By Krystal Plonski
As new models of primary care delivery are becoming increasingly team-based and multidisciplinary, what role can a naturopathic doctor play? Here Krystal Plonski, N.D. student at Bastyr University, explains.
Setting: Seattle-Tacoma International Airport, March 2009, waiting to board my flight back east after my medical school interview at Bastyr University.
Random man who struck up a conversation with me: So, you’re really going to ‘medical’ school to be a Nat-ur-o-path? What the heck is that anyway? Some kind of magician?
(And, yes, he really put air quotes around the word “medical”).
This would be the first of many encounters in which I would educate other people on what a naturopathic doctor (N.D.) really is, what the philosophy entails, and the scope of practice. I have tried to put a positive spin on the “magician” part, explaining that all medicine can work wonders when used appropriately. As a naturopathic medical student interested in primary care, I wanted to use this forum to explain how N.D.s can play an important role in primary care.
The Affordable Care Act, as it ushers in thousands of newly insured patients, will make the primary care shortage even more acutely felt. Naturopathic doctors can help address that shortage. Although few people know this, naturopaths are licensed medical providers who can serve as primary care providers. Some have their own private practices where they practice primary care or specialize in a particular condition, while others are part of team-care practices with other health care practitioners such as M.D.s, D.O.s, chiropractors, or acupuncturists, to name a few.
Naturopathic medicine is based on 6 foundational principles: (1) The healing power of nature, (2) First, do no harm; (3) Treat the cause; (4) Treat the whole person; (5) Doctor as Teacher; and (6) Prevention.
Through these six principles, N.D.s take a patient-centered approach that considers many factors, including the mind-body connection. Naturopaths strive to find the root cause of the patient’s suffering – whether it be mental, emotional, or physical, and treat accordingly. We have a toolbox of modalities to use in order to treat a patient: counseling, lifestyle modifications, diet and nutrition, herbs, homeopathy, physical medicine, hydrotherapy, prescription drugs, and minor surgical procedures. N.D.s manage conditions that primary care M.D.s also treat, which range from more acute cases, such as minor burns/lacerations, dermatological complaints, upper respiratory infections, sinus infections, and middle ear infections, to more chronic conditions, such as depression, anxiety/fatigue, gynecological complaints, sleep disorders, orthopedic complaints, hyper/hypothyroidism, hypertension, high cholesterol, anemia, gastrointestinal complaints, diabetes, obesity, and nutritional deficiencies, to name a few.
At Bastyr, health is defined as freedom from disease
, which all doctors strive to achieve for their patients. Freedom could be classified as, freedom from physical limitation by a particular diagnosis, from the negative side effects of certain medications, from the social stigma of a condition, as well as having the support and resources needed to regain optimal health. Primary care, whether provided by an M.D., D.O. or N.D., promotes this very definition, as well.
aturopathic medicine’s foundational principles are well aligned with the aims of primary care, particularly “Prevention” and “Doctor as Teacher.” The prevention of disease, as opposed to the treatment of symptoms, is the cornerstone of primary care and the key to lowering health care costs. And primary care providers empower patients with the education they need to prevent disease.
The “doctor as teacher” empowers patients to connect lifestyle to health status, to know there are steps that can be taken to make a change, and to recognize that the patient is ultimately responsible for his or her own health. In my experience in the teaching clinic, I have seen patients get caught up in the label of their diagnosis – “diabetes,” “hypertension,” “fibromyalgia” – and not know how to disengage from that particular identity. By educating a patient on how to take steps to be more in control of their health through basic lifestyle modifications, the other naturopathic principles, such as “treat the cause” for example, come into play.
As comical, not to mention extremely insulting, as that moment in the SeaTac airport was, it is unfortunately a true representation of how many people perceive naturopathic doctors. Like conventional medical doctors, we study and want to help and improve the same organism: the human body. We both strive to prevent disease and uphold a true definition of health, simply through different mechanisms.
Further, like M.D. students, N.D. students spend their first year of medical school studying biomedical sciences; their second year, studying diagnostic sciences as the curriculum gradually becomes more problem-based, incorporating evidence-based medicine; and their third and fourth years gaining hands-on clinical experience – with particular emphasis on learning how naturopathic therapies interact with pharmaceutical drugs to avoid harmful effects. We are trained to recognize emergency situations in which our care would not be helpful or appropriate. For example, when a patient needs to be managed by a specialist, or when a patient needs a specific prescription drug that is not within our scope of practice. As N.D.s, we know our limitations and refer accordingly.
N.D.s can provide primary care and thereby help address the current shortage of providers, many N.D.s and naturopathic medical students from various states lobby Congress every year to get naturopathic medicine approved for individual state licensure, included under the phrase “complimentary and alternative medicine.” Currently, naturopathic medicine is covered by health insurance in 16 states, Washington D.C., Puerto Rico, and the Virgin Islands. That leaves 34 states that require patients to pay out of pocket for naturopathic medicine, which can be extremely expensive, if even an option.
The Affordable Care Act will make great strides for primary care physicians and medical school residencies, as well as incentivize students to choose careers in primary care. I hope it also brings greater recognition and acceptance of the role N.D.s can play in addressing these upcoming health care needs. We as primary care providers and trainees across the allied health professions are all part of the movement towards better overall health for our present and future patients.
Krystal Plonski is a 4th-year N.D. student at Bastyr University in Seattle, WA, where she will also earn a masters in acupuncture and Oriental medicine. She enjoys educating others on naturopathic medicine and integrating a holistic and preventive approach to health care, with a special interest in pediatrics and adolescent medicine.