I’ve made it. Three years down, one year to go, and the clinical year to boot! I am at the halfway point of my final year – midway through my second semester as an intern– and it has definitely been an adventure. The summer was fairly busy with patients coming in. I was told that it was going to be slow – that was wrong, but I’m not mad about it. It was a great jumpstart into clinic. I definitely learned how to research patient conditions and it has taken me a while to organize my class notes in order to find things seamlessly, but I’ve got the hang of it now! I love all of my supervisors; they all have different ways for practicing which means that I get different perspectives to figure out how I want to practice myself.
Like any other profession, there are good days and bad days. There’s also the occasional difficult patient who chooses not to comply with treatment; so far, the great patients have been making up for them. In my short time as an intern, I already feel like I have learnt so much about myself and how to face this new journey that I am embarking upon. Of course, there are always new lessons to learn, but here is a list of the ones that I have come up with so far:
1. Having a plan, but learning to go with the flow at the same time
I'm the type of person who loves to be prepared. I will research and plan and then re-plan if the original plan isn’t going to plan (lots of planning!). However, I am slowly learning that this method will not work for all patients. You could create a protocol for their chronic constipation that they’ve been telling you about for weeks, then one visit, the patient comes in saying their stomach is fine but it’s their anxiety that is acting up and they don’t want to change anything in their diet anymore. I can’t just ignore the fact that they have a new concern even though I spent hours working on their digestion protocol. I have to learn to think on my toes and adapt. I was never good at improv in drama – now it’s come to bite me in the behind. Checking my reaction to this sudden change is also important, because I need to make sure the patient feels comfortable telling me about any health concerns they have. It is their life journey that I am assisting with; I have to make sure I can be flexible for them.
2. Meeting them where they're at VS. pushing them to reach the goal
This is a tricky one, and one that I struggled with a LOT in the first semester. One of the patients I was working with came in with a very specific diagnosis and goal. They could tell me exactly what they wanted and that they were committed 100% to getting there. I was so excited because it was an interesting case and you have no idea how amazing it feels to have such a motivated patient. However, with all the work and research I put in, the patient really wasn’t looking to do much. No counselling, no dietary changes and no willingness to do any work outside of our visits to achieve the goal in the predicted and evidence-based time frame. I struggled with telling this patient that I could not help them anymore, but my supervisor told me that they probably just aren’t ready to reach the goal they set out, and we have to meet them where they are at. We treat them as they see fit and they will get there on their own. To be honest, I am still struggling with this. On the one hand, it is true I should support the patient’s decision, and they are paying for the service so it’s important to make sure they are comfortable with the care I provide. The other side of the coin is that they came with the goal in mind, and I feel that it is important to be the outside source pushing them towards that goal, not enabling them to stay where they are. These are 2 different perspectives on how to approach the situation, and I’m realizing, they are both valid, I just have to assess for myself which method is best of which patient.
3. Know your boundaries
Some patients really like to talk, others will leave the really important stuff until the very end and a small number will probably get mad at you, think you are incompetent and that you don’t know anything, no matter what you say. The lesson here is to not be taken advantage of and not take anything personally. If you are confident in what you know (and in what you don’t know) then the patient will respect you more for that. It’s important to set that standard early on too, or else it can snowball into losing control of the appointment. For the patients that get mad at you, it can’t be taken personally. More often than not, they do not know you well enough to have such a strong opinion for or against you. It’s more about what they have been through in their past than what you have done in that moment. Learn to be okay with taking the hit, but also have your own support network who is around to cushion the blow.
4. Give the information and let the patient decide for themselves
I spent my years studying all the information, and I know how to research the best evidence-based or clinically proven techniques. I can give all the pros and the cons to the patient about one protocol or the next and give my professional opinion about how best to approach the situation. However, it is not my life, it is theirs – they have to decide to actually do it in order to get better long term. If they choose against it, I have not failed, they just chose not to do it. The next best thing I can do is ask them why they aren’t doing it and work with them to find a solution. If they still don’t want to do anything, then there is nothing more I can do as I am probably not the right practitioner for that patient – best to refer to someone else.
5. Some patients know more about health products than I do
There are new supplements and health products coming out all the time, sometimes it’s hard to keep track. Patients come to visits all the time and bring up products that they swear by and I’m doing my best to make sure I keep updated on all of that. Some products will have clinical merit and others will need to be debunked and replaced with the evidence-based/ clinically proven versions. With how fast trends come and go, I can’t possibly know them all. It’s good to have a group or network of colleagues around who can help fill in the gaps on product knowledge when necessary!
6. Be aware of patient budgets when making treatment plans
Naturopathic medicine is expensive, especially in Canada. Our healthcare system is considered “free” in the public eye (paid for through taxes) so we have to take that into account, especially if the patient is uninsured. I have to make sure to ask about patient budgets and create health plans for my patients that will both provide them with the best care and fit into what they can afford. It’s a creative balance that needs to be addressed, but hey, that’s why medicine is called an art and a science!
I am sure this is only the tip of the iceberg of what this future career will teach me. I’m up for it; no fear or frustrations will stop me from reaching that glorious graduation finish line and beyond! I hope that you enjoyed reading these lessons and will take some of them with you in the next adventures you face too.
Keep moving and be well!
- ND-B