by Dr. Talia Marcheggiani, ND | Apr 13, 2018 | Diet, Empathy, Evidence Based Medicine, Health, Medicine, Mental Health, Nutrition, Professional Development, Psychology, Self-reflection, Supplements
I will never get annoyed at a patient’s “lack of compliance” again.
Health care is scary, even when you know what you’re doing. When it’s your own health, putting yourself in the hands of a professional is not easy.
Yesterday I had an initial consult for myself with a nutrition specialist. She’s well-known in her field, super-academic, in her 70s, and has published books and papers.
She knows her stuff. She’s also really helped a friend of mine and the referral came from him. I had every reason to trust her and feel good about putting myself in her hands.
However, I was nervous getting ready to see her. I filled out a diet diary… what would she think? What would she say about my blood work? Would she be nice? Would she be understanding? Would we get along?
Survival instincts kick in.
We talked about a few things in the first visit (which cost an arm and a leg, but will be worth it if I’m left feeling great) and she prescribed some supplements for me to take.
I left, kind of satisfied. Ready to get on with our journey, with a list of things to pick up, dosages to tweak, things to consider and instructions to book again in 3 to 4 weeks.
Ok.
I woke up this morning, in the early hours tossing and turning, thinking to myself, “I don’t want to take vitamin E!” And “Did she truly understand my concerns?” And “what are all these supplements treating?” and “did she really hear me out?” And, “is all this going to actually help?”
The impulse to not trust, to run and hide, to override her assessment and recommendations with my own were overwhelming. (And, of course, as someone who does what she does for a living, the struggle to overcome this is real, we’re “experts” on the body, but it’s nice to let someone else give direction for a change, especially someone with 30+ more years’ experience).
Still, trusting is hard.
Being aware of the impulse to run and avoid, while also resisting the impulse, is hard.
I have people who neglect booking a follow-up even when they know that we still have lots of work to do.
I have people who don’t fill out diet diaries for fear of actually taking a hard look at their food intake.
I have people who email me that “nothing is working” when in fact they haven’t started taking their nutrients and supplements yet.
And, guess what, as frustrating as that may be (because ultimately, I want people to have success! I want people to heal), I’m doing the same thing.
Jeez, being in the patient chair is mighty humbling.
I highly recommend it to all my health practitioner colleagues out there.
And, yes, now I’m taking vitamin E. I’ve decided to just trust. (But I’m still taking my own multi-vitamin… hey, doctors make the worst patients… amiright?)
by Dr. Talia Marcheggiani, ND | Jun 8, 2015 | Canadian College of Naturopathic Medicine, Clinical Science, Evidence Based Medicine, Preventive Medicine, Professional Development, Research, Robert Schad Naturopathic Clinic, Science
Sigh… I just finished reading a rather annoying article in the Globe and Mail (don’t even bother to click and add more Google street-cred, seriously) that doesn’t really warrant a response but… here we go. It’s my day off.
The article was written by one Carly Weeks, who doesn’t seem to have a very positive view of naturopathic doctors. I don’t know Carly and have no idea about her health history, but I’m going to take a shot in the dark and imagine she hasn’t suffered from chronic eczema.
Let me know how that steroid cream works out for ya, Carly!
But, ad hominem aside, her issue with naturopathic doctors this week(s)—pun intended, aren’t I hilarious—is, what else: we’re a bunch of quacks who use nothing but false therapies and smooth-talking to coax our patients into thinking they feel better. Well, if that worked, I wonder why more healthcare practitioners don’t try copying those moves too. It might save the government some money, which is what, coincidently, naturopathic medicine is already doing and it’s not by false therapies and smooth-talking. (But we do make time for a lot of talking).
The Globe piece begins with a story about how physicians (not naturopaths, for the record) prescribed radioactive water in the 1920’s. It’s a cute and tragic story about limited safety profiles. And other than its juxtaposition in an article about NDs, I’m not sure what the writer’s point was. We don’t use radioactive water to treat anyone. If you want radiation, which is a therapy, a cancer treatment, then you must see an oncologist. Talk about throwing out babies and bathwater.
The article is largely about how naturopathic doctors are moving under a new regulatory board, under the Regulated Health Practitioners Act. This limits our scope compared to that of provinces like BC or certain US states, where naturopathic doctors have been prescribing drugs and even performing minor surgeries safely where it’s warranted.
Here are some facts:
Naturopathic medicine is incredibly safe. We are trained in conventional diagnosis, anatomy, physiology, physical exams, including gynaecological exams, breast exams and digital rectal exams. We have the ability to perform acupuncture in Ontario and give intramuscular injections. With additional training we can provide IV treatments. We are trained to order and interpret labs and to take blood. I will not deny that conventional medicine and pharmaceuticals have saved millions of lives. However, we know that 10,000 yearly deaths in Canada (and 100,000 in the US) are due to pharmaceuticals alone. A year ago I wrote a post talking about the off-label birth control pill Diane-35. Let’s not start comparing safety profiles here.
Naturopathic doctors are highly trained and educated: We have completed a 4-year very rigorous program that includes a 12-month internship where we treat patients in an out-patient facility. In our training we performed over 100 practical and written examinations. After our second and fourth year we complete two licensing exams, which span a course of 5 full days of examinations combined. Ask anyone I know if what I did was easy. Trick question: they wouldn’t know because they didn’t hear from me for the past 5 years–I was studying the WHOLE time. It’s ok, though, because now I know a lot.
Naturopathic medicine is a regulated profession: In order to practice in Ontario naturopathic medical graduates who have passed both licensing exams, must pass a series of board examinations that are both written and practical. We then must enter into a month-long application process, which includes a police background check and character reference check. If I try to delay treatment of an emergent condition or treat an emergent condition with something like homeopathy or acupuncture (effective treatments for other conditions, but not emergent, life-threatening ones), which is something we are often accused of potentially doing, my licence will be removed. It’s not something we do—it’s that simple. We are held accountable and have a lot of responsibility to deliver safe care.
Naturopathic doctors are health experts: In order to complete the naturopathic medical program we complete 1200 hours of clinical training and 3000 hours of classroom training. This does not include study time for our board exams and pursuit of side interests or continuing education credits that are required to maintain licensure. We are trained in nutrition, which many medical professional, including medical doctors, are not. Naturopathic doctors often see patients that have been failed by the conventional medical system, which means we deal with complex cases on a regular basis. This demands that we keep our skills sharp and our knowledge current.
Naturopathic medicine provides the public with an amazing service that patients are willing to pay for: We spent up to two hours at time with our patients, educating them on any topic of their health picture: the medications they’re on that their doctors don’t have time to discuss with them, their health conditions, their prognosis and what else they can do about it. I spent half an hour talking about an STI a patient of mine had been diagnosed with. She’d seen two doctors and a specialist. None of them had talked to her about it. Patients have told me their doctors no longer perform physicals. Well, we do. And, it turns out, people pay for excellent care. Naturopathic medicine provides the much-needed service of patient education, human-centred care and prevention of disease. It’s an excellent complement to an effective whole-person healthcare strategy.
Naturopathic medicine works: I could say more on this but let’s keep it brief: if it didn’t work, people wouldn’t pay for it. The Globe and Mail, more than anyone should know to “let The Market speak.” (Amiright?) I lied, I will say more. If you don’t think naturopathic medicine works, then call my patients who no longer have chronic pain or allergies or chronic constipation. Ask my patient who couldn’t conceive how her daughter is doing. Blah blah, we help people.
Naturopathic doctors prefer to work in collaboration with other healthcare professionals: Ideally each patient should be managed by a healthcare team. When I start seeing a new patient I immediately establish a relationship with his or her medical doctor. I refer out for labs and to specialists if necessary. Medicine should be integrative, not alternative. Patients shouldn’t be forced to choose.
In addition to accusing us of being a bunch of unsafe quacks, the author writes, “Ontario should have created a regulatory system based on the principle of evidence first.” So, there you have it. Only medicine that is based in evidence should be regulated by the province.
Wow, what a ridiculous statement made by someone who I imagine knows little to nothing about how medicine and so-called “evidence” works.
Firstly, there is more than one type of evidence. In fact, evidence is a hierarchy. At the bottom we have things like clinical case reports or expert opinion, what my friends the skeptics love to call “anecdotal evidence.” Sigh. If you’ve seen something work, you keep doing it. It’s not the best evidence we have, but it’s still evidence. The better forms of evidence, randomized control trials, are being done on naturopathic therapies and naturopathic therapies have been found to hold steady. Actually, many of the therapies we prescribe are done precisely because there is evidence to support it: fish oil for depression and bipolar disorder? Inositol for fertility in patients with PCOS? Evidence, evidence, evidence.
Secondly, only 10% of medical guidelines are based on the type of “evidence” that our friend Carly Weeks is likely referring to: the Randomized Control Trial, which involves comparing two groups: a treatment group to an inactive group that gets something like a placebo. Well, it turns out, we just don’t have that much “evidence” of this sort to dictate what happens in medicine. A tourniquet for a bleeding wound? Using general anesthetic rather than nothing? These things haven’t been compared against placebo. What is the other 90% of medicine based on? Expert opinion: a nice mixture of clinical expertise, intuition, common-sense, “what the heck, might as well try it it couldn’t hurts” and research. I don’t see Carly questioning the use of SSRI for mild and moderate depression or beta-blockers to prevent cardiac events as a result of high blood pressure, both of which have “no evidence” to support their use. Nope, just crickets when it comes to those topics.
Thirdly, the father of EBM, or Evidence Based Medicine, himself, Dave Sackett, said, “Good doctors use both individual clinical expertise and the best available external evidence, and neither alone is enough. Without clinical expertise, practice risks becoming tyrannized by evidence, for even excellent external evidence may be inapplicable to or inappropriate for an individual patient.” (Emphasis mine). Individual clinical expertise from both modern and traditional medicine, the best available external evidence and tailoring treatments to individuals patients needs and preferences? Sound like naturopathic medicine to me.
Naturopathic medicine is safe and effective. We have a patient-centred approach and offer wonderful service for the cost, which is often covered by insurance benefits. Naturopathic doctors take the time to listen to your story and educate you on what is happening in your own body. We treat the root cause of your condition, rather than masking symptoms. We are highly-trained healthcare professionals and we are regulated. Soon we will be moving to different regulation. However, the government will be removing some of the rights we’ve had, which include ordering certain lab tests that we’ve safely ordered for years. If you use or support naturopathic medicine, please click the link to sign the petition to maintain the current naturopathic scope of practice in Ontario and support safe and effective natural healthcare for all Ontarians.
Quack.
by Dr. Talia Marcheggiani, ND | Jan 3, 2015 | Gratitude, Health, Holidays, Medicine, Mindfulness, NPLEX, Professional Development, Relationships, Volunteering
2014 has been a year of beginnings and endings. I ended two major relationships: one with the school I went to for 4 years and another with a long-term boyfriend, and began two new ones: I embarked on my own career as a naturopathic doctor and started a new relationship. The past year for me represents the tail end of several important life-cycles and the promise of exciting new beginnings.
It was the year I turned 28, starting a new 7-year karmic cycle. I broke up with my now ex-boyfriend of 5 years and finished my studies at the Canadian College of Naturopathic Medicine. I dedicated a large portion of my time to social activities, self-expansion and personal growth. I got out into the world and made new friends while strengthening old friendships. I became a little more daring and a lot more open. These changes helped groom me into a better doctor.
I spent the summer working, dating and studying for NPLEX II. I embraced new opportunities and made many new friends with co-workers, ex-classmates and complete strangers. I became more artistic.
I went to India in August and September after finishing NPLEX II. After 4 years of constantly doing, it felt wonderful to relax into the chaos of India and become an observer for a month. Simply being felt foreign and very uncomfortable at times, but also balancing. I relished the long train rides, the heat and the variety of cultures, smells and colours – especially the food. India contains a furious energy about it. It was a wonderful experience and a brilliant way to open myself up further to new experiences while exploring a different corner of the world.
When I arrived home from India I was ecstatic to find that I had passed NPLEX II and my Ontario board exams. I applied for my naturopathic licence and began looking for clinic spaces. When I met Heather Osler at the Bloor West Homeopathic & Wellness Clinic, I immediately knew that the space was an excellent fit. So far, I’ve been right. The calming, healing energy of the space and the wonderful staff have been amazing. I have been blessed with a practice that has been slowly and steadily building from my first week. I am grateful for the wonderful patients that have booked with me in 2014. I have learned a lot from them and have had the opportunity to help them feel better, something that I love to do.
2015 brings with it the promise of more successes in private practice as I grow my existing patient base and eventually add more practice days to my week. I look forward to connecting with my ex-classmates and new colleagues, to giving talks and writing blogs and connecting with the community. I will be taking a course in Motivational Interviewing (MI) at OISE at the University of Toronto this January and February. I also hope to take more courses in psychological methods to strengthen my ability to treat mental health conditions; I plan to find ways to bring my love for art and writing to the therapeutic experience.
I have the opportunity to volunteer 1-2 days a month at the Yonge Street Mission health clinic and am looking forward to spreading naturopathic medicine to the community, a passion of mine. Between my private practice and volunteer work, I hope to quickly expand the number of people I help with naturopathic medicine.
2015 will bring with it creativity, in the form of exciting new writing projects and an effort on my part to make time for painting and consuming art.
I hope 2015 will be a year of love, bringing with it more fulfilling relationships and the opportunity to strengthen my existing ones with friends, my significant other, my family and, of course, my Colombian yorkie, Coco. I learn so much from my relationships and they remain the most important part of my life. They encourage me to grow and continue to challenge me to become a better person, writer and doctor. I hope to find mentors both inside and outside my profession that challenge me to continue to grow and provide me with needed guidance on my journey.
I plan to travel in 2015, to Puerto Rico, to visit the home of a dear friend and his growing family and back to Guatemala, to see my best friend in her tiny, bohemian village. I would also love to do a silent meditation retreat this year, finding more centring and balance.
I also know that 2015 will be about my own personal health. I have resolved to cut out sugar, drink more water and dedicate myself to becoming physically fitter by engaging in more yoga and strength training. I also resolve to strengthen my mindfulness practice and meditate more regularly, which I believe will help me become more conscious and present, both as a human and as a healthcare practitioner.
Most of all, I hope that 2015 will be about gratitude. As I become older, time seems to pass all the more quickly and I find this to be an alarmingly unpleasant realization. As a lifelong student and now a professional running her own business, I often find myself consumed by future goals, wants and needs, which interferes with my ability to live in the present moment, be reflective of and grateful for all the blessings I have been given in my life and currently enjoy. Dedicating myself to counting these blessings helps to anchor me to the present moment and feel happier with the wonderful life I’ve been given and the wonderful people who surround me.
2014 was an amazing year of transformation and growth. While Back to the Future II promised us a 2015 of flying cars and 80’s-style sneakers that automatically lace themselves, I believe the real 2015 will be an even better year filled with strength, opportunities for further growth and development and love. I hope to build more confidence and wisdom this year, develop more confidence in myself and add more stability to my life. 2015 will be about building strength and foundation.
I wish all of you the best this 2015. What are your reflections, hopes and resolutions for the coming year?
