The Importance of Community

Back again for my second "regular" Sunday post. I'm kind of procrastinating doing some work tonight, it's been a long day, but I'm going to do my post as promised.

This has been an interesting week as always, with our first ADNSA meeting, practicing CBT on standardized patients in Health Psych, trying out moxabustion and cupping in Asian Med, the Jays clinching the playoffs (woo! I'm such a bandwagon fan but boy is it a fun energy to be part of! Plus my grandfather loves the Jays and it's really nice to share something with him), and a really big one, the Proclamation Celebration on Thursday. That's right, the Naturopathy Act of 2007 has finally been proclaimed in Ontario - Okay, well it was actually proclaimed in July, but we're finally celebrating it. As with anything politically related, this is just one step on a long road, and you can't appease everyone as many people are a little upset about certain things, but overall, this is really great news for NDs in Ontario and across Canada and the US really. Improved regulation and legal rights leads to better patient care and protection, and better outcomes for doctors in the end. It was great to celebrate this occasion with fellow students and doctors, and to look back on how far we've come as a profession.

Anyway, onto the topic of my post for today. Community. An awesome TV show (well at least season 1-3); but also, an important word. A quick google definition of the word shows the following: "a feeling of fellowship with others, as a result of sharing common attitudes, interests, and goals." Coming from a large family, I think I've always taken for granted the importance of community, but it was really while reflecting on my last week, and doing some digging into some old psych notes that I got a greater understanding. Maslow's Hierarchy of Needs is an interesting concept based upon what it takes to find your purpose in life: self-actualization. I think this is something that everyone should and eventually will want to achieve, to answer the big question, "why am I here?" Maslow posits however, that in order to reach this point, you first need to attend to your most basic needs. This starts with physiologic needs like food, water and air, and then moves on to safety. How can you worry about your purpose if you can't eat, breathe, or drink, or if you don't feel safe from harm? But the next part of the pyramid is actually a feeling of love and belonging. We as humans have always survived and flourished because we build communities; we work together to help each other succeed; together. 

Of course being aware of this concept has led me to reflect on my recent past, going through this difficult program of Naturopathic Medicine. Could I have done this all by myself? Without a strong community? I really don't know. I do believe that we are all amazing beings with tons of potential for success, but I also think that we can all be better with the help of each other. In my first two years of CCNM, I was provided with endless resources from older students to help me succeed in my classes. I was given motivational speeches, invaluable tips, and people to talk to when I've felt overwhelmed. The help this community provides extends beyond just the older students though; my friends and classmates, future colleagues, are always there for each other. We all know that we have what it takes to succeed, but sometimes we need help to get through certain aspects. Individually, we are strong, but as a community, we are unstoppable. It is because of this that I am so glad to be a part of the NSA executive - my goal is to always help foster this sense of community among the students in years below me, and also students in my year and the one above me. 

This week I really appreciated the opportunity to give talks for the 1st and 2nd years on how to approach midterms, as it can be a little daunting. Having been in their position before, I know that it's tough, but I also know that they have what it takes. And more importantly, I know that they have what it takes to help each other get through. I have been pleased to see lots of sharing of resources and responsibilities among these students, sharing notes, creating study groups. This is the benefit of having a strong community, and I hope to continue to help build it stronger and stronger.

That's all for now, I've got work to do and my ability to write well is kind of flopping, but I'll leave you with this quote from Helen Keller: "Alone, we can do so little; together, we can do so much."

- and okay fine I'll put a funny cartoon this week!

But I swear I'm going to do my work today!
.... But maybe a quick break since I just wrote this blog post...

Tuesday! And I'm back for the second one, telling the truth!

Back again to summarize Tuesday's courses. I actually just finished doing some homework, the first homework I've really done all year! It's only the third week, I'll get in the groove I swear.

So the classes for today:

Health Psychology 3 - As our third health psych course, the expectations are getting a little higher, and there is a fair bit more practical work. This year is interesting though, because we actually have 2 SP cases for our group, and every practical, we will continue with those patients. Our first session was today, I fortunately didn't have to go as doctor (I'm a little too nervous to go first!), but it was a great experience to watch my classmates work with the biopsychosocial interview, as opposed to the more clinical focused one we watched yesterday in primary care. It was also interesting to see some of the homeopathy interviewing skills we've learned come into play here. Psych is cool though because you have a little more freedom than homeopathy to probe in different areas, but I find using those homeopathy skills helps really dig deep into what a patient is feeling, and what they actually mean when they speak. I'll also note that CBT (cognitive behavioural therapy) is a big focus this year, so we'll be working on that type of therapy with our patients in future sessions. Lucky for me, I got the textbook for free - it was actually a gift from a family friend of mine, cool enough he is a social worker who actually knows the author Judith Beck (her father is kind of the "father" of CBT as it is, and she has played a big role in it's development and popularity. I'm sure he'll be a good resource if and when I get more advanced and want some help getting better at using CBT. Oh ya I forgot to mention the professor - this one is taught by Dr. David Denis again, our professor from 2nd year. He is really great, a true counselling focused ND. He provides such a great presence when doing demos, and when helping as he floats through the different practical rooms. A wonderful resource to have in this course.

After health psych, we have a 3.5 hour break until nutrition. During this time, all the breakout rooms we use for primary care are scheduled out for the 3rd years, so we can use them for whatever we want, with IT and primary care work the main focus, if we want of course. Today however, I had to go to an exam policy meeting - 1 of my duties as one of the VP Academics for the NSA Executive Council. I'll definitely remember to do a post in the future reflecting on my experience on the exec council so far, as it has been pretty great. The meeting was a little boring, but also interesting. You can really see the faculty working hard to develop good policies to benefit the students, and also push them to better academic success. It's also interesting seeing professionals work in discussion group like this, because even though they are older and more experienced, they still have disagreements, multiple conversations and multiple people speaking over one another, all that fun stuff that happens when you do group work in school. A little more professional for sure, but it's interesting.

Nutrition 3 - Our final nutrition course is taught by none other than Dr. Prousky, who is the chief medical officer of the RSNC. It's pretty cool, because he is just a huge wealth of knowledge with many years of experience, and lots of scientific data. He is similar to Dr. Phil (from second year nutrition) in his strive for evidence based treatment, but he is also a little less intense, and worries about using a combination of evidence based medicine and individualized medicine. He is also big on orthomolecular medicine, which generally involved very high doses of vitamins and nutrients for therapeutic benefit. So this year will have a little less focus on diet and lifestyle that Dr. Phil provided (fish oil, 2 tablespoons of olive oil, a handful of nuts, and 30 minutes of walking a day will fix anything!), and instead look at more therapeutic use of nutrients. I think that a combination of these two courses will provide a pretty good foundation for using nutrition to effectively benefit many patients for many different conditions.

That's all for today, back to a little more homework before bed, but I'll be back tomorrow to talk about Wednesday. For now, enjoy this funny CBT cartoon I found.

Feeling Judged

Seems crazy I haven't posted in so long, and now this is my fourth post in a week! Anyway I was in homeopathy today and we had a practical working on case taking. This was fun because unlike health psych (where we have one person interviewing a standardized patient and everyone just watches), we all got a chance to interview each other. I definitely see the value in health psych, but this was great to get some more experience, and especially in a bit of a less threatening environment.

So while getting feedback on my turn as the doctor, my partner (who played the patient) mentioned that I made a good use of silence. Silence is an incredibly useful tool for a doctor as an interviewer, especially when it comes to mental/emotional things, because it provides patients with the time to think over what they've said and decide if they want to share more with you. This of course doesn't happen if the doctor goes through rapid fire questions and doesn't provide that silence (though of course rapid fire can be important when ruling out red flags for emergent conditions like a heart attack!). Anyway one of the things my partner mentioned was that she was empathizing with me and thinking that I felt like some of the silences lasted a really long time, but that for her it actually didn't feel that long.

I think this is really important to understand because it leads in to what I want to talk about, and that is the a feeling that you are being judged by others. This is something that I feel constantly and I'm sure many others do. You're hanging out in a group of people not saying anything, you're giving a presentation, whatever. You feel like other people and judging you, and as a result you get stuck in your head and don't feel so good. Basically the feeling I want to get across in this post is that in order to get out of this pattern, it can be helpful to be aware that in general, people aren't really judging you. They don't really care that much about the little things you think you are doing that may be embarrassing, because in reality, they are sitting there thinking the same things about themselves. People are incredibly self-conscious and other-focused, worried about what others think of them. As a result, you don't really need to worry about others, because they aren't so worried about you.

I understand of course that this is much easier said than done, and I know it is something that I am really going to start working on now and know it will be a struggle, but this again is of course where mindfulness really comes in. Be aware of your thoughts and feelings, try to understand where they come from, but ensure that there is no judgement. You will see that you can bring more confidence and a more relaxed disposition to your life.

- So if you're feeling too much in your head, what can you do? Push your feet into the ground a little bit and even try to grip the floor with your toes. This action reminds you that are not just in your head, you are in fact touching the ground, here, in this moment.

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.

                                               

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.

Mindfulness

    Health psychology was a really great class today, talking a lot about empathy and how to effectively communicate with patients, and people in general to ensure that they feel heard and that what they say matters. Before the full lecture though, we talked again about mindfulness and being in the present moment. To solidify this talk, Dr. Creech took us through a guided meditation in class, and then gave us a break to go outside and enjoy the sun. The whole experience has given me more understanding of how important mindfulness really is. We spend so much of our day thinking about the past and the future (even as I write this I'm worrying about work I have to do later tonight), and yet the present has so much importance. Past and future are important, but it is really the present where we actually exist. A smart guy once said, "life moves pretty fast; if you don't stop to look around once in a while, you might miss something."

   Through our discussions about mindfulness, I've also come to realize how important it is when it comes to speaking with patients, and also with our friends and families, really anyone we speak to. Think about the last time you spoke with someone, anyone. Were you completely in the present moment while you listened to them, or did your mind drift off at times onto things what happened that morning or what you need to do later that day or even right after you finish talking? It can be very difficult to stay present because our minds have so much information, how could they not wander? However, exercises like meditation and practicing mindfulness have the ability to get you focused on what is happening right now, and with practice comes to ability to remain present when you need to. This is something I plan to work on myself as I go through the program at CCNM, because my hope is that when I am in the room with patients in the future, I can forget about everything else in my life at the time, be mindful and present, and provide the patient with what they need. Hopefully this will also transfer to my social life as well, because though patients are obviously important, the important people in my life deserve the same attention as well.

    For those of you who would like to work on their own mindfulness, I suggest trying a short guided meditation such as this one. It is important with meditation to be in a quiet room where you can be comfortable, get in a comfortable position and close your eyes. Focus on breathing in through your nose and out through the nose because this engages the parasympathetic nervous system which will help you remain relaxed. Just focus on breathing in slowly, taking a pause, and then breathing out slowly, and repeat. As you focus on your breath and the sensations of your body, past and future dissipate from your mind, and the practice of mindfulness really begins. It is difficult and takes a lot of practice (I'm nowhere near where I'd like to be yet), but the benefits are well worth it.

(if animals really are like this, it must be nice to be so present with little worries)