Automatic Perceptions, and Mindfulness

   We had our second psychology practical today. It was pouring rain and Dr. Creech was running late, so one of the more experiences TAs started the class with a little bit of meditation, and then went over the lecture portion which related to automatic perceptions, especially with respect to transference and counter-transference in the doctor-patient relationship. Transference refers to when someone (e.g. the patient) puts an unconscious redirection of feelings onto someone else (e.g. the doctor) based on their feelings about someone else. For example, if a patient is mad at a co-worker and the doctor looks like their co-worker, they may act mad towards the doctor even though they aren't actually mad at the doctor. Counter-transference refers to the opposite, specifically when a doctor is emotionally entangled with a patient based on predispositions. For example, a doctor may show protective feelings over a female patient, and then realize through discussion that it was actually because the patient reminded them of their little sister.

   Transference and counter-transference are automatic processes that cannot always be controlled, but the important things as a clinician is to be aware of them when they happen. If you are not aware that they are happening, then that is where the negative effects really come into play. So once again the topic of mindfulness came into discussion during our small group talk today, and I really liked a new point that Dr. Ragbir brought up. There seems to this distinct connotation of the word meditation in which you imagine a person sitting in a quiet room with their eyes closed, maybe with the lights off, just breathing, maybe even doing some sort of humming or chanting.

                                                 Pretty classic looking meditaton here right?

    Now of course there is nothing wrong with that picture of meditation. In fact it is a very healthy way to relax and bring oneself into their mind and awareness, and to pull away from the stresses of their life. However, this does not have to be the only way to be mindful and meditate. Dr. Ragbir talked about a Buddhist monk named Thich Nhat Hanh, one who has been compared to the Dalai Lamai. He explained that when asked about what he does to be mindful, Thich said that he is always mindful. He is always aware of himself in all ways, because you really don't need to get into that quintessential meditation practice in order to be mindful. All it takes is practice and most importantly, removing any judgement upon yourself in the journey to mindfulness. Again there is this belief that to be mindful, you need to have completely unwavering thoughts, focused just here on the present moment (I should know, that's why I thought I've been meditating wrong all along). But in reality, it is not the way that you meditate that makes you mindful, it is just the awareness of what you do. Whether your mind is focused solely on the tides of the ocean, or if your thoughts drift to your schoolwork, and then traffic, and then what you want to do next weekend, they can all be true mindfulness, IF you are aware of what it is that is going on. Practice awareness, remove the judgement, and just do it for yourself and you will see the benefits that mindfulness brings.

     On another quick note I just wanted to mention that I did end up going all out for the Halloween costume yesterday, wearing the thing 2 costume (wish I'd thought to bring thing 1 and share it with a friend; oh well, maybe next time). It was pretty fun though laughing with others about being really silly (not to mention Dr. Terzic said to me, "Noah, I thought you were a serious student" --> I think he was kidding, after all it's okay to let loose sometimes). Not to mention Bonus! I came in third place and won a Starbucks gift card! Can't wait to top it next year.

There's me on the right, my friend Alex as batman on the left, and someone I don't know in a really sick scarecrow costume in the middle.

                                               

Cool Marine Video, and HEROs Class 2

    Today in homeopathy, one of the remedies we learned about was sepia officinalis (sep), aka cuttlefish ink. I won't go on about the details of this remedy, but Dr. Byden-Tailor showed us a really cool video of a cuttlefish before we started learning about the remedy, I really recommend watching it here just for the wow factor (I know its over 4 minutes, watch if you're interested, but if you're time is limited the first 20 seconds are all you need for the really cool part).

   I also had my second HEROs class today, which was the second part of Starting Smart/Leadership. Today was once again a little bit scary and overwhelming, but at the same time made me feel good about my choice to take this course early. My future in the business world is a bit of a scary thought, but it is an important reality and I know that if I procrastinate and wait too long, I'm only going to deny my own success, and with that, deny my ability to help people improve their health.

   So the focus of this class was really on where you can go as an ND. It seems that employment is not a big area for NDs --> it's possible to work for a supplement company, to teach or work for a government agency or other NPO (non-profit organization), but these opportunities are limited. There are also some residencies available, but these are limited, and also not long term. So the main opportunities really involve working for yourself. But, there are some possibilities that don't have to be you opening an office for yourself. We talked about partnerships, sole proprietorship, being an associate, and the management model (or zero partnership entity). What I learned is that partnerships are definitely a bad thing unless it is with a significant other (they seem nice, "us against the world," but once the talk becomes about money, there are problems, especially if one of the partners has a divorce with their spouse), and that sole proprietorship is the way to go if you have the resources to do it successfully (with the ultimate goal of hiring associates and building a successful "Clinic," rather than "Practice").

    However, if resources are tough then being an associate or the management model can be an effective way to start. We talked a lot about the details of contracts and the economics of things, and it's sad to hear that the situation around contracts within the naturopathic professional community is very bad. It really is just that a lot of naturopathic doctors do not know enough about business, and so a lot of bad contracts are written that lead to poor, win-lose situations. My hope is that with the knowledge from this course and Andre's help (fortunately with taking HEROs, my first contract review from him in the future is free), I can avoid these situations and get myself into a win-win situation first thing.

    That's all for now, off to bed and then tomorrow is Halloween (well October 30, but we have common time so there will be some fun events). I'm going for the costume contest as a pretty silly costume, but it should be fun!

This isn't me, but it is the costume I plan on wearing tomorrow. Go big or go home!

First Health Psych Practical!

    Today we had our first of 6 practical sessions in Health Psychology. This is pretty exciting because up until now, the majority of what we've been doing has been theory through lectures, with the exception of anatomy labs (for now just looking at bones --> real ones not models, but still not that crazy yet), and physiology labs (though hematology didn't include much work, and our spirometry lab was also mostly answering questions, not much practical application yet). So I'm pretty excited to actually start doing some practical work.

    The class started with a "short" lecture about naturopathic intake interviews from Dr. Creech (1 hour, but that's short compared to the normal 3 hour one). We then split into a bunch of groups and went off to different rooms (my group unfortunately had to stay in Classroom 4, especially bad because it was really cold today), each group getting assigned a TA who is an ND. My TA for the class is Dr. Rajesh Ragbir. He's a pretty interesting guy, considering that he was some sort of mechnical engineer before he changed his career path to become an ND (he used to fix and automate A/C and heat systems).

    The class was relatively easy-going for today. We just got into a circle and all introduced ourselves, talked about what our experience in health psychology was and what we were hoping to get out of the class. Then we talked about some different strategies when speaking with patients, the one that really stood out to me is from the acronym OARSS.

O - Open-ended questions. Dr. Ragbir really emhpasized that we should ask questions with a genuine type of curiosity. Even if you know the answer to something, you should still ask as if you don't know, because this way you get the most information from a patient that can be helpful to the case. For example, if a patient comes in and tells you that their family doctor recently diagnosed them with type II diabetes, obviously a naturopathic doctor knows what this means. But by asking a question like, "what does that mean to you?" you are able to learn how much the patient knows about the disease and how it will affect them, and even draw out other information about emotional and spiritual effects. Open-ended questions are very powerful, and definitely have a very important place in the naturopathic interview.

A - Affirmations. It is important to affirm what the patient says because it provides them with an understanding that you as the doctor trust and believe in them. This helps to build rapport and more importantly, strengthen the relationship between doctor and patient that can lead to successful treatment.

R - Reflections. It is also important to provide the patient with reflective statements on what they have told you, because it is an effective way of communicating empathetically, and this obviously has a lot of merit in practice.

S - Summarize. This is a very key step to interviewing, because it shows the patient that you were listening and helps them to feel "heard." This is a very important aspect of the naturopathic interview, because many patients come in feeling that they haven't been fully heard, and by summarizing you can validate their feelings. In addition, this step allows you to confirm if you understand what the patient has told you, allows them to correct any mistakes in the information you have taken down, and finally, it may draw out more information that they didn't think about at the time.

S - Silence. This last S is actually an addition (the real acronym for motivational interviewing is OARS), but Dr. Ragbir liked to add this one because silence is also a key aspect. Many interviewers can get worried and uncomfortable about silence, but it actually has a lot of power if used effectively, and can strengthen the doctor-patient relationship. "Silence is golden," can really be true in this situation, as effective use can provide a lot of benefits during the interview.

That's it for today, looking forward to the next practical where we'll focus on automatic reactions (which I bet I have some serious trouble with, body language!), and hopefully get into even more role playing and examples.

HEROs 1st class

    Today I had my first HEROs class. HEROs stands for Helping Everyone Realize Opportunity. It is a course run by business coach Andy Belanger, and is also known as the Health of Business Business of Health course in the United States http://www.hbbhealth.net/. At some of the naturopathic colleges in the US it is a mandatory course, while here at CCNM it is an extra course. Well I am glad I took it, and will go over a little bit of what we do each day. The course involves 4 modules, the first 3 taking place on Monday or Tuesday nights (I'm going to Tuesdays since I have Physiology Monday nights), and then the last one on a weekend in the winter. The modules include Starting Smart/Leadership, Operations, Marketing, and Administration/Accounting.

   Andy has been teaching business to health professionals and working with naturopathic doctors specifically for 26 years now, and it seems like he has a very strong understanding of the field and of what it takes to be a successful naturopathic doctor --> on the entrepreneurship side. I say this because the majority of people who go to school to become NDs will likely have the skills and ability to be very successful and strong doctors, but the problem is that you also need to be an entrepreneur. It would be amazing if we could help people be healthy and that would be that, but the reality is that we need to be successful business people in order to that. If we are struggling financially to live keep our offices running, or even to survive in your personal life (pay your mortgage, buy groceries), then we wouldn't really be able to help a lot of patients. Also, marketing is such a key aspect of naturopathic medicine because so many people still don't know about it or understand the benefits they can get from it, so we can't really help people until they know we exist.

   So the first class today was on Starting Smart and Leadership. Andy provided a bit of an overview of the course, and talked to us a lot about what you need to do to hit the ground running. We talked about goal planning, business plans, how to properly "position" yourself in the market (how to determine where to set up an office and what kinds of things you should do to ensure that you have the correct services to provide for that area), and talked a lot about what successful and unsuccessful people have done. So I'm very excited to move through this course and work hard to learn from it, and use the lessons in my planning for the future so that I can be successful and help lots of people in the future. I'll continue to comment on the next sessions in the future (with the next one being next Tuesday).

Medical Equipment!

   So after our final biochem midterm yesterday (woo finally done!), our Clinic rep Alex had an awesome medical equipment demo for us at his apartment. He's been doing a really great job of setting everything up for us and trying to get us the best equipment and best deals --> I'm very impressed and glad I voted for him. So Ken from Steven's Medical Group (a great company, my Garan said he actually used to deal with them for medical equipment for his office) brought in all the Heine equipment including sphygmomanometers (blood pressure gauges and cuffs), diagnostic sets (eye and ear scopes), and stethoscope. He also brought in Littman stethoscopes and Welch Allyn sphygmomanometers, though he actually had to do it in a separate room (another rep he works with was there who exclusively shows Heine equipment, so he had to do that because of conflict of interest or something).

   I tried out everything, it was pretty cool checking out the eye and ear scopes and actually seeing everything. I was also really happy with the Littman stethoscopes --> I've tried a stethoscope before in my physiology class at Laurier, but the quality was really poor and I could barely hear anything, so it was good that the one I'm going to buy had great sound quality.

   So in the end I ended up buying the Heine diagnostic set and sphygmomanometer, the Littman Cardiology 3M stethoscope (great sound quality, bell and diaphragm for high and low frequency sounds as well as easier to use for pediatric patients), and all the extra stuff we need (reflex hammer, tuning fork, eye chart, pen light and thermometer). We only need the sphyg and stethoscope for this year, but I got a great deal buying everything at once. The original deal was if you got a Heine sphyg and diagnostic set, you'd get a free stethoscope --> I really didn't like their stethoscope and couldn't hear much, so Ken was really nice and gave me a $147 credit rather than getting the stethoscope, so it was definitely worth it in the end (though everything together cost me over $1300! Hopefully I'll use it for the rest of my life though, so then I guess it's worth getting the best stuff).

   I'm pretty excited to have my own professional equipment (which I'm sure I'll bother my family and friends with a lot when I want to practice using them). When I get them in a couple of weeks I'll definitely post some pictures of them, but for now here's a picture of the stethoscope I got:

Here's the funniest one you can get --> pink tubing with a rainbow chestpiece! I obviously didn't get this one because it may make patients find me, just a wee bit unprofessional (I think this is more for pediatric doctors). Pretty funny though!

Midterms

    Finally finished midterms yesterday. 5 midterms in a week was pretty intense, especially because my brother came in from North Carolina for Thanksgiving and that really cut into weekend study time. Oh and not to mention that three of my exams were basically in another language (Botanical Medicine, Homeopathic Medicine and Asian Medicine). Overall they went pretty well though, and it was nice finally getting to relax last night after studying every day for the past 15 days! I'll do a quick recap of what the exams were like.

Tuesday morning --> Anatomy
Dr. Terzic wrote a pretty fair exam. It was 85 multiple choice questions, 3 questions were matching but the rest were just straight up. Overall it wasn't so bad, I just had a little trouble remembering exact locations of some ligaments and muscles. The practice midterm questions someone put up on facebook were really helpful.

Wednesday --> Botanical Medicine
This was a pretty hard exam. All multiple choice (I think 50 questions). Quite a few questions about specific actions or names of phytochemicals. I think knowing the specific classes well would definitely help with this, also knowing some specifics from the safety stuff (especially about how to affect specific parts of liver detox, not just phase I or II) would've been good.

Homeopathic Medicine
This was a pretty tough exam with 50 multiple choice questions, just because knowing the remedy pictures was so hard for me. The stuff not related to remedies, like philosophy and terminology was actually not bad, I knew most of it pretty well. So just knowing the remedies better would be good; there was lots of questions about specific cases and what remedy should be used. The really tough questions asked "what would be the best question to ask to determine the correct remedy?" To help with this, it would be great to determine key difference between remedies.

Thursday --> Asian Medicine
Having past midterms was really helpful for this exam, but also it just wasn't so bad overall, with 60 multiple choice questions. Asian medicine seems daunting at first, but the more you study the more everything makes sense. There was a lot of questions just giving you symptoms and asking what pathogen is involved and stuff like that. There was also 3 full case studies, but then he gives specific symptoms from the list and asks questions about them, so you don't really need to read the case studies. As long as you know elements, pathogens, patterns and vital substances well, there really isn't any tricks in this exam.

Friday --> Biochem
This exam wasn't too bad because I've taken biochem already in undergrad, but also because it really followed our assignment closely. If you did well on the assignment, or made an effort to ensure you understood the stuff from it well, then it should be okay. The only real curveball of a question was about epimers and anomers --> kind of random stuff from our first lecture, but aside from that just following the assignments and past midterms on google drive was really helpful. The whole exam was short answer which was a bit of a change, but it really wasn't so bad since going over all the material and assignments made it pretty easy to talk about. And fortunately you can write point form so you don't have to kill your hands.

So that's it for the first set of midterms, 5 wasn't so bad, though 8 during finals will be interesting!

Where do we go from here? Part 1

   Even though I'm busy studying for midterms (they are creeping up!), I still decided to go to the NMSA seminar tonight. Where do we go from here? is a 3 part seminar series they are holding to help students get a grip of the future and be aware. I think it's a great idea --> it's easy to get caught up with school and studying and all that, but in the end, we're here to become doctors and go treat people. So it's definitely great to hear about experiences of people who are actually doing it.

   The first part of the series was Interns, and that was tonight. We were in classroom 5 (though I went to classroom 4 at first and was worried no one was there, I guess because 99% of first year is in that room I just assumed!), and there was a fair amount of people, though it seemed like most of them were in third year. They also had pizza which was pretty good, though a lot of people showed up so I only got one piece.

   Anyway to the point! So basically there was a panel of about 10 fourth year interns that talked about their experiences in the clinic and answered lots of questions. There was pretty good representation of fourth years, with interns from all four of the specialty shifts and several of the satellite clinics. They also talked about externships, though none of them had done one at the time, and may not be doing that anyway.

   So I'll talk more about some of these in the future, but here are all the current shifts available for CCNM interns:

Regular Shifts:

Monday 2:45pm-7pm
Tuesday-Friday 8:45am-7pm
Saturday 8:45am-3pm
Sunday closed

Interns work during these shifts with all kinds of patients. They have about an hour of "preview" at the beginning (meet with supervisor and all co-interns on the shifts --> go over some of their current cases and what they plan to do, make sure it is okay with the supervisor; get all paperwork and everything in order), see patients for 4 hours (I think a max of 4 patients at RSNC, satellite clinics and externships can see more depending on the situation), and then "review" (go over what they did do in their big groups, maybe learn about specific topics from their supervisor like HIV, vitamin D, anything relevant).

Specialty shifts: These are limited so only people who really want them do it. They also limit you from doing the one month externship

Sports Medicine --> focus on athletes, lots of nutrition and musculoskeletal stuff (this is where I actually see my intern since I always get hurt!)

Pediatrics --> working with kids anywhere from a day old to 18 years old (the parents actually stay in the room for most of the visits, but you are treating the kid --> great for preventive health care!)

Fibromyalgia/Chronic Fatigue Syndrome --> really great shift helping people that in many times, conventional medicine and mental health professionals give up on and tell them it's all in their head, when really it is quite physical and we can do a lot to help them

Adjunctive Cancer Care --> very intense shift, great learning opportunity, and get to help with IV therapy (supporting patients, we can't learn parenteral therapy until we are licensed I think)

Satellite clinics: (all of these are free for patients, and generally a very different income bracket so treatment can be a little different; dispensories are available but based on donation so a lot of it is acupuncture, physical medicine and counselling)

Parkdale Community Health Center (Queen and Dufferin)

Sherbourne Health Center (Toronto) --> a lot of work with patients who have HIV

Anishwabe Health Toronto --> a lot of helping patients who are Aboriginal

Queen West Community Health Center (Toronto)

Brampton Civic Hospital --> really cool integrative learning clinic --> the first and only naturopathic clinic within a hospital (but there will be more soon I'm sure!)

LAMP Community Health Clinic (Etobicoke)

Externships:

So you can do an externship for one semester that is 1 day per week --> this may be with an ND who is from your hometown or out of the city or something, but this is during regular shifts as well

You can also do a one month externship in August, November or Februrary --> some people take this opportunity to go to their hometown in Canada (we can't currently go to the US for insurance reasons)

Thats all for now, time to make lunch for tomorrow and then off to bed before another day of midterm studying (woo...)

Front desk at RSNC. I like how the walls are a brighter colour, compared to some medical clinics that can be a little too white (the bright colour keeps your mood up!)

Midterm Studying

   So it's Monday night, 8 days before my first midterm and I'm sitting at home studying for the last few hours, after already studying for a few hours Saturday and Sunday. 10 days before a midterm? That's something I would never have done in undergrad. Maybe for a final, but definitely not a midterm. Why the change? Maybe because I have 5 midterms in 4 days, 3 of which are practically in another language! It's definitely going to be an interesting ride next week, but I'm working hard now and have a pretty good study schedule to get myself as prepared as I can (again something I would never have done in undergrad, but with the way things are it seems like a good idea, and I hope it goes well).

   One thing I wanted to mention today though was just how great my class is. Everyone is very supportive and wants to help each other succeed, and it really feels great to be part of this community. We have a gmail account which we share and on the google drive, everyone posts lots of stuff to share and help each other out. We also have access to the 2nd, 3rd and 4th years accounts, and there is plenty of useful information, study notes, and even practice exams that really help with studying. All of the information is really great to have, not to mention that my classmates are so diligent at posting on the facebook group if they've added or found anything new and useful for everyone else to download.

   So it's definitely going to be a tough first midterm break, but at least I've got the support and help of a lot of great people to get through it. On that note, I hope anyone else studying for exams out there is doing okay with it. And tip of the day (since I feel like I should probably post something useful for the readers out there): make sure you take some time for yourself. No one can effectively study if they just go straight for hours on end; you won't retain all of it and you won't feel so good either. Take frequent study breaks to get up and walk around, get a snack, and even set goals for yourself and your studying. When you achieve them, reward yourself with a TV show or hanging out with friends. It makes studying much more bearable, and makes it a lot easier to get back to it when you're done.

     It's hard and there's a lot to know, but a good plan helps make this a lot more manageable

Early Practice Management Tips

     We had our last Clinic lecture this morning, my SOAP charting assignment has been handed in, and now all I need to do is go to my clinic shift on November 23 (really excited about it, sad it's not for so long), and write the reflection for that. What I want to talk about today though was the presentation we had before our lecture started. We were lucky enough to have Jonathan Wilde come in and talk to our class for a little while before we started looking at case analysis. Jonathan is the teacher for Practice Management in third and fourth year, but it was nice that he came in to have a short talk with us today.

    I really liked listening to Jonathan because he went over some key points that I think are really important. First and most important is the importance of business in naturopathic medicine. Of course the vast majority of naturopathic students (including myself) got into this field because we want to help people to live better lives; if we wanted to make lots of money, we would've gotten into some sort of business. But it is important to remember that we are still part of a business. Business includes things like marketing, and they are so vital to naturopathic practice. Of course we want to help people, but if you don't have any patients, then you can't really help anyone.

    So hopefully the practice management courses in third and fourth year will be helpful, and I've also signed up for the business club and will look into other avenues for some extra business education to help in the future (great that I've got some accountants and lawyers in the family), but here are some of the great tips that Jonathan gave us that we can start right now:

1.  Get a website so you can start getting your name out --> hopefully by working on this blog I've started that a bit

2. Preceptoring --> I think a lot of people see this as something you need to check off your list, just get as many hours as you can as quickly as you can, and likely with few practitioners so you can just get a lot of hours done faster. Jonathan's presentation really reinforced a key aspect of preceptoring --> working at the front with the receptionist and asking lots of questions about the business. It is obviously important to watch different practitioners with patients and learn from their interactions, but the business side is a key aspect which should not be overlooked. Preceptoring under many practitioners, asking lots of questions, reflecting on the experiences and learning what works well and what does not are key activities that can help naturopathic students prepare for their futures in business.

3. The obvious one --> getting out there. Everywhere you go, when you meet new people or when you're talking with friends and family, it is important to be proud of what you do and are going to do, and to educate people. Developing a strong elevator speech about naturopathic medicine helps to provide people with the information they need to determine if they want to know more, and to know that you are a reliable source for information about this wonderful field.