Would you consult with an ND (naturopath)?

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I LOLed hard @ "ozone injection." WOW

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What are the legal aspects of letting an ND at your patient?

Pt present with signs of GERD, but ask for his ND, ND says he is having an acid imbalance with citrus fruits and prescribes herbal tea, patient whats to be discharged.

3 months later

Pt has Barretts esophagus.


If this went to court, would the ND be held accountable or would the blame be held of the real doctor?

You have to ask? The doctor would be held responsible unless he documented extremely carefully his objections to whatever therapy the patient ultimately pursued and the patient's refusal to follow his recommendations. Reason number 1004 not to consult with or refer your patients to quacks and maybe even to consider firing a patient from your practice who takes snake oil seriously. If you referred to a naturopath you would definitely be held responsible for any bad outcome
 
When the chiropractor, again as an example, sends a patient to a real doctor after having claimed to be able to treat real disease, he is admitting that his profession is worthless...

Hmmm... I think that is a stretch. I'd counter by saying your "profession" doesn't include many of the invasive procedures, and thus you concede your profession as worthless every time you consult surgery or cardiology (for the trips to the cath lab), GI (for the scopes of upper GI bleeds), etc... I agree in principle that chiropractors, NDs, etc...shouldn't be calling themselves primary care providers, but I'm not so sure Ob/Gyns should, either, as their training doesn't really include the long term management of chronic diseases.

M.Furfur said:
However, my concern is with the boundaries. Like what's next consult with a psychic or a voodoo witch?

I don't know what they could really add to the treatment of the problem at hand. I don't typically treat patients for depression secondary to the loss of a loved one. Perhaps if I were in primary care or psych...;)

In all seriousness, I do think there are certain things naturopaths can bring to the table that I don't know about or that they can simply help to ease the nerves of a patient. As long as I have the final say, I don't see the harm. Also, if my patient decided to follow their recs over mine, that isn't any different than their refusing my treatments; I'd simply document that, in my professional opinion, what they were doing was wrong and let them do what they want. I'm not their father and it isn't my place to force them to my will.
 
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Hmmm... I think that is a stretch. I'd counter by saying your "profession" doesn't include many of the invasive procedures, and thus you concede your profession as worthless every time you consult surgery or cardiology (for the trips to the cath lab), GI (for the scopes of upper GI bleeds), etc... I agree in principle that chiropractors, NDs, etc...shouldn't be calling themselves primary care providers, but I'm not so sure Ob/Gyns should, either, as their training doesn't really include the long term management of chronic diseases.

Procedures and specialists are a continuation of an allopathic medical system so your "profession" is not "worthless" every time you call a consult if you are not procedurally based.

You just realize your scope of practice and refer on for care, I'm not sure that's all bad or "worthless" in your words.
 
Procedures and specialists are a continuation of an allopathic medical system so your "profession" is not "worthless" every time you call a consult if you are not procedurally based.

You just realize your scope of practice and refer on for care, I'm not sure that's all bad or "worthless" in your words.

Right. We just refer to a higher level of care. If, as many chiropractors believe, they can cure most diseases with manipulation, where are the chiropractic hospitals, chiropractic emergency departments, and chiropractic intensive care units? Nowhere. Woo doesn't work on the big stuff either.
 
... I do think there are certain things naturopaths can bring to the table that I don't know about or that they can simply help to ease the nerves of a patient. As long as I have the final say, I don't see the harm...

The harm is that it cost money and when you, as a real physician, legitimize it by either endorsing or tolerating, you give the purveyor of snake oil a footing on which to claim public and quasi-public (private insurance) money. What's next? Psychics claiming prescription rights? Are you going to consult with a faith healer just because your patient asks you to? Being open-minded is nice but you occasionally have to make a rational decision about something.

Easing the nerves of a patient is nice but do we have to add a layer of otherwise useless expense to the treatment of the patient? Alprazolam is effective, well tolerated and a low dose (0.5 mg PO TID) costs an order of magnitude less than regular visits to your woo provider.
 
Procedures and specialists are a continuation of an allopathic medical system so your "profession" is not "worthless" every time you call a consult if you are not procedurally based.

You just realize your scope of practice and refer on for care, I'm not sure that's all bad or "worthless" in your words.

I think profession and practice are synonyms. Plus, I was being dramatic to make a point, whether or not I agree with it or not, that by referring to another person in the medical world doesn't mean you are admitting that your profession is worthless. Family practitioners are considered primary care. Apparently, that is what some chiropractors and naturopaths are calling themselves, too. My point was, FPs (as PCPs) send their patients to the hospital/refer them to a specialist when they are dealing with a condition out of their "scope of practice." The chiropractor/ND is doing the same thing. How about the DO PCP who refers his patient to an allopathic hospital? Will you, on this forum initially hosted by a DO student, say he is admitting his profession is "worthless?"

Panda Bear said:
If, as many chiropractors believe, they can cure most diseases with manipulation, where are the chiropractic hospitals, chiropractic emergency departments, and chiropractic intensive care units?
Because they see themselves as part of the medical community in the role of the primary care provider. They don't see themselves as outside of our profession. It is the same reason you don't see FP hospitals, emergency departments or ICUs.

Panda Bear said:
Are you going to consult with a faith healer just because your patient asks you to?
I call the chaplain, which, as you know well from our past discussions, I feel is just as effective and is actually providing the same sort of support.

Panda Bear said:
The harm is that...you, as a real physician, legitimize it by either endorsing or tolerating...
I don't know that I agree that it is a harm. When Juan Parodi first started doing endoluminal stenting of aortic aneurysms, people thought he was crazy. Look at vascular surgery now. You can't simply say something is wrong because you don't think it will work or can't understand how it will work or hasn't been done before. I don't know there is anything wrong with alternative medicine when used as an adjunct to other medical care. Simply because it doesn't fit with what you believe and because you don't believe there is any evidence to support it simply because there is no real scientific explanation for why they seem to get results doesn't mean it is bad.

Maybe it is because of my take on religion that makes me more open-minded to this because I see it as the same thing; something done to make the patient feel better that may or may not have a clinical benefit that we can't scientifically explain.
 
Because they see themselves as part of the medical community in the role of the primary care provider. They don't see themselves as outside of our profession. It is the same reason you don't see FP hospitals, emergency departments or ICUs.

I think the training is quite different between a naturopath and a Family Practice Doctor. It's one thing to say that you'll just defer to a specialist when you think there is something wrong, and another thing to realize that there is a problem in the first place having at least been trained to recognize it. The training and depth of knowledge just isn't there in many ancillary medical fields to equate them with a FP. Would you expect a nutritionist or chiropractor to recognize complex signs and symptoms and know who to consult? If I was a FP, I'd be offended by the statement posted above that somehow FPs aren't real doctors.
 
I think profession and practice are synonyms. Plus, I was being dramatic to make a point, whether or not I agree with it or not, that by referring to another person in the medical world doesn't mean you are admitting that your profession is worthless. Family practitioners are considered primary care. Apparently, that is what some chiropractors and naturopaths are calling themselves, too. My point was, FPs (as PCPs) send their patients to the hospital/refer them to a specialist when they are dealing with a condition out of their "scope of practice." The chiropractor/ND is doing the same thing.

Because they see themselves as part of the medical community in the role of the primary care provider. They don't see themselves as outside of our profession. It is the same reason you don't see FP hospitals, emergency departments or ICUs.

The DO Argument you pose is moot, well worn, and ridiculous. They are equally trained. FP's are allopaths or osteopaths (I make no distinction other than academically).

ND's are not trained to be PCP's and therefore have no business seeing patients on this basis.

They can call themselves whatever they want. Your philosophical arguments are tiring. :rolleyes:
 
Monkeyguts, you were the one who said allopathic medical system, not me. While I consider MDs and DOs equal, it doesn't mean everyone else does. I wanted to make sure that, in a discussion about who should be considered a PCP and what training is required, you didn't really mean "allopathic" as in MD as much as "allopathic" or conventional medicine. FPs are physicians who have completed a residency in Family Medicine; they can be either MDs or DOs, but not all FPs are "allopaths." Semantics, I know, but that is what this entire thing is at this point.

LifetimeDoc, I don't think NDs/naturopaths should be considered PCPs anymore than anyone else here and I don't think I ever said I do; I agree that the training is different and there are probably things they wouldn't notice (although, there are probably things they would notice that you, an allopath, wouldn't). I see them as consultants, just like PT, OT, RT or any other xT you want. However, just because I see them that way and you see them that way and Panda Bear sees them that way doesn't mean they see themselves that way. If you examine it from their perspective, they wouldn't see it as admitting their profession is worthless when they send a patient to a hospital anymore than a FP would. They would see it as sending a patient for treatment outside their (to use your words) "scope of practice" and that they are just trying to "refer on for care."

It is important to understand the perspective of the other side in order to better understand how to best relate to and work with them. I think this is something to consider even if you never consult an ND because even in the different specialties of "allopathic" medicine the personalities, priorities and approaches to the patient are vastly different.
 
Monkeyguts, you were the one who said allopathic medical system, not me. While I consider MDs and DOs equal, it doesn't mean everyone else does. I wanted to make sure that, in a discussion about who should be considered a PCP and what training is required, you didn't really mean "allopathic" as in MD as much as "allopathic" or conventional medicine. FPs are physicians who have completed a residency in Family Medicine; they can be either MDs or DOs, but not all FPs are "allopaths." Semantics, I know, but that is what this entire thing is at this point.

LifetimeDoc, I don't think NDs/naturopaths should be considered PCPs anymore than anyone else here and I don't think I ever said I do; I agree that the training is different and there are probably things they wouldn't notice (although, there are probably things they would notice that you, an allopath, wouldn't). I see them as consultants, just like PT, OT, RT or any other xT you want. However, just because I see them that way and you see them that way and Panda Bear sees them that way doesn't mean they see themselves that way. If you examine it from their perspective, they wouldn't see it as admitting their profession is worthless when they send a patient to a hospital anymore than a FP would. They would see it as sending a patient for treatment outside their (to use your words) "scope of practice" and that they are just trying to "refer on for care."

It is important to understand the perspective of the other side in order to better understand how to best relate to and work with them. I think this is something to consider even if you never consult an ND because even in the different specialties of "allopathic" medicine the personalities, priorities and approaches to the patient are vastly different.

As I said I make no distinction b/w allopaths and osteopaths. They compete for and complete allopathic medical residencies. Call it what you want allopathic, osteopathic, conventional whatever.

It's much more serious than "just semantics", it's about a psuedo-profession that provides largely unproven, possibly substandard and inadequate care to their "patients" under the auspices or the cloak of being "primary care physicians".
 
I think profession and practice are synonyms. Plus, I was being dramatic to make a point, whether or not I agree with it or not, that by referring to another person in the medical world doesn't mean you are admitting that your profession is worthless. Family practitioners are considered primary care. Apparently, that is what some chiropractors and naturopaths are calling themselves, too. My point was, FPs (as PCPs) send their patients to the hospital/refer them to a specialist when they are dealing with a condition out of their "scope of practice." The chiropractor/ND is doing the same thing. How about the DO PCP who refers his patient to an allopathic hospital? Will you, on this forum initially hosted by a DO student, say he is admitting his profession is "worthless?"


Because they see themselves as part of the medical community in the role of the primary care provider. They don't see themselves as outside of our profession. It is the same reason you don't see FP hospitals, emergency departments or ICUs.


I call the chaplain, which, as you know well from our past discussions, I feel is just as effective and is actually providing the same sort of support.


I don't know that I agree that it is a harm. When Juan Parodi first started doing endoluminal stenting of aortic aneurysms, people thought he was crazy. Look at vascular surgery now. You can't simply say something is wrong because you don't think it will work or can't understand how it will work or hasn't been done before. I don't know there is anything wrong with alternative medicine when used as an adjunct to other medical care. Simply because it doesn't fit with what you believe and because you don't believe there is any evidence to support it simply because there is no real scientific explanation for why they seem to get results doesn't mean it is bad.

Maybe it is because of my take on religion that makes me more open-minded to this because I see it as the same thing; something done to make the patient feel better that may or may not have a clinical benefit that we can't scientifically explain.

A few things:

1. The chaplain is cheap. He is usually working pro bono and, in the case of my priest who makes calls to the hospital not only for his parishioners but any Orthodox Christian who needs him, he is paid by our congregation directly. Cost to the government and the private insurance pool? Zero. Nada. If he insisted on billing Medicare, the Holy Grail of the woomeisters, I'd tell him to take a hike. Does the priest offering the sacraments make the patient feel better? Of course he does. I am a faithful son of the Greek Orthodox Church and I'd want my priest to come see me. Should we pay for this kind of thing from public or quasi-public money? No. Real benefit to the patient's medical condition? Extremely little to none. The priest comes by, offers his prayers, we venerate the icons, but if the patient is going to die he dies and if he's going to get well, he gets well. My priest is not a "healer" and makes no claims in that regard. Our church is not a cult where we imbue the priest with magical powers.

2. There is a difference between being skeptical of an unproven surgical procedure and something like Reiki or acupuncture. The surgeon proposing the new procedure can at least explain why he thinks it will work, something that nobody in the woo community can do about any of their therapies. You're confusing being "open-minded" with being gullible.

3. Chiropractors do not, most emphatically, see themselves as part of the medical community. the major selling point of almost every chiropractor I am aware of here in my medium-sized city up here in the vast frozen wastes of Yankeeland is that they are an alternative to (evil) real medicine. There are "Reformed" chiropractors who limit themselves to essentially physical therapy but a much, much larger percentage are "Straight" or "Mixers" who view subluxation as the cause for all diseases. Many advocate not vaccinating children which puts them at odds with every pediatrician in town. Not to mention that, as children do not suffer from too much lower back pain (and if they do you need to get them to a real doctor), what precisely, are chiropractors doing treating children anyways?

That's right. They advocate the use of manipulation as a substitute for vaccinations, antibiotics, and breathing treatments for your kid with asthma, something that no real physician would even consider.

"We'll control your kids asthma by cracking his back."

The "Nobody Here But Us Good Little Allied Health Professionals" is their public face, a ruse to get their foot in the door.
 
I think one thing that is missing here is that many on the forum are confusing the words profession with the word industry. They are not the same.

I profession is a group of people who through there merits, virtues, and qualities have been granted the right to govern themselves in what they do. Thus they determine their standards, their requirements for entry into the profession, their educational standards, procedures for internal punishment of those who fail the standards, etc. It is this group that grants all the rights, privleges, etc. not the state. There are only a few of these Medicine, dentists, accountants, lawyers, engineers, and a few other. Sure the state grants you a license but the requirements for licensure are determined by the individual medical societies, NBME, etc not the state itself.

Industry is something that conducts business or provides services but they are regulated by the laws of the land. So nursing is not a profession it is an industry because they do not regulate themselves based on the definition above, same with business etc these are not professions.

THIS DOES NOT MEAN PEOPLE ARE NOT PROFESSIONALS that is a totally different word. But things that are truth professions are very few.

ND is not a profession it is not granted to rights by the states to govern themselves, etc. It is an industry. (except for Oregon a state that can be convinced to do anything by every outside organization known to man. If someone told them that they would have cleaner air by rubbing cats together they would enact laws making people rub cats while they drive)
 
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It's much more serious than "just semantics", it's about a psuedo-profession that provides largely unproven, possibly substandard and inadequate care to their "patients" under the auspices or the cloak of being "primary care physicians".

That has nothing to do with the original question; would you consult with an ND if your patient requested it. Again, they are being used as consultants, not PCPs, and you as the PCG have the final say as to whether or not to implement their recommendations.

Panda Bear, let me see if I can summarize your position accurately. We should not consult any naturopaths/homeopaths because they don't practice real, evidence-based medicine and any benefit that may be derived isn't worth the cost, and to consult them validates them and puts them in the position to then go on and (a) politic for insurance reimbursement and (b) claim they should be allowed to serve as PCPs. Basically, your two big objections are financial and patient safety.

The financial thing is easy; it's already happening. As you said, in your community, chiropractors are already calling themselves PCPs. Was that a result of (a) their active lobbying for it, (b) conventional medicine referrals, (c) the denouncement of the field by conventional medicine or (d) the practitioners of conventional medicine not listening to their patients' wants and needs? I bet the answer isn't (b).

I think many people go the alternative medicine route because they aren't happy with the treatment they are getting from the conventional medical community. To talk about the alternative practices as "woo" or to discredit them to your patients may only serve to drive them there more, as most patients are more concerned with the way you talk to them than how good you are, and the alternative medicine people are much more likely to spend the extra 10-15 minutes listening to and talking with their patients, and a lot of the time that is all that matters. I think that, if a patient ever asks for a naturopathic consult, they are already leaning that way. If you deny that consult, they are still going to seek it out. If they like what they hear, they may not come back to you. If you give the consult, you are validating your patient. It also puts you in the driver's seat for following the recs given by the ND; you can tell your patient that you don't recommend following their recs for (evidence-based) reasons x, y and z, and they are more likely to listen to you than if you had already discredited the naturopathic field by telling your patient it was a waste of time. You are doing the patient a greater disservice to alienate them than to validate them, even if it means consulting with a service whose practice you believe to be complete b.s.

People are going to be disenfranchised with conventional medicine regardless of what you do (and sometimes because of what you do); the best way to keep them from completely abandoning it is to let them do what they are going to do and serve as their informed guide rather than proclaiming their wishes to be foolish and slam the door on it, as you may be slamming the door on them, too.
 
That has nothing to do with the original question; would you consult with an ND if your patient requested it. Again, they are being used as consultants, not PCPs, and you as the PCG have the final say as to whether or not to implement their recommendations.

Panda Bear, let me see if I can summarize your position accurately. We should not consult any naturopaths/homeopaths because they don't practice real, evidence-based medicine and any benefit that may be derived isn't worth the cost, and to consult them validates them and puts them in the position to then go on and (a) politic for insurance reimbursement and (b) claim they should be allowed to serve as PCPs. Basically, your two big objections are financial and patient safety.

The financial thing is easy; it's already happening. As you said, in your community, chiropractors are already calling themselves PCPs. Was that a result of (a) their active lobbying for it, (b) conventional medicine referrals, (c) the denouncement of the field by conventional medicine or (d) the practitioners of conventional medicine not listening to their patients' wants and needs? I bet the answer isn't (b).

I think many people go the alternative medicine route because they aren't happy with the treatment they are getting from the conventional medical community. To talk about the alternative practices as "woo" or to discredit them to your patients may only serve to drive them there more, as most patients are more concerned with the way you talk to them than how good you are, and the alternative medicine people are much more likely to spend the extra 10-15 minutes listening to and talking with their patients, and a lot of the time that is all that matters. I think that, if a patient ever asks for a naturopathic consult, they are already leaning that way. If you deny that consult, they are still going to seek it out. If they like what they hear, they may not come back to you. If you give the consult, you are validating your patient. It also puts you in the driver's seat for following the recs given by the ND; you can tell your patient that you don't recommend following their recs for (evidence-based) reasons x, y and z, and they are more likely to listen to you than if you had already discredited the naturopathic field by telling your patient it was a waste of time. You are doing the patient a greater disservice to alienate them than to validate them, even if it means consulting with a service whose practice you believe to be complete b.s.

People are going to be disenfranchised with conventional medicine regardless of what you do (and sometimes because of what you do); the best way to keep them from completely abandoning it is to let them do what they are going to do and serve as their informed guide rather than proclaiming their wishes to be foolish and slam the door on it, as you may be slamming the door on them, too.



I don't often say this but I enjoy reading your comments immensely. They are well-thought out and well written.

1. The answer is a) with partial credit for some of the others. Chiropractors have always had an active lobby and even filed and won, if I remember, an anti-trust suit against the AMA. Doesn't make them right, just poltically savvy, not to mention that even our elected officials have a very shakey understanding of science and medicine. Even if they did, to take a principled stand against chiropractic (as well as other woo) earns you the support of handful of educated people but alienates you from the proles.

2. I don't tell my patient who use woo that they are *****s, I just tell them that it doesn't work, has no scientific basis, and, in the case of naturapthy which at some level does an empirical basis, it is based on a shoddy philosophy..."The Healing Power of Natue," a ridiculous credo as nature can and does kill preferentially to healing. In other words, the patient will go to a naturopath for treatment and will be loaded with medicinal herbs produced with shoddy quality control when he could get the same effect cheaper and more safely with a conventional, quality-controlled drug...that isn't "natural" of course, but "natural" is a marketing phrase, not a meaningful description.

So at best, a naturopath is a minimally effective herbalist without the training to recognize or treat disease. Unfortunately, most naturopaths are completely credulous of every other woo under the sun

3. The patients can do whatever they want. If they're going to see a woo-practitioner, that's their lookout. If they need my blessing they're not going to get it and if they don't like it, they are welcome to find another doctor. We are not slaves to our patients and we do not have to humor them to the point of acting contrary to our own values.

4. If you refer to a naturopath (or other woo purveyor) and something goes wrong, you had better be able to prove in court why you sent the patient there, including having to potentially either lie under oath or to admit that you referred to a provider who you knew to be a fraud and therefore dangerous and incompetent.

Woo, by the way, is a word that you and I use...insider language. To the patients it's "An unproven treatment modality, ridiculous at face value, and with no scientific basis."
 
I think one thing that is missing here is that many on the forum are confusing the words profession with the word industry. They are not the same.

I profession is a group of people who through there merits, virtues, and qualities have been granted the right to govern themselves in what they do. Thus they determine their standards, their requirements for entry into the profession, their educational standards, procedures for internal punishment of those who fail the standards, etc. It is this group that grants all the rights, privleges, etc. not the state. There are only a few of these Medicine, dentists, accountants, lawyers, engineers, and a few other. Sure the state grants you a license but the requirements for licensure are determined by the individual medical societies, NBME, etc not the state itself.

Industry is something that conducts business or provides services but they are regulated by the laws of the land. So nursing is not a profession it is an industry because they do not regulate themselves based on the definition above, same with business etc these are not professions.

THIS DOES NOT MEAN PEOPLE ARE NOT PROFESSIONALS that is a totally different word. But things that are truth professions are very few.

ND is not a profession it is not granted to rights by the states to govern themselves, etc
. It is an industry. (except for Oregon a state that can be convinced to do anything by every outside organization known to man. If someone told them that they would have cleaner air by rubbing cats together they would enact laws making people rub cats while they drive)

Yes, it is. In Washington and Nevada, to name a few states.
 
....Basically, your two big objections are financial and patient safety....

Yes, but let's not forget my other objection....that basically acupuncture, Reiki, homeopathy, iridology, reflexology and the like are so friggin' ridiculous that I would be embarrassed as a residency-trained physician, a liberally educated man, and a guy with the required fourth-grade understanding of biology, physics, and reality to be associated with it.

You do know what homeopathy (for example) is, right?
 
I don't often say this but I enjoy reading your comments immensely. They are well-thought out and well written.
Thanks. I wouldn't waste my time if I didn't feel the same about you. :love: ;)

In other words, the patient will go to a naturopath for treatment and will be loaded with medicinal herbs produced with shoddy quality control when he could get the same effect cheaper and more safely with a conventional, quality-controlled drug...that isn't "natural" of course, but "natural" is a marketing phrase, not a meaningful description.

I think the bolded part in what you said is the most important thing to emphasize to your patients when they come back with the naturopath recs or when they come to you after seeing a naturopath; quality control. Quite a few of the medicines we use are derived from the products given by naturopaths, just is a purified form synthesized in a lab subject to rigid federal standards.

The patients can do whatever they want. If they're going to see a woo-practitioner, that's their lookout. If they need my blessing they're not going to get it and if they don't like it, they are welcome to find another doctor. We are not slaves to our patients and we do not have to humor them to the point of acting contrary to our own values.

I think we are in agreement (for once) on this, at least in principle; we simply have chosen different approaches on how to act. I don't think I will ever go to a naturopath personally, much as I would have never opted for an abortion in the event of an unplanned pregnancy. That said, I'm not going to shun or fire my patients simply because they want to. I'm just of the opinion that remaining on good terms with the patient allows me to temper the potential damage they could do by placing too much faith in some of the "cures" promised by alternative medicine, and I think denying the consult takes me out of that realm.

You do know what homeopathy (for example) is, right?
It reminds me a lot of Scientology with its "miasms" and "proving" and other made-up words. Still, they were the ones who gave us the name "allopathy," so they aren't completely worthless...:)
 
My naturopath anecdote:

I had a patient with mild to moderate congestive heart failure seeing a naturopath who had prescribed, after I sorted it all out, an Oleander blossom tea. Oleander contains compounds that are cardiac glycosides, like digitalis. I guess the principle is sound. You give cardiac glycosides for CHF to improve the heart's inotropy. This has been known, with various explanations having to do with evil spirits and foul humors, for thousands of years.

The patient was insistent that natural was better although, although considering her heart rate was about 40 and heading for block territory and we had to intubate her about fifteen minutes after she came in I would beg to differ. Digoxin, prescribed by a doctor, would have been a better choice. It is not a perfect drug but it can be dosed accurately and has levels that can be measured, not to mention that their is an antidote which is not the case for the compounds in Oleander tea (I could be wrong about that).

Oleander tea? What's the dose? How much do you drink? When were the blossoms picked? In what kind of soil did they grow? How old were the blossoms? What else is in the tea? Who picked it? Who packaged it? Who inspected it? Who did quality control?

Here's you on the witness stand:

Plaintiff's Attorney: So doctor, would you say that by referring Mrs. Smith to the naturopath, you trusted her medica skills and l judgment and felt safe sending my client to her?

You: Uh....
 
Here's you on the witness stand:

Plaintiff's Attorney: So doctor, would you say that by referring Mrs. Smith to the naturopath, you trusted her medica skills and l judgment and felt safe sending my client to her?

You: Umm....

...(because I start everything I say with "Umm") after a lengthy discussion with Mrs. Smith, I told her that I was fine with her seeing the naturopath her second cousin from Oregon recommended, provided she spoke to me before starting any of the recommended treatments. See exhibit 101.4, her medical record, where I documented said conversation. Mrs. Smith chose not to call me or come back to me prior to her taking the Oleander tea. She also skipped her next two scheduled appointments and did not return my clinic's phone calls to her (exhibits 101.5-6; the record documenting our attempts at calls when she missed her clinic appointments). Had she contacted me, I would have told her that the ingredients are similar to those found in digoxin. We would have had a conversation about the risks and benefits of digoxin and as well as the quality control comparing the tea to the digoxin. I would have expressed to her my concern over taking something where we don't know the exact dose of active ingredient she would be receiving. If I felt it appropriate, I would have started her on digoxin, making sure to follow up on her serum levels on a regular basis until she had reached a healthy steady-state.

I totally would have rocked in primary care. :laugh:
 
Why should we be open-minded about things that are patently absurd? None of this stuff would fly in any other field:

Me: Yeah, so I can't get this toilet unclogged.
Reiki Plumber: Hmm. It seems like something is interrupting its energy flow. Let me try to fix it. *waves hands over toilet*
Me: Huh? What are you doing?
RP: I'm realigning the toilet's qi.
Me: Get out.

Me: I'll take a gin and tonic.
Homeopathic Bartender: Here you go.
Me: This is just water.
HB: No, it's actually an incredibly potent drink.
Me: There's no alcohol in it.
HB: Yes, but the water remembers the alcohol.
Me: Give me my money back.

Me: It's been making this really awful noise every time I shift into fourth gear.
Chiropractic Mechanic: Yeah, we see this a lot these days. You see, the chassis has a misalignment, or subluxation, as we call it.
Me: What?
CM: Vital energy flows from the chassis into the transmission. Fortunately, this is easy to correct. *smashes car with sledgehammer*
Me: WTF! Get away from my car!

Me: After that storm we had last week, none of the outlets in this room have worked.
Acupuncture Electrician: There's an ancient Chinese technique for fixing problems like this.
Me: Really?
AE: It's quite simple. All I do is take these acupuncture nails and hammer them into the room's meridians.*starts pounding nails into random parts of the wall*
Me: Get out.

It's all the same sort of magical thinking, just dressed up in different outfits, and it's all a scam.
 
That has nothing to do with the original question; would you consult with an ND if your patient requested it. Again, they are being used as consultants, not PCPs, and you as the PCG

Obviously. I was responding to your discussion regarding the difference between a DO and an MD and regarding the formers profession of as worthless. I'm glad you can see the forest from the trees.
 
I'm glad you can see the forest from the trees.

And I'm sorry you can't. My whole point was to extrapolate where the logic of a health professional referring to another health professional would take you if you said that doing so meant you were admitting your field is worthless. Again, I never argued they should be considered PCPs, I simply said that a PCP referring to a specialist (which is how they see what they are doing) doesn't mean your practice is worthless.

But thanks for the vote of confidence; that's what I've been doing on this forum for the last seven years...awaiting your acknowledgement. :rolleyes:
 
Why should we be open-minded about things that are patently absurd? None of this stuff would fly in any other field:

Me: Yeah, so I can't get this toilet unclogged.
Reiki Plumber: Hmm. It seems like something is interrupting its energy flow. Let me try to fix it. *waves hands over toilet*
Me: Huh? What are you doing?
RP: I'm realigning the toilet's qi.
Me: Get out.

Me: I'll take a gin and tonic.
Homeopathic Bartender: Here you go.
Me: This is just water.
HB: No, it's actually an incredibly potent drink.
Me: There's no alcohol in it.
HB: Yes, but the water remembers the alcohol.
Me: Give me my money back.

Me: It's been making this really awful noise every time I shift into fourth gear.
Chiropractic Mechanic: Yeah, we see this a lot these days. You see, the chassis has a misalignment, or subluxation, as we call it.
Me: What?
CM: Vital energy flows from the chassis into the transmission. Fortunately, this is easy to correct. *smashes car with sledgehammer*
Me: WTF! Get away from my car!

Me: After that storm we had last week, none of the outlets in this room have worked.
Acupuncture Electrician: There's an ancient Chinese technique for fixing problems like this.
Me: Really?
AE: It's quite simple. All I do is take these acupuncture nails and hammer them into the room's meridians.*starts pounding nails into random parts of the wall*
Me: Get out.

It's all the same sort of magical thinking, just dressed up in different outfits, and it's all a scam.

This is pretty funny. Here is an MD version to add to your collection ;).

Me: Yeah, so I can't get this toilet unclogged.
MD Plumber: Let's take an X-ray, take a stool sample, and run a lead analysis on the water.
Me: I read something on the internet about this. How about trying a plunger or maybe Roto-Rootering it out?
MD Plumber: (Long, loud laughter). I wish I had a dime for every customer who comes up with these crazy things you read on the Internet. I'm sorry, we're going to need to treat this scientifically and plungers are not FDA approved because they carry a high risk of splinters. Also, we don't want to treat it until we know what it is. I could lose my license otherwise.

($200 later, after an X-ray that can't penetrate the ceramic of the toilet and is nowhere near the lesion, a lead analysis that is less than irrelevant, and a stool sample "quick strip" followed by a culture that showed normal gut flora)

MD Plumber: We weren't able to find anything unusual, but I suspect it's something viral that was brought on by a broken handle. People don't wash their hands before operating the handle, and those handles don't seal well. The viruses leak into the tank and next thing you know we have a huge viral load that leads to a clog. Here is a prescription {written with an ACME Toilet Handle, Inc. pen} for a new flush-handle and a prescription for 1 lb of ciprofloxacin to be dumped into the toilet 3 times per day for 10 days. Be sure to finish the entire 30 lb bag.
Me: Huh? The handle looks ok to me. If it's viral, why are you prescribing an antibiotic?
MD: The handle feels loose to me on physical exam. The break is probably internal where you can't see it. Statistics based on 8000 truck stops say it's the handle 80% of the time. If that doesn't work come back and I'll write you a prescription for a new commode; I'm hoping it won't come to that because that would cost a mint.
Me: That's ok. I think I'll see a plumber without an MD. :smuggrin:

I'm not saying we get it wrong all the time. However, let's not pretend we have it all figured out; much of what passes for medical diagnosis is little more than educated guessing.
 
Any good doctor should take into account a patient's beliefs. If they want to pay to talk with a "naturopath" I would have no problem giving them medical records and discussing with the patient things that he/she talks about with said naturopath. However, at the same time, I am not going to agree with anything that doesn't have scientific evidence behind it and I will have no problem flat out telling the patient that those ideas have no rhyme or reason. As a doctor, it is your responsibility to treat the patient how they want to be treated, however, it is also your responsiblity to treat the patient effectively, which 99% of the time won't be done by a naturapath type person in a oncological setting.
 
This is pretty funny. Here is an MD version to add to your collection ;).

Me: Yeah, so I can't get this toilet unclogged.
MD Plumber: Let's take an X-ray, take a stool sample, and run a lead analysis on the water.
Me: I read something on the internet about this. How about trying a plunger or maybe Roto-Rootering it out?
MD Plumber: (Long, loud laughter). I wish I had a dime for every customer who comes up with these crazy things you read on the Internet. I'm sorry, we're going to need to treat this scientifically and plungers are not FDA approved because they carry a high risk of splinters. Also, we don't want to treat it until we know what it is. I could lose my license otherwise.

($200 later, after an X-ray that can't penetrate the ceramic of the toilet and is nowhere near the lesion, a lead analysis that is less than irrelevant, and a stool sample "quick strip" followed by a culture that showed normal gut flora)

MD Plumber: We weren't able to find anything unusual, but I suspect it's something viral that was brought on by a broken handle. People don't wash their hands before operating the handle, and those handles don't seal well. The viruses leak into the tank and next thing you know we have a huge viral load that leads to a clog. Here is a prescription {written with an ACME Toilet Handle, Inc. pen} for a new flush-handle and a prescription for 1 lb of ciprofloxacin to be dumped into the toilet 3 times per day for 10 days. Be sure to finish the entire 30 lb bag.
Me: Huh? The handle looks ok to me. If it's viral, why are you prescribing an antibiotic?
MD: The handle feels loose to me on physical exam. The break is probably internal where you can't see it. Statistics based on 8000 truck stops say it's the handle 80% of the time. If that doesn't work come back and I'll write you a prescription for a new commode; I'm hoping it won't come to that because that would cost a mint.
Me: That's ok. I think I'll see a plumber without an MD. :smuggrin:

I'm not saying we get it wrong all the time. However, let's not pretend we have it all figured out; much of what passes for medical diagnosis is little more than educated guessing.

I wonder what the MD plumber's malpractice/license-bond costs are compared to the acupuncturist electrician et al. :p
 
Let me start by saying that I agree with PandaBear and his views on "woo" medicine. However, I also agree that some back pain can be considered mysterious and shifty, and may simply be a minor problem which the pateint must live with rather than undergoing risky surgery, etc. Could Panda agree that chiropractors can provide a "placebo" effect for these patients through manipulation and thus take away their frequent visits to the doctor who will simply waste his time and provide them with more pain medication? Also, I am curious as to how exactly attendings/residents go about directing a patient who is insistent on using "woo" medicine. How much must you explain to them to cover yourself legally and designate them AMA? In other words, when can you say "I can't do any more to convince you, do what you want"?
 
Lets take a different approach. If a patient came in and said that they knew a guy who knew a guy who knew a guy who was a witch doctor in an ancient African tribe, and that they wanted to bring this guy in to do some consultation work and help maintain a traditional dark diet consisting of rare bat dung and stink beetles, would anyone allow him into their hospital to take part in the healthcare team? Probably not.
 
As above, it seems like there's a distinction between letting them be present and asking their advice.

Also I think it's important to distinguish between a Naturopathic Doctor (ND) and a Naturopath. A naturopath can do a certification course and that's it, obviously leading to minimal quality/training control. ND goes through a 4-year school and are licensed in something like 11 states to be primary care providers. I'm not saying everything they do is evidence based in an RCT way, but at least they've got a standardized level of schooling.
 
As above, it seems like there's a distinction between letting them be present and asking their advice.

Also I think it's important to distinguish between a Naturopathic Doctor (ND) and a Naturopath. A naturopath can do a certification course and that's it, obviously leading to minimal quality/training control. ND goes through a 4-year school and are licensed in something like 11 states to be primary care providers. I'm not saying everything they do is evidence based in an RCT way, but at least they've got a standardized level of schooling.

That's like the difference between a mugger and a burglar. They're both thieves but one works harder at it.
 
So i heard on the radio, from a doctor ( I am assuming an ND), that when a person is having a stroke or heart attack that giving them cayenne pepper would stop it on contact......That seems hard to believe

Is there any truth to this?
 
So i heard on the radio, from a doctor ( I am assuming an ND), that when a person is having a stroke or heart attack that giving them cayenne pepper would stop it on contact......That seems hard to believe

Is there any truth to this?

Um...no. No truth. A medline search of (cayenne or capsicum) and stroke yield ZERO results. Not a single paper, not even a case report.

My issue with ND's is that a good deal of what they're taught has NO evidence to back it up.

That being said, as my old neurology professor loved to say:

Absence of Proof does not constitute Proof of Absence.

Meaning that just because there's never been any evidence looking at something and proving it, is not the same as evidence studying it and specifically showing it doesn't work.

Could cayenne do something for stroke? I have no idea. But if you have risk factors and get suddent onset dizziness, numbness, tingling, slurred speech, or weakness, don't go to the spicerack. Get your *** to the ER and get TPA.
 
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