There are times in which I have closely interacted with dentists as an otolaryngologist. Patients who have snoring and sleep apnea (a condition in which a person stops breathing while he or she is sleeping) often go to an otolaryngologist. For example, I consult a patient, Jay, with this problem and suspect that a large part of the problem is due to a lower jaw that is abnormally developed and poorly positioned. In addition, while Jay does not realize that the jaw problem is related to the snoring, he admits that this has bothered him cosmetically during the past decade. I refer Jay to the oral surgeon, who is able to surgically correct the deformity both from a functional and cosmetic aspect. After all the necessary investigations and opinions, Jay decides to proceed with the surgery. He is in the hospital for a couple of days after the surgery and all his care is managed by the oral surgeon. Many people do not realize that dentists can function in this capacity.
In the end I had a happy patient who was sleeping better and was more confident about his appearance. Jay’s success was largely due to the collaboration of the different professionals who came up with the best management plan unique for him. This example demonstrates how much the two professions overlap with similar interests, concerns, office dynamics, and most importantly for the benefit of the patient.
2.4 Dietetics
A dietitian has many options for choice of practice once training is complete, including working independently in an office setting. The person might also choose to be based in a hospital, or in an environment with other health-care providers, such as an endocrinologist (i.e., one who specializes in diabetes), a lipidologist (i.e., specializes in patients with raised cholesterol), or a weight-reduction clinic.
The term “nutritionist” is also used for someone in a similar profession, but the credentialing and services provided need to be reviewed by the individual seeking care. In some countries only individuals with the appropriate training and certification are permitted to call themselves a dietitian. Just as in other health-care fields, dietitians can choose to be just as specialized, for example working in pediatric, research, and corporate settings.
2.5 Midwifery
Midwifery is a profession in which a person can have varying responsibilities and independence, depending on choice, where they completed their training, and the location of practice. In many regions, they can practice as independent practitioners, and provide care relating to pregnancy, including prenatal care, delivery, postpartum care, and care relating to breast-feeding. Some midwives also provide primary care to women relating to female related issues (e.g., birth control, yearly gynecological exams). Many mi wives are closely affiliated with a hospital setting, or with other medical professionals such as obstetricians or family doctors.
Most midwives that I have come across have a nursing background, but many do come from other diverse backgrounds unrelated to medicine, before embarking on training in midwifery. During my undergraduate medical training, I was taught and instructed by midwives relating to normal childbirth in the clinical setting.
2.6 Naturopathy
Personally, I am a big believer in vitamins, natural remedies, and consultation with naturopathic doctors when the need arises. Besides personally utilizing these natural routes of care and supplementation, I incorporate it into my practice as much as possible. Naturopathic physicians practice in many ways just like their medical doctor colleagues, and some patients prefer to have a naturopath as their primary care physician.
One example of how I use non-medicated care for my patients as the first line of management is a relatively new type of nasal spray — seawater. Yes, it is from the ocean and prepared commercially for nasal application. I believe it works great for regular nasal hygiene as well as a sole, or adjunctive maintenance regime, for such problems as nasal bleeding, sinus disorders, and allergies. I have anecdotally heard of many people whose nose and sinus symptoms clear up when they swim in the sea. I know when I swim in the ocean my nose and sinuses seem to clear up, so I was not surprised when I saw seawater on the drugstore shelves for general use.
Obviously, naturopathic doctors are experts in many different conditions and can recommend naturopathic intervention for most disorders to some degree or another. I have referred many a patient to a naturopathic doctor for an opinion, one classic example being a consultation for ringing in the ears (otherwise known as tinnitus). Some naturopathic remedies have been known to be helpful with this condition. While there is often no medical treatment available for tinnitus, some patients have been helped with naturopathic remedies.
While naturopaths can take care of many things, they do not commonly prescribe medication or perform surgery. There are some countries and jurisdictions that permit naturopathic doctors to prescribe medicine, but that is not universal and very much of a dynamic change. They, too, examine patients as do medical doctors, and have a training program that is in many aspects very similar to medical school.
Although naturopaths try to avoid medications as much as possible, I have been referred many patients from naturopathic doctors as well, when they have seen the need for medical or surgical intervention.
Just to demonstrate the forever and rapidly changing scope of the allied health professions, in the area that I practice, very recently a new ruling has come to effect that naturopathic doctors are permitted to prescribe limited medications themselves.
In terms of the naturopathic office environment, things can run in a similar fashion to an office of a primary care medical doctor, and I know several naturopaths who practice in the same office as a medical doctor.
2.7 Nursing
The nursing profession goes hand in hand with medicine, and in many ways the two disciplines need each other to function. The nursing field has expanded in so many exciting ways, from an educational, research, and practice point of view. The duration of training has become longer in many parts of the world and the specialty options are immense.
Some nurses with advanced training and skills choose to set up an independent practice of their own, either alone, with a group of other nurses, or with other health-care providers. These nurses are referred to amongst others as Nurse Practitioners, Advanced Practice Nurses, Advanced Practice Registered Nurses, and Independent Nurse Contractors. In some areas in the United States and in Canada, these advanced nurses can set up their own independent practices, while in other areas they can open independent practices only with physician collaboration. In some states and provinces, the advanced nurses can also prescribe medication, refer patients to specialists, and even admit patients to health-care facilities. Note that not all states and provinces allow advanced nurses to practice independently. For more information talk to your local nursing association.
Clinical nurse practitioners in North America practice in some ways similar to, and together with, medical doctors. For this reason, the office setup of a nurse practitioner has much in common with that of a medical doctor.
While working up in Northern Canada’s isolated communities as a visiting doctor, I came across several nurse practitioners who performed amazing work in medically under-serviced areas. The nurses take care of the patients, do the necessary examinations, prescribe medications, and work closely with doctors. Nurse practitioners are an evolving profession, becoming more independent in the urban setting too, with different countries and jurisdictions permitting different levels of practice.
I will give you a concrete example of how this profession can function. Patient Zen was an infant in a remote area in Northern Canada who had recurrent ear infections in the first two years of his life. He needed antibiotics periodically, and if the clinical nurse specialist had not been practicing there, the complications as a result of untreated ear infections could have been significant.
One of the consequences of untreated ear infections is a condition known as mastoiditis