interview: dr. li hsu, ND Lic. Ac

this is the first in a series of interviews i hope to conduct with practicing ND's or acupuncturists. dr. li hsu was the doctor who introduced me to naturopathy and only after countless conversations with her was i convinced that going to naturopathy school was for me. here is the transcript from our interview today:

what was the most useful part of your naturopathic education? what was the least useful?

i think the most useful part is the exposure of all the different aspects of naturopathic medicine, because naturopathic medicine is very vast. i didn't know how vast it was until after i graduated-- it was just so many subdivisions of each major component, like for homeopathy there's some branch out of that, and even for acupuncture there's different schools of thought, and botanical medicine-- you know i mean there's just subbranches of each of these subspecialties-- it's a very vast discipline. so i think the most useful part is the exposure to all the different areas of this so that you're at least aware of them so that you can choose the one you want to pursue. i think that's the most useful part.

however, in order to find your niche, you have to be exposed to all the others that you may not be so interested in. then it becomes less useful when you don't use them all the time. but you can still have that in the back of your mind when and refer patients who you think might benefit from certain things, like for example, i learned colonics at school. when i went to school we needed to do rotations in the clinic and we needed to do everything that was offered. i think colonics will not be something that i'm interested in doing; however, i was exposed to it and i know what it is involved, and i can refer people to those specialists.

so the least useful i guess is just the time that it took to find my niche. because there's so many of them.

how much of the basic science of the 1st and 2nd year do you remember? how much do you find relevant and apply regularly?

actually i don't know if that will apply the same for everybody. because i came from a very science background-- i majored in biochem in college, so i already had all the prerequisites. however when you're doing all the biomedical sciences like anatomy, physiology, then biochemistry... i think all those are basic foundations. i don't think there's a shortcut to it. however, depending on the teacher, they can structure the class in such a way to have a great exposure and just teach the structure so that when you get into subcategories you'll be able to understand and search that out for yourself. i don't think it's necessary for people to go through the whole memorization of all the subcategories. that's my personal opinion, you know.

but for example, anatomy is crucial if you're trying to study acupuncture, because all of the point locations have to have anatomical descriptions to find the point, so you have to know your anatomy. the physiology, if you want to functional medicine or clinical nutrition, you have to understand physiology. i don't think there's any shortcut to those; it can be overwhelming, but i think those subjects are crucial in order to do good medicine. otherwise you're just doing "cookbook"-- when you come to 3rd and 4th year, you'll get a lot of protocols. like, for this condition, you do this and that. if you don't have a strong foundation in understanding physiology, then you may not know why you're giving certain things, and how to vary things when the situation becomes different. so i think it's important to have that.

if you could go back and do the ND program again, what would you do differently?

i'm not sure my answer will be valid because i've jumped around a bit; i didn't start an ND program on a clean slate like you did. i actually went to an acupuncture school and studied one year there. and then i went to another to study naturopathic medicine and acupuncture. and they had a combined program, so they allowed me to transfer credits from here to there, so i did a part time ND program at first-- i didn't take all those courses at once. and then i transferred schools again, which had a different curriculum, and at the 3rd school, the naturopathic and acupuncture departments were separate, so it was a different type of exposure.

so my first year as far as the load and curriculum was very different that what you're experiencing now, because i kind of split it in two years to do it. but i think if i were to do it again, i would have some more preparation in science. when i was in school we had a lot of people in different backgrounds, like accountants, builders... for me it was OK to take the biomedical sciences because i'm used to studying science. but i can't imagine those people who aren't used to studying science who have to just jump in and study anatomy physiology and biochemistry all of a sudden. i don't blame them for being overwhelmed. i think for people without a science background it might be good for them to split the first year in two parts to do it; otherwise they might feel overwhelmed and lose interest.

what was the most difficult part of setting up your practice?

the most difficult part of setting up your practice is to make yourself known. i mean, you're just out of school, nobody knows you-- especially if you come to a new place. i think just making yourself known and being out there and educating people, that's the hardest part. the reason why i say it's the hardest part is because it's the most time consuming. and it takes a lot of self motivation, because nobody's out there to tell you "OK, this is the deadline for your homework" or anything like that. you have to motivate yourself on a day to day basis to go out; you have to have a very strong purpose, keeping in mind why you are doing this profession. and that will motivate you to go out.

i went into this profession because i want to help people, and because it helped me i have a strong conviction that this is the right medicine for the 21st century-- i mean this was my attitude, thinking that preventative medicine is the right type of medicine for the 21st century, instead of crisis intervention. and so when you're out there putting your energy out there, educating people, then your practice will just flow. i think the hardest part is just to have that basic motivation and foundation.

and it's hard when you're not that focused, when you're just out of school-- if you haven't prepared in the 4 years a vision of where you want to be, and you're just out there all of a sudden, you'll feel lost. that was kind of the way i felt, because i came to a new place where i didn't know anyone.

what did you do to make yourself known? where were the strategies that worked for you?

well at first, just because of my immigration status, i worked for somebody else. and i was very fortunate to have worked for somebody who was willing to train me. so he sent me out. and i, by nature, i'm not the type of person who likes to go approach strangers and talk about what i do. but essentially that's what it boils down to. it's almost like, being on your purpose everywhere you go-- like if you're in a restaurant having a meal, and somebody has a heart attack or an asthma attack next to you. would you be the first person to go and get up and help that person with your natural method? or would you say, i hope there's someone who knows how to fix this. so it's that type of difference. even though you might not be able to have the full equipment to help that person- it's your motivation, your initiation, your purpose, this is the essence of the usefulness of your education.

what is the most challenging part of running your clinic?

well i'm in a good place right now. i mean, it wasn't like this at the beginning. the hardest part was to hire the right staff also. initially it was hard to get out there and have the motivation, and then after you kind of get it going, you need to find the right person to help you. if you find the right person to help you at the front desk, who has the same purpose as you, you feel like you can fly-- you just feel like you can go and conquer the world, you know what i mean? but if you have someone who is always telling you what you can't do, then that's more like a thorn in the flesh ... that you have to work with on a daily basis. so i say, finding the right person as a helper.

what do you dislike about the profession?

i think for me, it's not being able to practice fully, because massachusetts doesn't license ND's yet. i don't know how many states are licensed now, but when i graduated there were only 8 states that were licensed to practice naturopathic medicine. which basically means there's a law governing the board of naturopathic physicians. and there's a law that tells you what you can do, and what you can not do, like the scope of the practice. in massachusetts we don't have that. we are fighting to get that now, but we've been fighting for as long as i've been here.

the good news is that all of the other new england states are licensed. so we're surrounded by people who are permitting this practice, so i think it's just a matter of time. i think massachusetts has a lot of controversy and strong opponents here, so it takes a little bit of fighting to get through that. and it takes the right people to be the senate and representative of each district for the law to be passed. i think it's just a matter of time. when there's no law governing, states can be neutral. massachusetts is neutral, so you can go hang up a shingle and no one will give you trouble- but you just can't make mistakes. if a patient of yours ends up hating you and starts badmouthing you, then there's no law to protect you, that kind of thing. so massachusetts is that way right now.

how often do you examine the new research that comes out on naturopathic or chinese medicine?

i examine everything that comes through my mail [laughs]. i don't go out of my way to read more, because i have so much mail that comes. i read publications on naturopathy, acupuncture, there's integrative medicine, there's just... a lot. to tell you the truth, i don't read them all. i just skim through and see what might be pertinent in helping my current patients and pay more attention to those.

do you have to present the medicine more from a western perspective to win over patients?

you definitely have to explain to them why, everybody wants to know why they're taking certain things. and it's hard, sometimes, to explain certain things- because western medicines have specific functions, like OK, this will get rid of your cough. but if you take herbal medicine, sometimes it's not so specific in terms of its formula. saying "this will strengthen your immune system or help to boost up your adrenal glands" is much different than getting rid of the cough or helping stop a runny nose. but you have to say it in those terms for them to have some ground for grasping the function of the herb.

how often do you encounter people who are skeptical of the efficacy of naturopathy or acupuncture?

well, a lot of people have no idea what naturopathic medicine is, and sometimes they don't even care, you know. i guess it depends on what type of environment it is; like if i'm on a cold contact, outreach type of event, then it happens a lot. so what i would do is prepare some screening questions to screen for the people who are more interested in alternative medicine, so that i'll be able to explain to them what their alternatives are. usually these are the people who have health problems; those people who don't have health problems, they couldn't care less. they might be just interested in learning about the concept of it. i'm more focusing on targeting people who have health problems. so first i will ask them if they have any health concerns, and if they do, i'll ask them if they have heard of naturopathy or acupuncture, and if they express interest in that i'll go into it further.

so is it more often the case the patients are not informed rather than mis-informed by the negative literature?

i honestly don't think there's that much negative literature on naturopathic medicine. although there are some magazines that are coming out, i think there's a whole group of people trying to disprove herbal medicine and all the benefits it gives. they would say, "st. john's wort has all these side effects, doesn't really help depression, blah blah blah". i mean that might be true to some extent, that st. john's wort causes photosensitivity, and may hyperpigmentate the skin and so forth. but they put it in a tone that is overly negative.

but frankly i haven't come across too many people that will present to me that kind of negative literature. i mean there are people out there that are like that. in fact one of my patient's husband is like that. the wife is a strong believer in natural medicine. she doesn't want to take western medicine, she wants to do everything natural. she comes here and gets benefit and tries to get her husband to come. and the husband is a very high achieving scientist. and he is a strong dis-believer of acupuncture or natural medicine. but he came in anyway, just because his wife wanted him to. and i explained the whole thing to him, in one and a half hours, the whole scheme of things. in the end, he said "...i don't believe you", and then he walked away!

so, you know, he could have said that earlier, before i went through the whole nine yards in trying to win him over. but after that i changed my attitude. i'm not here to necessarily "win people over". i'm here to make it known what it is i have to offer. it is their choice, ultimately, so i can't force them to do anything- all i can do is to educate them. and i think once i've changed that attitude inside of me, i don't take things personally anymore. when he did that, i felt... offended, you know? like he did that on purpose, to hurt me, to waste all my time, etc. etc. but, if i have the attitude of: i'm here to offer you what i know, and i think this will be really helpful to you- the effect of that is that when he said "i don't believe you" and walked away, my thinking will be "that is your loss, and not mine". i educated him, and he actually has gained a piece of knowledge, that he can now process in his mind-- so it's a whole different frame of mind.

so now, i don't run into too many of those. if they're not interested, then i say, well... it is your choice. i'm just letting you know what i can offer.

can you talk a little more about how you integrate naturopathic medicine and chinese medicine? are there conditions that are better suited for either naturopathy or acupuncture?

for naturopathy, my focus is in clinical nutrition. basically supplements- vitamins, minerals, herbs. and i do use some chinese herbs and homeopathic remedies. so what i do is evaluate the person holistically, meaning taking into consideration their physical, emotional, and mental plane. and then i offer the modalities that i have on hand available to them. and then they choose what they will like, what they feel might work for them. you know, some people don't like needles, so they say i don't want acupuncture. but then there's a non needle technique i can offer, and they might say, "ok, that might be feasible for me to try". some people don't like to take pills- they're OK with acupuncture but they don't want to take any pills. even though i explain, these are not pills in the sense of medication, these are dense nutrients. so some people, comprehending that, would succumb to taking pills, but other people still don't like the concept of taking pills.

so, i let them choose. because it does take involvement on their part to take responsibility for their own health. first the education comes from letting them know that they have to take part in restoration of their own health. it's not like a "come and fix me" type of attitude. so we have to get them participating in eating well, educating them about food, educating them about exercising, and all the things that they want to incorporate into their lifestyle. and then i'm here as an educator, a helper to help them get there.

so i think the integration comes from their evaluation at the beginning- from there it's like the different choices that they're able to make.

is there any other advice you want to give to our class?

[laughs] no, i think that's pretty thorough. some of these things i don't even think about every day so it's not like i can come up with a good answer right away. but i think on the whole, that's how it is. i think you'll also find that everybody has a different journey and path and these things may not be applicable to everybody but this has been my own journey to this point and my own experience. i hope this is helpful.