Clinical Skills and How to Develop Them

When I first took a course from the North American Institute of Medical Herbalism (NAIMH), I was delighted with the different style they had and the emphasis on clinical skill as it relates to humoral herbal medicine. One comment Paul Bergner made was that many of the early herbalists were very practical and had their “sleeves rolled up.” I remember how this impressed me. At that time, I had already been practicing herbal medicine for about a decade and had learned that not every great-sounding idea that was well sold turned out to be true in real life. The studies being published often also did not represent truth or even practical application, but rather theory and distant conjecture.

The good old days may not have been all that good, as the song says, but in one way information from 1950 and earlier is a lot better. The information coming out then on natural healing was from people who were actually practicing in clinical settings where they got to see when an approach did not work. They got to notice when a diagnosis did not appear to be the real problem. They observed when patients did not respond.

Today, what happens far too often is that practitioners are actually just consultants. They tell the patient what to do as they have learned it and then when the patient does not get well, the “practitioner” ends up blaming the patient or throwing out some other untested idea. The amount of conflicting health information today is part of the confusion. In the next few lines, I want to explore what I believe should happen instead.

(1) The practitioner is a keen observer of nature and knows when the patient is responding and getting better or is actually getting worse or not responding. This is not easy to develop and there are few places to learn it. It cannot be fully developed unless the practitioner actually has a clinical practice and sees patients over and over. The practitioner has to carefully assess the patient for progress and needs to honestly note it to the best of his or her ability.

Another part of this point is that the practitioner should spend plenty of time out in nature, observing how it works. The practitioner should be congruent with his or her own beliefs, morals and ethics to a meticulous point. This is vital because incongruent living clouds thinking and perception.

The practitioner should learn to notice pulse, voice, facial characteristics, posture, skin luster, tongue diagnosis and any other observable phenomenon that will represent the progression of health of the individual. Massage therapists or at least foot reflexologists and zone therapists have an advantage in that they are able to touch and feel the overall tone and flow of the person. Chiropractors are also able to determine if the body is integrating well.

(2) The practitioner is always interested in refining his or her understanding about what is happening with the patient. This involves considering carefully assumed diagnosis as well as subsequent treatment. Does the treatment really work? This is how I first figured out that candida might not be what they said it was. I noticed that I could kill candida–in fact I could do it while feeding the person fruit juice–in a couple days using oak bark or Dr. Christopher's Yellow Dock Combination. But when the mythical “systemic candida” case came, my own treatment helped minimally and none of the other treatments and diets worked well either! I considered at that point that candida might not be the right diagnosis. While everyone else kept on running on the same bad assumptions, I asked myself some questions based on the first point above. One of them was: “Is it likely that candida would be able to take over all the functions of an otherwise healthy person and ruin their health all by itself?” I had to conclude that such an idea was ludicrous. Now I have the best success treating “systemic candida” of anyone I have ever heard of and I never treat candida. I know it is gut failure and subsequent imbalance and endocrine exhaustion. The candida shows up last, if at all.

One way to look at clinical skills is simply application–can you apply some therapy or idea. The rest of the story is that clinical skills must include the ability to assess what is wrong, how the patient is responding, what is the natural faculty failure that got us to this point, what is the actual need of the body, what part of what is going on is actually adaptation (rather than actual weakness in the body), what current factors are limiting or confounding in the healing process (such as exposure to vast amounts of synthetic estrogen in the environment today, or such as all the EMF exposure today), etc.

I have this conversation again and again in my courses, gradually (I hope) developing in my students a process of critical thought when it comes to clinical application. I teach some basic face diagnosis and reflexology in my retreats each year, hopefully teaching my students how to determine overall health of the patient. I sometimes attack modern ideas that have lost the vision of the body as an intelligent part of nature. In these cases, I may be overzealous but I get the student to consider another perspective.

One key to good clinical skill is to be able to consider multiple perspectives objectively. One has an opinion, of course. What we do not do when faced with a problem is defend our position. Rather we consider what we see and possible ways of looking at it. This is certainly easier for some than others, but some ability to do this is vital. A favorite quote comes from Aristotle, who said, “It is a sign of a trained mind to be able to consider an idea without embracing it.”

The quote is deeper even than it appears at first. The implication, to me at least, is that the ignorant, undisciplined and untrained mind, has only two choices when presented with a new idea: embrace it or reject it. The trained mind has the power to consider an idea for its merits, adopt a change of soul if the idea exposes flaws in the one considering it and then look for the wisdom in the origin of the idea–all without actually either embracing or rejecting the idea.

The individual's own opinions are viewed honestly as opinions. What the individual actually knows that s/he knows is accepted quietly as a foundation on which to consider all other ideas. A practical approach is just a practical approach, a tool set so to speak, and is never treated as dogma.

Finally, the good clinician is always asking in every situation, “Have I (or my system of thinking) mistaken the end for the means?” This is precisely what happened with two very popular ideas today: candida and pH. The end of a healthy gut, good nutrition and wise behaviors is blood with an alkaline pH. Manipulating pH is no better whatsoever than cutting out a gall bladder that does not work. The cause and the potential cure are ignored completely and the gall bladder is treated like the cause alone. Candida we have already mentioned. It is very like the people who come to a train wreck to scavenge up the usable items. They are not the cause of the mess or wreck! They may slow the cleanup and getting rid of them is not always bad, but they also might help the cleanup!

I do not believe good clinical applications can ever come out of any mistake of the end for the means. We always should be looking for what is the real need of our neighbors and brothers and sisters in the human family. Why are they manifesting disease and how can I help? That is the honest question of the good clinician. The answer is not always forthcoming and the best approach may sometimes prove insufficient, but good clinical skills will produce a culture that is healthier and healthier. That is not what is happening today.