What is Naturopathic Medicine?
Naturopathic medicine is a system of primary health care that encourages the body’s self-healing processes through the use of natural therapies drawing on both traditional healing methods and modern medical science. It emphasizes prevention of disease through lifestyle choices and wellness and employs a wide variety of modalities. Naturopathic medicine is focused on treating the whole person, identifying and treating the underlying causes of disease and empowering patients through education. According to the Association of Accredited Naturopathic Medical colleges, naturopathic medicine “utilizes the most natural, least invasive and least toxic therapies to treat illness and to promote wellness by viewing the body as an integrated whole” and “above all, it honors the body’s innate wisdom to heal.”
Naturopathic medicine looks at health from a holistic perspective where every system is interconnected – body, mind and spirit. The six principles that are at the heart of the naturopathic philosophy are:
The Healing Power of Nature
Vis Medicatrix Naturae
The body has an inherent ability to heal itself. The physician’s role is to facilitate and augment the body’s healing process and to identify and remove obstacles in its way.
First Do No Harm
Primum Non Nocere
The goal of the doctor is to use the most natural, least invasive and least toxic methods and medicines first in order to minimize the risk of unnecessary and/or harmful side effects. The more gentle and least invasive the therapy, the less disruptive it is to the patient on the whole.
Identify and Treat the Cause, Not Just the Effect
The goal of the doctor is to identify, address and treat the underlying cause of illness rather than treating or suppressing symptoms alone. Symptoms are signals that the body is out of balance and is attempting to heal, but symptoms are not the cause of disease. When only symptoms are treated, the underlying cause remains. Finding and treating the cause of an ailment can prevent more serious, chronic conditions and help the patient reach an overall state of health – not just absence of disease.
Doctor as Teacher
Beyond an accurate diagnosis and appropriate prescription, the physician’s goal is to work to create a healthy, sensitive interpersonal relationship with the patient. A cooperative and sensitive doctor–patient relationship has inherent therapeutic value. The doctor is a facilitator in the patient’s healing process with responsibility to educate, encourage, and empower the patient in taking steps to achieving and maintaining optimal health.
Treat the Whole Person
Health and disease are conditions that involve a complex interaction of physical, spiritual, mental, emotional, genetic, environmental, and social factors. The goal of the physician is to treat the whole person as an individual with unique circumstances and to take all of these factors into account. The harmonious functioning of all aspects of the individual is essential to recovery from and prevention of disease and requires a personalized and comprehensive approach to diagnosis and treatment.
Prevention is the Best “Cure”
The goal of the doctor is to promote wellness and prevent disease by assessing risk factors and susceptibility to disease and making appropriate interventions to prevent illness. Health is a reflection of how we choose to live. The doctor’s goal is to help patients recognize how their choices affect health. Preventing disease before it happens is the easiest way to keep patients healthy!
What kind of education and training do naturopathic doctors receive?
To be a licensed naturopathic doctor, one needs to successfully complete a Doctor of Naturopathic Medicine degree at one of the seven four-year accredited naturopathic medical schools, and successfully pass both steps of the NPLEX board exams, plus any additionally required exams for the particular state within which they would like to practice.
Naturopathic doctors are educated in all of the same sciences as medical doctors (including things like anatomy, physiology, biochemistry, etc…) and the same diagnostic training (including physical exams, lab tests and x-rays/imaging) but also study holistic, natural and nontoxic approaches to therapy with a strong emphasis on disease prevention and optimizing wellness. In addition to a standard medical curriculum, NDs are trained in clinical nutrition, homeopathic medicine, botanical medicine, psychology, physical medicine and counseling. Additionally, naturopathic doctors are required to have over 1150 hours of direct supervised clinical training.
Upon graduation, to maintain licensure, NDs are required to fulfill continuing education units (CEs) similarly to MDs and DOs, and per what John Bastyr was known for always saying — “never stop learning” is the prevalent theme seen among graduates 5, 10, and 25+ years after graduation.
(see this data in table form here.)
What about residencies?
One of the reasons I really appreciate my clinical education at Bastyr is that we are trained especially in primary care and start clinic observation shifts from year one – slowly gaining more involvement and responsibilities. Upon passing the clinic entrance exam at the end of the spring of the second year, students begin as secondary student clinicians on patient cases in the clinic, and during the fourth year as primary student clinicians, students handle all aspects of patient cases (supervised by licensed NDs, DCs, etc.). In addition to our required hours within clinic, we are required to complete preceptorships in clinical settings outside of school with NDs, MDs, DOs, DCs. This clinical training both inside and outside of our teaching clinic combined with our coursework and all of the extra-curricular learning opportunities we seek out (seminars, conferences, webinars, etc.) prepares us to begin work as a primary care doctor after graduation and successful completion of board exams.
At this time, federal funding is not directed towards residency options for naturopathic medicine on a wide-scale for recent graduates. Therefore, residency options are limited and privately funded. Some recent graduates choose the option of working in a clinic that has a team-care approach where similar colleague mentorship may be available.
Therapeutic Modalities used by NDs
In practice, NDs perform physical examinations, laboratory assessments, gynecological exams, nutritional and dietary assessments, metabolic analysis, allergy testing and use a detailed medical and social history that may also include sleep patterns and patient stressors to form a holistic diagnosis.
Therapeutic modalities used by NDs include physical manipulation, nutrient therapies (vitamin/mineral supplements – often referred to as orthomolecular medicine), botanical / herbal medicine, homeopathy, hydrotherapy, bio-identical hormone therapy and counseling – and an ND may recommend changes in diet, lifestyle and exercise and other mind-body therapies as well.
According to the American Association of Naturopathic Physicians, NDs treat all medical conditions but conditions that are commonly and effectively treated include, but are not limited to, asthma and respiratory conditions, allergies, chronic pain, digestive and gastrointestinal issues, fatigue, cardiovascular disease, diabetes, hormone imbalance, endocrine issues, cancer, migraines, depression, anxiety, autoimmune disease, and gynecological issues.
The scope of practice of NDs varies by jurisdiction and is specifically defined by the legislation in the various states and provinces that license or regulate naturopathic medicine, and practice varies significantly among states, provinces, and countries. (See a list of the states, provinces and territories that license NDs).
California Practice: In California, NDs have a broad scope of practice and are licensed as primary care doctors. NDs can diagnose, order lab and imaging tests, and treat illness with natural therapies. NDs can also prescribe all hormones independently and can prescribe many other drugs under the supervision of an MD or doctor of osteopathic medicine. This makes integrative health clinics a common and very practical arrangement for patients – providing the most integrative care.
- Physical Medicine and Hydrotherapy: Naturopathic medicine has its own methods of therapeutic manipulation of soft tissue, muscles, bones, and spine. NDs also use ultrasound, diathermy, exercise, massage, and gentle electrical therapies. Hydrotherapy is the applications of hot and cold water to stimulate blood flow, lymphatic drainage and the immune system. These treatments are simple, but often highly effective.
- Botanical Medicine: Medicinal plants have been used as food and medicine by peoples around the world for thousands of years, and many plant substances have powerful healing properties. Many pharmaceutical drugs actually have their origins in plant substances. NDs learn how to use plants as medicine including extraction principles, dosage considerations, interactions, clinical applications and treatment regimens for their healing effects and nutritional value. When properly utilized, most botanical medicines can be applied effectively with minimal likelihood of side effects.
- Pharmacology: Naturopathic doctors are trained to use conventional drugs when necessary as well as drug interactions and side effects.
- Clinical Nutrition: Food is the best medicine and adopting a healthy diet is often the first step towards correcting many health problems. Many medical conditions can be treated more effectively with foods and nutritional supplements than they can by other means, with fewer complications and side effects. NDs use specific nutrition planning and nutritional supplementation with their patients.
- Homeopathic Medicine: Homeopathic medicine is based on the principle of “like cures like.” Homeopathic medicines are very small doses of natural substances that can stimulate the body’s self-healing response without side effects. Some conditions for which conventional medicine has no effective treatments will respond well to homeopathy.
- Mind/Body Medicine, Lifestyle Counseling and Stress Management: Mental attitudes and emotional states may influence, or even cause, physical illness. NDs are trained in counseling, nutritional balancing, stress management, hypnotherapy and biofeedback. They also attend to environmental and lifestyle factors that affect their patients’ health and to help them heal psychologically.
- Minor Surgery: Naturopathic physicians perform in–office minor surgery, including repair of superficial wounds and removal of foreign bodies, cysts, warts and superficial lesions with local anesthesia.
- Naturopathic Obstetrics, Midwifery, & Natural Childbirth: Naturopathic physicians who have additional specialty training provide natural childbirth care in an out–of–hospital setting. They offer prenatal and postnatal care using modern diagnostic techniques combined with ancient midwifery wisdom. The naturopathic approach strengthens healthy body functions so that complications associated with pregnancy may be prevented.
- Oriental Medicine: Oriental medicine is a healing philosophy that is complementary to naturopathic medicine and adds to the Western understanding of physiology. Some NDs complete extra training to be licensed to use acupuncture, acupressure, and Chinese herbal medicine.