Naturopathic physicians graduate from 1 of 6 naturopathic medical schools accredited by the Council on Naturopathic Medical Education (CNME) (TABLE 1). The CNME is a member of the Association of Specialized and Professional Accreditors recognized by the US Department of Education. Each school in the United States is also accredited by, or has candidacy status through, the specific regional agencies responsible for overseeing postsecondary institutions of higher learning.
Requirements for admission. The goal of naturopathic medical education is to prepare clinicians for the challenges of general practice, with a foundation in current medical science as well as traditional naturopathic theory. Candidates for admission to naturopathic medical school must earn a baccalaureate degree (or equivalent) prior to matriculation, including standard premedical undergraduate courses.
Naturopathic curricula. Subjects include inorganic and organic chemistry, physics, general biology and psychology. Other coursework is comparable to that of allopathic and osteopathic medical schools (TABLE 2). While the first 2 years of education combine courses in naturopathic principles with basic and diagnostic sciences, third and fourth year students focus on clinical practice, receiving training at naturopathic primary care outpatient clinics as well as conventional medical facilities (TABLE 3). Academic faculty at such institutions include NDs, PhDs, MDs, DOs, and other allied health professionals.
Practice principles of naturopathic medicine
Naturopathic medical practice is based upon the premise that it is intrinsic to the nature of living organisms to heal. The naturopathic physician understands illness to be a disruption of normal orderly function. Healing therefore is the process by which living systems return to a resilient equilibrium, either unassisted or with the therapeutic support of the practitioner.
Western medicine rarely takes into consideration the inherent organizing forces underlying known physiologic processes such as metabolism or tissue repair. Naturopathic medicine calls this primary principle the vis medicatrix naturae, or the healing power of nature.
Another principle fundamental to the can complement customary clinical practice restoration of health is the understanding that any intervention employed should not further disrupt a system attempting to regain homeostasis. This is expressed as primum non nocere, the imperative to first choose interventions which do the least harm.
When confronted with an ill patient, the naturopathic physician seeks to understand the totality of fundamental causes disrupting the patient’s optimal equilibrium. In order to remove the cause of the illness (tolle causum), one must treat the whole person.
In pursuit of removing or moderating the insults and stressors that result in harm to the patient, the doctor becomes teacher (docere) and engages the patient in the essential responsibilities of self-care. Participation in the restoration of personal wellbeing prepares the patient to behave proactively in the future, when mutual efforts at prevention predominate in the physician-patient relationship.1
Although these practice principles form the foundation of the naturopathic approach to health and healthcare, the philosophic and conceptual approaches of conventional medical theory apply as well, including complexity science, quantum physics, medical ecology, public health, energy medicine, and the biological basis of healing. The above principles do not replace the foundation of biological pathology, but offer the practitioner an expanded perspective when treating each individual patient. Naturopathic medicine ascribes to a therapeutic hierarchy that integrates the full spectrum of modern biomedicine in a continuum that includes mental, emotional and spiritual therapies, as appropriate to each patient’s needs.2 Applied in this context, biomedical interventions are highly valued as both diagnostic and therapeutic approaches.
Clinical approach to patients
The ultimate goal of each clinical assessment is to obtain an in-depth understanding of the patient’s underlying condition (including his or her experience) and to effectively communicate relevant information to other healthcare providers participating in the patient’s care.
Essential to a comprehensive evaluation is the extended interview, which ranges from 60 to 90 minutes for new patients. Follow up visits range between 30 and 60 minutes. A standard review of systems is supplemented with patient-generated reports of daily activities, such as dietary habits, physical activity, and psychological issues (see Naturopathic approach to one patient’s case). NDs perform physical examinations appropriate to the patient’s presenting complaint and health history, and employ conventional laboratory and diagnostic imaging services as needed. Clinical evaluation is patient-centered and addresses a full range of factors that influence health as well as illness, generating a problem-oriented patient record based on International Classification of Diseases (ICD-9) criteria.