Who’s Who: Concluding Thoughts

The final installment of the “Who’s Who” posts.

Before providing my conclusion to this series of posts, I want to briefly touch on a few other health professions that are becoming more significant to the primary care sector of our health system:

Nurse practitioners and physician assistants are growing in number to help with the primary care deficit were are facing.  Nurse practitioners are advanced practice registered nurses meaning that they have done 1-4 years of graduate training (masters or doctorate) beyond the registered nurse designation and they are able to perform patient intake, physical exam, lab work, diagnosis, treatment, and prescribing. Physician assistants are masters level degree holders that go through three years of training and assist MDs on almost everything from history taking, physical exam, lab orders and interpretation, formulating a treatment plan, and prescribing.  While they are able to do these things independently they must work contractually with an MD in order to do so.  Both professions are invaluable to primary care but mostly in the way of helping to make basic care needs available to everyone. Unless they have additional training in holistic care I do not see these professions contributing to necessary change needed within the current medical paradigm.  

Also, a note on health coaches – these are not medical practitioners.  Health coaches are utilized to help facilitate behavioral change around health.  They have a valuable place within healthcare but they do not have medical training and they do not have the ability to diagnose or treat.  Any health coach that is suggesting or providing supplements, making recommendations from lab work, or even suggesting a therapeutic diet is practicing outside of their scope, which is illegal.  This is an issue popping up more and more as there is no current regulating body in this space.  Health coaches operate to provide you with the tools to achieve your health goals whether it be exercising more, making better food choices, decreasing stress in your life, etc., but any medical advice received should come from licensed medical professionals.  Education for this role varies but is usually obtained via an online course or certificate program, with no educational pre-requisites required to my knowledge.

Conclusion: These posts have been of one perspective – mine – and are intended to provide a general overview of the medical landscape to insight and inform your own understanding and philosophy around healthcare. As I only have experience as an ND, information on other professions was gathered from their respective professional organizations and my personal knowledge and experience, and is therefore subject to bias and should not be taken as the complete picture. Every single one of these medical professions has value, importance, and a place in healthcare and the only perspective on how to approach or utilize them should ultimately be yours.

A friend aptly uses “medication managers” to describe the role of most conventional providers today and this is not to be derogatory but to speak truth. With appointment times averaging just 17 minutes there is not much care that can take place beyond this. I have heard many conventional providers argue they suggest lifestyle modifications all the time, and that may be true, but to what extent? Simply telling someone to “eat healthier” or “lose weight” while also prescribing the pharmaceutical alternative and/or not providing resources to help with the recommendation rarely invokes action. Some have rebutted “that’s what nutritionists and health coaches are for”and this is exactly the point – if medical doctors are not facilitating foundational health changes themselves their role is mostly in managing medications and overt disease. I argue that the general medical practitioner role needs to move beyond this and into health promotion if there is to be a change in the trajectory of healthcare. This is what naturopathic medicine offers.

In my perfect healthcare paradigm, lifestyle-focused, health-promoting practitioners with prescriptive ability (i.e. NDs and functional medicine MDs/DOs) would replace your general primary care providers as you know them today. These practitioners would utilize pharmaceuticals conservatively and responsibly, with non-pharmacological approaches at the forefront of treatment approach, where appropriate. Referrals to non-physician practitioners would be readily made to support this emphasis on lifestyle and wellness (acupuncture, counseling, energetic medicine, etc.), as well as to conventional MDs/DOs as they practice today for higher force intervention needs: management of multiple medications, in-patient/hospital care, specialty care, and surgery. The fact that 90% of the MD profession chooses a non-primary care practice shows their preference for these disease-focused roles anyway. In this model, all of the different providers work together with the health-focused primary provider at the hub, and I think reorganization in this way would beget real health progress over the perpetuation of chronic disease the current system promotes today. I encourage you to seek out a holistic-focused physician to supplement or conduct your primary care needs to create this more health-centered care paradigm for yourself.

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