Research is the Unsung Hero

Working harder and longer is not the same as working smarter

Alison Chen, ND

Patients can readily justify paying for the time during their clinical visit, but what about all the time that goes into researching their case outside of office hours?

Research is critical, especially for new practitioners and complex cases. But the time spent researching often creeps into family time, social time, and personal time, and never sees a paycheck.

Research is necessary but not acknowledged nearly enough.

When first starting out, many physicians spend far too many hours researching patient protocols and treatment strategies. Meanwhile, more experienced clinicians may be too comfortable with their “stand-by” treatments, thereby missing important novel research.

Strategizing your research time will make you a more effective and efficient doctor.

The first step toward efficient use of your unpaid time is to set clear boundaries and time limits for yourself. Knowing how to manage and maximize your research time can be the difference between sanity and chaos.

9 Ways to Effectively Manage Your Research Time

1. Pause the visit

During patient visits, don’t be afraid to take the time to pause the intake in order to research crucial facts about their condition, current medications, interactions, or symptom picture.

2. Don’t do too much

One of the main deterrents for patients is information overload. In the first visit, give the most obvious and pertinent prescriptions. You don’t need to change a patient’s entire lifestyle in the first or even second visit. Most patients aren’t ready for it, nor is it sustainable to make such drastic changes.

3. Stay flexible

Creating a general plan over a period of time is great, but the details will change, so don’t sweat it. Know that roadblocks and bumps in the road will come up, so don’t force your “perfect protocol” onto your patients when it may not be best for them.

4. Give yourself breaks

Create 15-minute breaks ever few hours to eat, go to the washroom, meditate, or catch up on patient charts and research. Avoid the daily burnout, which makes end-of-the-day research exhausting.

5. Create boundaries

Avoid bringing work home with you. But if this isn’t possible, create a separation from your home life. Create a physical boundary by only working at one specific table during specific times.

6. Understand Parkinson’s Law

Parkinson’s Law states that a task will expand to the amount of time allotted for it. If you give yourself a day to research your cases, you will inevitably procrastinate and take the whole time to complete the task. If, however, you restrict yourself to 30 minutes of research per case (and be firm with your time allotment), you will be much more efficient.

7. Dedicate a day to research, bookkeeping, and marketing

Setting aside a day of the week (or part of a day) dedicated to research and marketing may help to focus your energy. A full day of seeing patients makes it difficult to have the energy and focus to do effective patient research at the end of it.

8. Charge for the visit AND the research

Many practitioners feel hesitant to charge their patients more than $150 per hour. However, if you take into consideration the intake and time set aside to research, not to mention all the overhead costs, rent, and the 4 years of medical school, naturopathic doctors are often undercharging for their services. They are also often going into more debt or sometimes even bankruptcy. So, charge what you are worth, not what you think you are worth. And let’s change our perceptions of self-worth.

9. Use high-yielding resources

You don’t need to survey your Facebook group for every single patient condition that walks through your door. This is because we all know that Facebook leads to procrastination – mostly looking at old friends’ wedding photos and watching silly cat videos.

Which brings me to the next section…

Maximize Your Research Time

At any given point, you may need to look up various conditions, treatment strategies, specific modalities, drug interactions, journal articles, or supplement/lab companies.

The following is not an exhaustive list, nor should be used in sequential order. You may be looking up a treatment for a particular condition, and then suddenly add a differential diagnosis to your list that you’ll need to research for more information.

Use this list as a guide to help navigate, focus, and maximize your research time and efforts.

1. General Search

Start with a general search for complex conditions, symptom presentations, or lab findings to make your rule-in and rule-out differential diagnosis list before blindly accepting a diagnosis.

• MedScape: www.medscape.com
• Clinical Key (aka MD Consult): www.clinicalkey.com/#!/
• Basic Google search: www.google.com

2. Treatment Strategies

Various sites and books can help narrow your treatment strategies, depending on the patient’s underlying condition and symptom presentation.

• Natural Medicines Comprehensive Database (formerly Natural Standard Database): http://naturaldatabase.therapeuticresearch.com/home.aspx?cs=&s=ND
• ND Assist: www.ndassist.com
• Clinical Naturopathy (Jerome Sarris & Jon Wardle)

3. Perform Your Own Research

Blindly following another practitioner’s treatment protocol is dangerous but so easy. Own that you have a good grasp on the mechanisms of disease and useful treatment options; start your research into case studies.

• PubMed: www.ncbi.nlm.nih.gov/pubmed
• Google Scholar: https://scholar.google.com/

4. Watch for Interactions

Always, always, always check for possible interactions between a patient’s existing protocol and anything you are adding on to it. Especially with patients taking multiple pharmaceuticals, always ensure that adding something to their existing plan isn’t going to make them worse.

• Natural Medicines Comprehensive Database: http://naturaldatabase.therapeuticresearch.com/home.aspx?cs=&s=ND
• Compendium of Pharmaceuticals and Specialties (CPS): http://tinyurl.com/h2n5tk5 (includes online version)

5. Specific Modalities

Everyone has their favorite go-to resources for modalities, depending on your school, mentors, and required readings. Some of my favorites are listed below; feel free to let me know yours.

     a. Nutrition:

• Nutritional Medicine (Alan Gaby, MD)
• Modern Nutrition in Health and Disease (Catharine Ross, PhD)
• Principles & Practices of Naturopathic Clinical Nutrition (with errata) (Jonathan Prousky, ND)

     b. Acupuncture:

• The Foundations of Chinese Medicine: A Comprehensive Text for Acupuncturists and Herbalists, 2nd edition(Giovanni Maciocia, CAc)
• Acupuncture Desk Reference (David Kuoch)
• Fundamentals of Naturopathic Acupuncture (Neemez Kassam, ND, & Matthew Gowan, ND)

     c. Health Psychology:

• Mind Over Mood: Change How You Feel by Changing the Way You Think(Dennis Greenberger, PhD, & Christine Padesky, PhD)

     d. Botanical Medicine:

• Medical Herbalism (David Hoffmann, FNIMH, AHG)
• The Ultimate Herbal Compendium: A Desktop Guide for Herbal Prescribers (Kerry Bone, ND)
• Principles and Practices of Naturopathic Botanical Medicine: Volume 1: Botanical Medicine Monographs (Anthony Godfrey, PhD, ND; Paul Saunders, PhD, ND; Kerry Barlow, ND; & Matt Gowan, ND)

     e. Homeopathy:

• Desktop Guide: To Keynotes and Confirmatory Symptoms (Roger Morrison)

6. Supplement Companies

Knowing the supplement combinations carried by companies is helpful for making a quick search during a patient visit. Some products are superior in efficacy and quality, while others can be safely chosen based on affordability. Having supplement companies’ websites on hand is great, but I especially like using NDAssist (see above) for being able to look up a supplement or ingredient (eg, ashwagandha) and see its monograph and all of the professional lines carrying it, including combination formulas.

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Alison Chen, ND, is the co-creator of the Naturopathic Doctor Development Center (www.theNDDC.com) and the winner of the Canadian College of Naturopathic Medicine’s Humanitarian Award. Her background in competitive gymnastics, volunteer work in Africa, and her honors degree in biology provide her with a well-rounded view for living well. Originally from Toronto, Dr Chen travels the world with her partner. Learn more at: www.dralisonchen.com.