Accuracy in our professional language, and why it’s important.
One way I supported myself as a naturopathic student was working as a phlebotomist in a large Seattle hospital. It was my introduction to working in healthcare and a significant part of my medical education, albeit extra-curricular. It was also my introduction to laboratory medicine, and it set me up to work even more in the lab, as a medical lab tech, for a period of time after finishing my ND.
While there are many aspects of laboratory work that I don’t miss, like waking up ill patients at 6:00 a.m. to poke them with a needle, there are also elements that I really enjoyed. These include tasks that were well defined, instructions and procedures that were clear, results that were specific, and a lot of variety as well. My time in the laboratory also made very real for me the principles of sensitivity and specificity, two parameters that define the boundaries of usefulness for many test procedures and techniques. A third quality, accuracy (or precision), is also very relevant in the laboratory – without it tests and instruments quickly lose value and relevance. This was very evident to me in the clinic, but I’ve found it stands out in relation to language and communications in the world outside the clinic, as well – and something that will be increasingly important as our profession continues to grow.
According to the online Merriam-Webster dictionary ‘accuracy’ is defined as:
1 freedom from mistake or error: correctness
2 a: conformity to truth or to a standard or model: exactness. b: degree of conformity of a measure to a standard or a true value — compare precision
As executive director for the WANP, I’m in a relatively unique position to get a broad view of our profession. In fact, until relatively recently, I felt I knew where all our doctors were in Washington. We’ve grown enough that I can no longer make that claim – though I do still keep a rather detailed mental map of who is where and what many of our doctors are doing.
So, what does this have to do with accuracy and precision? Well, my job gives me the opportunity to review a lot of ND promotional and marketing materials, and to get a sense for how we, as a group, are communicating with the rest of the world. Prior to working for the WANP, I was involved in a variety of the institutional-level healthcare activities, from credentialing and contracting to corporate business and governmental interactions. A common focus through all of this was a strong focus on highly specific language and related communication skills.
What I have learned in the 15 years that I’ve been doing this type of work is that accuracy and precision are crucial to success on a variety of levels. For example, in contracting, the more familiar both parties are with the terms of the contract, the more expectations are managed and the less chance there is for conflict and upset. That said, I’m still rather surprised at the rather small number of our colleagues who actually read and understand their preferred provider contracts and liability insurance policies. (A recent example of this came up in the middle of last year, when an astute WANP member became aware that a prominent liability insurer does not cover NDs for care for newborns – something many NDs are likely not aware of.)
I’ve also learned there is a language specific to mainstream healthcare, built on a lot of history and past experience, and invested with a lot of meaning. Knowing this is often a key element in building the bridge that facilitates recognition for naturopathic medicine. Awareness of mainstream language and concepts comes to the fore particularly in political work where use of established language (ex. ‘primary care provider’) is something that legislators and regulators can relate to and understand – though such terms certainly don’t define the full range of naturopathic practices or professional roles. So, in light of my particular background, I want to share some observations and suggest where I think we may need to clarify some of our communications and language.
Minding Our Credibility: On review of numerous naturopathic websites, it is quite common for NDs to refer to themselves as “board certified.” However, currently there are only two fully recognized naturopathic professional boards and each confers an additional credential for those who successfully meet the criteria: the DHANP, for a diplomat with the Homeopathic Academy of Naturopathic Physicians, and FABNO for a fellow with the American Board of Naturopathic Oncology. Too often, though, the claim “board certified” really just means the doctor is licensed.
The fact that we refer to our national qualifying tests as ‘board exams’ is probably one source of this confusion, but nonetheless, this descriptor isn’t really accurate. For a small, relatively unrecognized profession, such a small detail probably won’t make much difference – today. However, as we grow, our profession and our individual doctors will be increasingly scrutinized by the larger society. What is a minor inaccuracy for one doctor could diminish our value on a larger scale, particularly by those less friendly to the new kid on healthcare block.
Defining Our Practice: Similarly, in mainstream healthcare a ‘specialty’ is often a board certified position. Should NDs refer to themselves as specialists? What about ‘residencies?’ In looking at the differences between allopathic residencies and the naturopathic variety, questions arise – not about the value of the additional training – but about the accuracy of using the same term for both of these formats. In each of these cases, there is an established understanding as to what the language means, and it’s very important that we recognize the similarities and differences and we assess whether we’re being as accurate as we can and should be.
Another reason to do this is to insure that unique aspects of our profession are not assumed to be the same as those of other professions just because we use the same terminology. Each of these issues will be situational. In one case, we may choose to use language that is the same as that of the mainstream, or we may choose to use it in one situation – such as in a legislative effort. In another, we may want to coin our own term as a way of differentiating the unique aspects of naturopathy that are new to or different than the status quo. For instance, is naturopathic primary care a distinct entity? Do we need uniquely naturopathic CPT codes? These are the type of questions we need to be asking.
Legal Implications: Accuracy is equally important in understanding the contracts and laws that regulate our professional lives. Knowing what a health plan requires and has the legal ability to do, such as request medical records or audit charts, is prerequisite to interacting effectively with these bureaucratic behemoths, manage expectations and reduce one’s stress level. Knowing the specifics of the Washington naturopathic practice act (RCW 18.36A), and in particular the specific prescriptive rights within that statute are essential as well. Failure to do so can cast a particularly unprofessional aura around our practice. When in doubt, finding a primary source for clarification, such as the Department of Health website (click here), is the best prescription.
Now We’re in the Spotlight: As our profession grows, the need for accuracy grows as well. To paraphrase an old radio ad, “People judge you by the words you use.” It’s true. We need to be aware of our language in all the areas where our medicine interfaces with the rest of healthcare and society. Making this a priority will also help us with our own intra-professional understanding and consistency. And, lest there is any doubt, our need to do this is a very good sign. It means our profession is getting attention. It means we are being taken seriously and we are past the days of just fighting for survival. In the past, how could we have even considered examining such details? Attending to accuracy proactively will have preventive benefits, I’m sure.
A focus on accuracy is already well underway in many parts of our profession. It is an integral part of the naturopathic research agenda in assessing our clinical work. It is part of our medical schools and their efforts at curriculum development. It is part of the Foundations Project in the creation of the new textbook. All of this is very positive! Let’s encourage it and extend this to the language we use as well, collectively and individually. This will aid tremendously in making sure our message and our mission are clear and the public know who we are, what we do and how we are unique.
As always, I appreciate your attention to my thoughts and I welcome yours.
All the best,