lab, or training in minor surgery or physical exam techniques), or supervised interaction with real patients (minimum 1,200 hours for licensed ND's).  There are qualified ND's in unlicensed states; most practice very conservatively (as a "healthcare consultant" or something similar), and simultaneously hold a license in a licensed state.  This is because there is no governing body in that state.

In licensed states, you can simply search for any Naturopathic Physician or Naturopathic Doctor to find a well-qualified medical professional.  Ask around to find one that suits you - many ND's have additional training in certain areas, or tend to focus on a specific patient population (like pediatrics, or physical medicine/body work, or cardiology patients).  Different naturopathic physicians have different personalities just like everyone else.

3) Get involved! Are you in an unlicensed state?  Call/e-mail your state senator or representative and ask to draft legislation requiring the licensure of naturopathic physicians.  Check the AANP website for updates regarding the status of your state.  Currently New York, North Carolina, Massachusetts and Pennsylvania have legislation in the works, in addition to Maryland, Virginia, Colorado and Iowa - states whose legislative sessions have ended for the year. 

Remember, you can make a difference when it comes to a patient's right to choose appropriate, effective, preventive healthcare.

"So you're going to be, like, almost a doctor, aren't you?"

I talk about Bastyr and naturopathic medicine a lot.  By now all of my friends and most of my family's friends are well-versed in naturopathic medicine, our role as primary care providers, and my educational level.  I was having one of these conversations with a family-friend (my parent's generation) who finally asked me "so, you're going to be, like, almost a doctor, aren't you?" Ouch.

After nearly four years of medical school, dozens of 12-hour days, hundreds of patients seen, and more information than I can possibly fit in my brain, I certainly hope I will become a doctor.  This brings up a common misconception: that naturopaths are quacks who get online degrees and don't know what they are talking about.

So what is our educational training? 

Naturopathic physicians attend four-year graduate schools that are nationally accredited by the Council for Naturopathic Medical Education (CNME).  The CNME is recognized by the U.S. Department of Education, which classifies the ND degree as a Doctorate-Professional degree, on par with MD and DO.  Currently 6 schools in the US and Canada are accredited through the CNME to provide naturopathic medical education.

The naturopathic program consists of at least 4 years of study with over 4,100 clock-hours in the classroom or clinic.  A minimum of 1,200 hours are spent in clinical education with direct patient contact under supervision.

The first two years of the ND program are very similar to an allopathic program.  We learn all the basic sciences including anatomy, biochemistry, immunology, microbiology, histology, pathology and physiology.  Here is a breakdown of the curriculum:

University of Washington medical students average over 70 credits per year (72 and 78 credits for the first and second years), which is similar to Bastyr's ND program (74.5 and 77 credits for the first and second years, respectively).

The main difference in education between allopathic and naturopathic physicians in the the area of specialization.  By definition naturopathic physicians are specialists in natural treatment of primary care conditions.  From the beginning of our education we focus on primary care - diseases and conditions that a practitioner would encounter in an outpatient clinic.  We touch upon emergency medicine, surgery and high-force pharmaceuticals (like chemotherapeutic drugs) in the context of referrals and co-management.  However, unlike allopathic students we do not go through rotations in these areas.  While MD students do rotations in specialty fields in their 3rd and 4th years (like Oncology, Obstetrics, Surgery, etc), ND students do clinical work in naturopathic primary care only*.   We see people in an out-patient setting, directly managing the care of "our" patients under the supervision of a licensed naturopathic physician.

Also, naturopathic medical education differs in that we have a broad scope of practice with multiple modalities that we can offer our patients as treatment.  Throughout our education we have multiple courses in pharmacology, botanical medicines, homeopathy, counseling, nutrition, and naturopathic manipulation. In the state of Washington naturopathic physicians can prescribe most medications, perform minor surgery, offer counseling services (just like a licensed mental health counselor), offer nutritional advice (like a dietician), and perform osseous manipulations of the spine and extremities (like a chiropractic physician).


Naturopathic medical students also take board exams comparable to the USMLE boards taken by allopathic students.  These tests are called the NPLEX exams - naturopathic physician licensing examinations, and are governed by NABNE.  Only students from accredited schools of naturopathic medicine are eligible to sit for these exams.  Students must complete two sets of examinations, one after the first two years of the ND program (the basic science boards), and one after graduation (the clinical science boards).  Just for a comparison, our basic science boards are similar to USMLE Step 1 exam, and the clinical science boards are similar to the Step 3 exam.  The USMLE Step 2 exam, which evaluates physical exam and clinical skills, is similar to our Clinical Entry exam, which is governed by the school (Bastyr) itself - we must do a complete intake, physical exam, and differential diagnosis on a standardized patient (actor), graded by a member of the clinical faculty.  We must pass this exam (after our 2nd year) in order to see patients in the clinical setting. 

Only after completing all 4,100 hours, passing both sets of board exams, and getting a diploma is a naturopathic student eligible for licensure.  This is in contrast to some so-called "naturopaths" who receive online or distance-learning degrees. In all 17 states that license naturopaths, only those who graduated from an accredited 4-year school can call themselves naturopathic physicians or doctors.

So to clarify, YES, I am going to be a doctor! A naturopathic doctor, that is. 

References:
Source: "Basic Science Curriculum." UW Medicine.  University of Washington, 2011. Web. http://uwmedicine.washington.edu/Education/MD-Program/Current-Students/Curriculum/Basic-Sciences-Curriculum/Pages/default.aspx. 19 May 2011
Source: "Program Tracks and Curricula for Doctor of Naturopathic Medicine." Bastyr University.
Bastyr University, 2011. Web.  http://www.bastyr.edu/education/naturopath/degree/curricula.asp. 19 May 2011. 
Association of Accredited Naturopathic Medical Colleges. AANMC, 2011. Web. http://www.aanmc.org/. 19 May 2011.


(*with a few exceptions - we can do adjunctive care for cancer patients, but not primary treatment). 

My story...

I have had several requests to speak a little about myself and how I came to Bastyr and the ND program.  I would love to share with you my journey to naturopathic medicine...

I was born and raised in a Swedish-American family in the Pacific Northwest.  My relationship with nature grew at an early age, and thanks to the encouragement of my parents much of my childhood took place outdoors.  I spent my summers picking blueberries and wild strawberries in Sweden, swimming and playing in Lake Washington and hiking to alpine lakes in the Cascade mountain range.  Winters were dominated by my love of snow, with plenty of adventures by skiing, snowshoeing and sledding.  These activities laid the foundation for my appreciation of nature, and eventually led to my decision to become a naturopathic physician.

As a right-brained child, I gravitated to various art and music classes.  At age 6 I joined an internationally touring children’s choir, and at age 8 I began learning classical piano.  I took drawing, painting and ceramics classes throughout my youth to feed my desire for creativity. 
Music and art became my therapy during adolescence, a healing power that I still value.

As a teenager I retained my love of the arts but also discovered the pleasure of solving puzzles, especially in math and science.  I followed both of these passions throughout my undergraduate education at Gonzaga University where I finished my bachelor’s degree with a double major in visual arts and biology.  Originally I planned to become a medical illustrator but soon realized that a career in an isolated cadaver lab was not for me. I realized that I love people and that I thrive in an environment where I can develop relationships with others.  Because my biology degree closely mirrored the premedical curriculum, I started thinking about attending medical school to pursue a field where I could help and heal others.  Taking some time off of school, I moved to Nashville after graduation to participate in an AmeriCorps program in a low-income health clinic.

In 2005 my family and I had our lives dramatically changed when my father had a major stroke.  After weeks of hospitalization and months of physical therapy, his insurance stopped paying for rehabilitation.  At this point my parents turned to several alternative therapies, including acupuncture, warm-water physical therapy and Feldenkrais.  On one weekend home I had the opportunity to take my father to his acupuncture appointment with Dr. Yuanming Lu, who also happened to be a professor at Bastyr University.  My parents, wanting me to move back home to Seattle, encouraged me to check out the naturopathic medicine program at Bastyr.  In 2006 I visited Bastyr and immediately fell in love with the campus, the community, and the philosophy of naturopathic medicine.  My eyes were opened to a completely new type of medicine - a natural, holistic and truly patient-centered model of practice. 

At the same time it was becoming apparent that I had my own health issues that were getting progressively worse.  After multiple rounds of imaging and medication trials to find the cause of my stomach pain, I was finally diagnosed with Irritable Bowel Syndrome and was told by my medical doctor that there was nothing more I could do.  Being a motivated patient, I searched for answers on my own, and learned of the link between food sensitivities and IBS.  After my doctor refused to do the testing, I called the Bastyr Center for Natural Health, and the year before I began the ND program I had my first experience as a naturopathic patient.  I learned that I had multiple food sensitivities, including gluten, soy and dairy.  Eliminating these foods from my diet, in addition to other naturopathic therapies, changed my health and changed my life.  I am happy to report that I am now 99% symptom-free, and my health continues to improve year after year. 

In 2007 I began my education at Bastyr University in their Doctor of Naturopathic Medicine program. The journey continues to amaze me, and every day that I am in school I fall more deeply in love with this incredible medicine.  I am excited to become a Physician, a Counselor and a Healer, and I am honored to be a part of the lives of patients as they are transformed.

Docere - Doctor as Teacher

We are in the age of passive medicine.

Our current medical model reimburses physicians for investigating/making a diagnosis, and managing treatment of that particular diagnosis.   Physicians get paid for the diagnosis or treatment, not for the amount of time spent with patients (with some exceptions).  This leads to short patient visits and very little time discussing the rationale behind the treatment or the implications of the diagnosis.  The result is what I call "passive medicine,"  because the patient has almost no active role in the healing process.

The role of the naturopathic physician is to fulfill the original meaning of the word doctor.  "Doctor" derives from the Latin "docere," which means "To Teach".  The process of education shifts the role of participation back to the patients so they can take control of their own health. 

Bastyr University describes the principle of Docere as such:

"Naturopathic physicians educate the patient and encourage self-responsibility for health. They also acknowledge the therapeutic value inherent in the doctor-patient relationship."

This definition of Docere is really describing empowerment.  Naturopathic physicians teach so patients can reclaim authority over their own bodies.  Empowered patients are savvy healthcare consumers and are better able to stay safe and prevent mix-ups in the medical system. Educated patients also tend to have more success in completing treatments, and feel more confident in their health.

The concept of Doctor as Teacher is really about shifting the balance of power back to the patient.  Personal empowerment is the only prescription that can create permanent change leading to better health.