Tuesday, October 6, 2015

Mastering the Interview

Interviewing and doing a little research is a great way to shop around for care. Early in my practice several people told me I was a 'last resort doctor'. The patients had tried many other providers, suggestions from others, and done research and were still searching.....this explains why many of my patients travel great distances to see me, more than half are out of state. Finding the RIGHT provider or system or modality makes ALL the difference to some people. And just because I'm the right provider for some people doesn't mean I am such a great physician....just that I was a good match for them.

People that invested in making good choices wasted less time and effort going through a series of providers, and improved their health more quickly. So be prepared to take some time and choose wisely.

I always say choose a practitioner to interview first that is NOT your first choice. That way you will get to practice and you will hopefully have some concerns about the doctor or practice to discuss. Remember most of us have been trained from birth to submit to what the doctor tells us to do. This is a role reversal where you recognize you are a consumer purchasing a product and have the ability to get what you pay for. It may take some practice.

Do your homework. Consider what you are looking for and why. Consider what characteristics are important to you. For example I cover my own call. My patients rarely have an emergency and do not get me directly. I also do house calls for sick kids that are local. These were things that mattered to me so I incorporated them into my practice. Ask for references....patients you can contact and ask about their experience. Do some research and have specific questions written down before you go in.

Interview Etiquette. Explain to the staff that you are looking for a provider and would like to schedule an interview. Expect to pay. Bring a friend or family member to help you. 

During the interview assess how you were treated. Were questions answered? Were your views respected? Did she take time for you? How long did you wait? Remember this is not a visit to get medical care.....don't ask questions like, what do you do for diabetes ( see the later article on free medical advice)? Make sure you interview at least two or three people. Don't be afraid to go a greater distance to find the right person. 

Good luck in your search. The process of interviewing providers is daunting but empowering for most. It sets the stage for being a good consumer and learning to evaluate material critically - an essential skill since there is a lot to sort through!

Being a Good Consumer of Healthcare

People shop for vacuum with more deliberation than they do for a healthcare provider.

 I think this is because we have an inherent trust that a healthcare provider has our best interests in mind and has the same objectives we do. Because we expect this to be true we often forget to shop around. Also the way medical professionals are revered in our culture, we often don't feel we have the right to  ask the tough questions. But I assure you, a physician or other provider has a greater influence on your life than a vacuum and should be selected with care.

In our next post I will discuss the interview process. For now I want to share some general issues on consumerism. We feel we have the right to demand service, get what we pay for, and resolution for conflict immediately as consumers all day. But we walk into the Dr's office, get rushed through, do what we are told and make it home before the vague uneasiness hits. He never heard me. He never asked about the problem. He just ran me through the conveyor belt. Before you get up in arms about these issues, consider both sides. Patients demand the right to sue which creates liability insurance which not only costs a fortune but also changes the type of care you get. Instead of care focussed on you, protecting oneself from liability issues means a physician follows a  standard of care. Standards of care are one size fits all solutions to problems that require many considerations based on individuality. Patients demand insurance reimbursement. Reimbursement to physicians means providing care within reimbursement standards. It defines the time you can spend with a patient and what treatments will be covered. The BIG BUSINESS of Medicine today, in some cases, has a greater impact on your care than what you need or what is in your best interest. The situation is vastly more complex than this.... but the point is that physicians are significantly limited in how they think and what they can do. This limitation is inversely proportional to the amount of education and legal regulation a profession has ( which can be both bad and good....but we will cover that later).

On the other hand how do you expect to get what you need when you don't ask? Why would you give up all your power over healthcare decisions to someone who spends 4 minutes with you? What do you have a right to complain about if you passively sit back and act like a 'good patient' who does what they are told.

Is this a fair representation of Dr's and Patients? No. Not  an average experience perhaps. But if you look into people seeking alternatives in healthcare, they are disproportionally dissatisfied with conventional medicine and their experiences are striking in their similarity. If you are seeking alternative care, and go about it the same way you go about accessing Allopathic care....you are likely to get the same results. Maybe changing how YOU interact with your provider is the KEY to achieving your healthcare goals.

So Training is Everything, right?

So, the person with the most training is the best practitioner, right? Wrong. We all know of brilliant physicians totally lacking in bedside manner and communication skills who are completely unhelpful. And sometimes the lay herbalist with no formal training is the one who observes and listens carefully and recognizes the issue. It's easy to be a snob about education - especially for me. I put in my time, completed my training, and have many years of clinical experience under my belt. But I have learned over time that personality and rapport are sometimes more valuable than the knowledge gleaned at University. I mean anyone can look something up Online, right?  I have notice three truths I wish to share.

First is integrity and disclosure. It's more important that you know the training level of the
practitioner you see, than how much she has had. I have been disappointed in how many healthcare providers present themselves ( this includes Dr's, lay practitioners, and MLM promoters ). I see how many weekend or mail order diplomas grace the walls of the lesser educated. And how often patients forget to ask specific questions about training before they make a choice on providers. Again, you are not necessarily seeking the MOST training.....but you are seeking someone who truthfully represents themself. There needs to be a lot of different types of practitioners in the world because each patient is unique and resonates with a different type of practitioner.

Secondly is the snake oil factor. When I was fresh out of med school and patients would come in and share what was working for them....if it wasn't something I believed in I would dismiss it and talk them into a replacement. While sometimes this IS the best option, whether or not something makes sense to ME is not the point. The point is that everything out there works for someone. This is greater than a placebo effect. If we are scientists then we observe with an open mind, evaluate the outcome, and draw conclusions about what we see and what the patient reports. Supporting the patient in achieving greater health is our objective.... Not winning over patients to our point of view. I will repeat over and over my belief  in the superiority of individualized care. Look for a practitioner who listens, is open to what you are saying, and who supports your individual values. There needs to be a lot of different types of medicine in the world because each patient is unique and responds to a different treatment.

Lastly and most importantly is consideration of the level of responsibility you wish to assume. For me personally, I see myself as an educator as much as a physician. My goal is to convey knowledge of health and options, explaining why I make suggestions and how I consider issues of health, and foster independance in my patients. I often say if I do a good job I will teach them to get better and stay OUT of my office because they will manage their own healthcare. Not everyone wants to manage their own health or understand why certain modalities are suggested or learn about self care. There needs to be a lot of different styles of practice in the world because each patient is unique and is looking for something different.

So I hope you recognize that while education is important and should be considered, evaluating practitioners based solely on education is too simplistic. We will discuss the importance of how you choose a provider or evaluate your existing provider in a future post.

Recognizing your Needs and Personal Strengths

So, over the next several posts we are going to address approaching Natural Medicine with assistance from a professional. After that I will will write about finding your own way with Natural Medicine and how to find resources you can access yourself. Working with someone else or doing it yourself is one of your most important considerations in terms of being successful, but barely anyone really thinks about it. Here are some questions that may help you assess your objectives and your personal strengths.

1. How serious are your healthcare issues? Managing allergies or colds on your own is very different from dealing with hormonal imbalance, diabetes, repetitive infections/issues of immune compromise, etc. Generally the more serious your circumstances, the better idea it is to have guidance and support.

2. What are your personal resources? Do you have time? Existing knowledge you can apply? Finances to invest in your care? Materials on hand or available to utilize?

3. What is your objective? Why are you seeking Natural Healthcare? Do you have a single issue or a complicated array of symptoms? Do you know what's wrong and just want appropriate care or are you trying to figure it out? Are you seeking alternatives because something else you tried didn't work? Are you seeking knowledge and increased ability to take control of managing and improving your level of health; or do you only want to solve an issue that limits you? 

4. What is your temperament? Do you learn well from others? Do you like to be in charge or are you more likely to let others lead? Do you have good self discipline or do you work better with encouragement? Do you like to understand how and why things work, or do you just focus on results?

These questions don't DETERMINE what type of Natural Healthcare will work best for you. Rather
these are considerations that apply to everyone. Knowing what you need and what your personal skills are WILL help you find the most appropriate care for you.

The best part of living in the age of accessible information is that with a little research, you have almost endless options. This allows you to individualize your care and get the results you want. The problem, since your options are so many, is discernment. Along with credible information, you will be exposed to bias, incorrect information, and dangerous material cleverly presented by seemingly creditable people. How do you know? 

First of all, does the information make sense when separated from the personality of the presenter or the glitz of the site? Secondly are you reading critically, questioning, looking for inconsistencies? And are they there? Third, how does the site or organization or individual benefit from 'winning you over'? And lastly, do the concepts pass a friends test (run it by someone who understands you and see what they think)?

I suggest you come back to this page later in the month and reread it in the context of what you have learned about healthcare in a month.

Saturday, October 3, 2015

Natural Medicine Defined

What is Natural Medicine? What does it include? How are practitioners trained? Is it safe? The fact that it takes a month to fully answer these questions should tell you something about the complexity of the answer! And while I will define these terms, remember that the people using them online or in practice often throw these words aound and use them interchangeably (and incorrectly) making it almost impossible for even well educated consumers to make decisions without talking directly to a practitioner or reseaching a particular source.

What differentiates healthcare providers from one another is the type of training they receive and the philosophy that guides their care. Up until recently in modern times there has been essentially one choice in the United States for Healthcare. This type of medicine is called 'Allopathic' medicine and this includes MD's, Nurses, hospital care, etc. The philosophy of this care is based on determining a diagnosis and using drugs and surgery to alleviate the symptoms of disease. This has also been called the dominant school of medicine. It is the one that is backed by most insurance companies, the pharmaceutical industry, hospitals and clinics, state and federal government, a complex legal system that manages the liability, etc. And we derive much of what we believe about healthcare from this paradigm.

While these practitioners simply think of themselves as 'Physicians', the term
allopathic care is 'an expression commonly used by homeopaths and proponents of other forms of alternative medicine to refer to mainstream medical use of pharmacologically active agents or physical interventions to treat or suppress symptoms or pathophysiologic processes of diseases or conditions.[1] The expression was coined in 1810 by the creator of homeopathySamuel Hahnemann (1755–1843)'. Interestingly enough the term allopathic comes from a root word (Greek ├íllos) meaning 'other' or 'alternative'. The decision to call something alternative is relevant to one's own perspective! Today an estimated 30-70 % of all Americans have used alternative care according to a simple Internet search....but the impact of alternative care on healthcare choices and practices is, in my opinion, probably higher.

Integrative Medicine is generally an MD or Nurse practicing 'alternative' care. I will discuss this in detail in a future post in this series.

There are other types of physicians besides MD's. Osteopaths, Chiropractors,
Naturopathic Physicians, Doctors of Acupuncture. The training and licensure of these practitioners varies from state to state. I am a Naturopathic Physician and graduated from Bastyr University in Washington, where I went to medical school. Naturopathic Physicians are licensed as primary care providers with mandatory insurance reimbursement, hospital privileges and prescription rights in Washington. In Idaho where I live, the scope of practice is significantly less than my training and there is no legal or academic requirement to call oneself a Naturopathic Physician.

Checking with the professional associations nationally and by state will help you understand the terminology in your area. In Idaho many lay people, chiropractors and others call themselves Naturopathic Physicians even though they have no Naturopathic Training. This makes it challenging for consumers to make educated decisions. I think that it is critical for consumers of alternative care to understand these things.

All these practitioners listed above may practice alternative care or natural medicine in spite of a highly variable levels of training. But alternative care is also practiced by a wide range of other 'lay' professionals. Some carry certificates, others have engaged in self study, and still others have learned from others in an apprenticeship setting. I will discuss issues of education in my next post.

Lay practitioners also have a philosophical ideology, but because their education is less standardized, their guiding principles are also less consistent and they generally have considerably more variability in practice.

The area where alternative practice has probably grown the most is by consumers practicing 'do it yourself healthcare'. Although the increase in all alternative practices probably coincide with the ease of access to information that the Internet created; self care seems directly served by Internet sites, MLM companies, and grass roots movements that disseminate information on a variety of practices and products. The Internet has also impacted allopathic care in the same way as prescription drugs are now easy to obtain - pharmaceutical companies have picked up on this trend and now direct market to consumers on TV, radio and other media.....'ask your doctor about....'.

So while this is an exciting time in history if you seek alternative or natural care; the array of options can be overwhelming. And because everyone promotes their own platform and criticizes all other types of care, your opinions are likely to be formed with biased information. I also have my own biases as I write these articles. Knowing what platform I identify with and what my training is should help you see areas where I may lack objectivity. But as you read about natural medicine these next 31 days, hopefully you will recognize my most prominant bias: knowledge is power. My objective is to provide you with as much information as I can, support you in making a great decision about your care, and provide whatever resources help move you along in the journey towards exceptional health.

Friday, October 2, 2015

31 Days to Lifelong Health

Welcome to my 31 Days project! This project began as an educational program to introduce my patients to Natural Medicine and has expanded to include a much broader community. Please feel free to participate in the full series or pick and choose information that is relevant to you.

Natural Healthcare is a broad topic meaning many things to many people with undefined terminology and multiple purposes. Natural Healthcare has touched everyone. My goal over the next 30 days is to define a more specific vocabulary, present various philosophical approaches to healing, and create the foundation to make you more effective at healing yourself and working with others who can assist you on your journey.

I hope this will propel you on a journey towards greater health; provide knowledge and some new tools; and be a reference you refer back to as you move forward!

31 Days to Lifelong Health

Day 1: Natural Medicine Defined
Day 2: Recognizing Needs and Personal Strengths
Day 3: So, Training is Everything, Right?
Day 4: Being a good Healthcare Consumer
Day 5: Mastering the Interview

Have a Happy Healthy Day,