The Yin and Yang of Hospital and Private Practice
I have recently found myself in the interesting position of counseling my naturopathic colleagues as they transition from a hospital-based residency into the world of private practice. I described my own transition in between these two worlds as being raised in a hospital but growing up in private practice. To be raised as a new doctor in a hospital setting shaped my worldview of medical care, but the freedom of being in private practice has allowed me to grow into the physician I want to be. Being a naturopath in a hospital setting gave me a balanced perspective about the variety of ways to approach patient care, opened my eyes to the good and bad of medicine being a business, and allowed me to examine the strengths and weakness of a variety of medical settings from the ER to family practice.
My first year at the hospital I kept a journal of my experience documenting the changes in culture as if I was an archaeologist studying a far away island noting the behavior of the natives. I changed the pace of my walk so the cadence sounded like the other physicians in the hallways. I took out my nose ring (this was a dress code requirement). I even altered the way I held my arms when I was standing still, because somehow this was a non-verbal cue of experience and expertise. I made these subtle changes because I felt it would be the best way to learn from the immersion experience of a hospital-based residency.
When I talk to other naturopaths about working in a hospital the questions about rules and regulations quickly comes up. It is mostly through necessity that hospitals have rules and regulations. They treat hundreds of patients a day, and my hospital was the largest employer in the county. With clearly defined roles, a sense of confinement allowed me to fully explore the value of naturopathic medicine to very ill patients without the bells and whistles of injection therapies, drug therapies, and an endless medicinary built on a whim instead of a pharmacy committee. Emerging from this well-defined space left me wondering… how often do I need to recommend IV therapies? What is the time and place for off label drug use? Can I be effective with less capsules?
When I reflect back on shifting who I thought I was in order to fit into someone else's definition of naturopathic medicine, there were definitely times that I felt suffocated and constricted. But it is in contemplation of these experiences that has allowed me to define who I really want to be as a healer. I know that it was through trying on different personas and seeing what fit and what didn't fit that helped me clearly define who I am as a doctor now.
When I started my private practice, I was overwhelmed by the freedom of self-expression. My patients were of a different variety and wanted to buck the conventional medical system, pushing me towards standing on naturopathic medicine alone as a treatment for cancer, instead of resting on the concept of integration. I found myself walking a tight rope between good health care with sound clinical judgment and pushing the boundaries of medicine. This was a scary place to be in at first, but as I get more used to this dynamic I find myself willing to take calculated risks with clear boundaries of measuring what works and what doesn't work.
If you were a fly on the wall when I first started private practice you would often hear staff saying “you are not in a hospital anymore, you don't need to do that” and “you're sound like an MD not an ND.” Based on this reintegration experience, I would encourage our profession to use some of the models that work for hospital based systems. Honestly, I miss having a single language that we all spoke in, a similar charting template, the same referral letters, and even the same cadence while walking down the hallway. These kinds of behaviors create community and a sense of connection. It let me know that no matter who was on the other side of the phone or the chart that we had a similar perspective.
I also find that in private practice there tends to be ill-defined procedures, shaky safety protocols, a lack of continued informed consent, and the missing link of role definition. Although NDs might take pride in not fitting into a box and living fully in the joy and freedom of self-expression, I ultimately believe that this will be a growing pain for our profession. A growing pain that when dealt with proactively will help define us as a group as we gain increased national exposure.
When all is said and done, I feel the best healthcare is provided through integration. I loved sitting around the table with other medical professionals with different specialties and viewpoints discussing a case and I miss those types of daily interactions. I have a profound appreciation for those that provide conventional medicine and their support staff. On the other hand, I am excited about defining my medicinary, while still applying what I learned from the pharmacy committee. I love being more flexible in my workday so I can schedule time for self-care. I am so grateful for the freedom of self-expression, which has included energy medicine, yoga therapy, meditation, and more intense diet therapies that were not part of my clearly defined role at the hospital. Ultimately, I have enjoyed both the yin and yang of each experience.
Looking forward, my hope for the naturopathic profession is that we find a balance between conforming to an environment that limits our full potential as physicians and always having to strike it out on our own. I hope that we can find a way to create the boundaries of standards and community, while celebrating the uniqueness of each physician. Your comments on how to do this are greatly appreciated.
Dr. Heather Paulson is a Fellow of the American Board of Naturopathic Oncology (FABNO), which represents the highest expertise in the area of naturopathic oncology. After graduating from Southwest College of Naturopathic Medicine, Heather furthered her training at IU Goshen Health System for two years as an oncology specialty resident. Currently, Dr. Paulson is in private practice at Arizona Natural Health Center and has an oncology focused practice that brings together the best of natural therapies for cancer care. Dr. Paulson enjoys sharing her naturopathic oncology passion by teaching oncology at Southwest College of Naturopathic Medicine. You can reach Heather Paulson at www.aznaturalhealth.com or firstname.lastname@example.org.
Thank you to Emerson Ecologics.