The following is a transcript of Season 1, Episode 6 of The ND Will See You Now, a podcast by the Institute for Natural Medicine.
On this episode of The ND Will See You Now, our host Anna-Liza Badaloo talks with Dr. Bill Walter, a licensed naturopathic physician in Oregon who is one of the first naturopathic doctors (NDs) to practice as a primary care physician (PCP) in a government-operated clinic in the United States. In fact, Dr. Walter has been working at the Community Health Centers (CHCs) of Lane County for nearly a decade. Learn more about his work managing patients’ chronic pain, developing chronic pain and opioid prescription policies, supporting individuals through the HIV Alliance’s Needle Exchange Program, and more. Dr. Walter is a well-known leader in whole-person primary care and naturopathic medicine who encourages listeners to consider how the impact of trauma and stigmatization can drastically alter the course of someone’s life. Listen through the end as he provides concrete examples of what he is doing to be a more trauma-informed PCP in patient care and public health.
DISCLAIMER & EDITOR’S NOTE: This transcript of podcast interview has been edited for clarity. The opinions of the host and guests on this podcast are their own and do not represent INM. This podcast and its respective transcript and social media posts do not constitute medical advice; and, are not meant to diagnose, prevent, treat, or cure any conditions or diseases. This podcast and its respective content are for educational purposes only. Consult your doctor before implementing any changes to your care. If you would like to find a naturopathic doctor (ND), please see ourFind an ND directory. To learn more about the Naturopathic Academy of Primary Care Physicians (NAPCP), please visit their site here.
Anna-Liza Badaloo (ALB): Hi there, and welcome to the Institute for Natural Medicine’s podcast, The ND Will See You Now. In this podcast, we talk to naturopathic doctors across North America about their whole person approach to health, what patients can expect, and why their work is so very vital to patient health.
I’m your host, Anna-Liza, and today I am just delighted to speak with naturopathic doctor, Bill Walter. Dr. Walter is a licensed naturopathic physician in Oregon, and one of the first naturopathic doctors (NDs) to practice as a primary care physician in a government-operated clinic in the United States. He has been working at the Community Health Centers of Lane County for nearly a decade. We’re also going to speak to him about his work with the HIV Alliance’s Needle Exchange Program. And if that wasn’t enough, he has also done work developing chronic pain and opioid prescription policies. Dr. Walter, it’s such a pleasure to have you with us today. Thanks so much for joining us!
Dr. Bill Walter, ND (BW): Thank you Anna-Liza, I’m really delighted to be with you today.
AL: Well, let’s dive in here. I mentioned in the introduction that you have been practicing as a naturopathic primary care physician (PCP) at the Community Health Centers of Lane County in Eugene, Oregon, for almost a decade now. And of course, you were one of the first NDs to be practicing as a primary care physician in a government- operated clinic. I’m thinking that many of the patients that you have seen there, have perhaps never encountered naturopathic medicine before. And, it may even have been a surprise to them to have naturopathic medicine available at a government-operated clinic.
Dr. Walter, can you give us a sense of what response you have been receiving from these patients who, again, perhaps have never encountered naturopathic medicine before?
BW: First, I should put out a disclaimer that even though I have worked for Community Health Centers of Lane County, nothing I’m saying today should be construed as representing official Lane County Health and Human Services’ policy. Thank you for giving me a moment.
In terms of the patients who come in to see me, who don’t know that I’m a naturopathic physician, on the first office visit I always announce myself. I don’t want them to feel like they’re not understanding who they are working with. Especially for people from out of state, where licensure for naturopathic physicians might not even allow primary care [within their scope of practice], I just describe what a naturopathic doctor is and what I do, where my limitations are, perhaps compared to medical doctors [MDs], and where there are other things I can offer. The responses are overwhelmingly positive. Many times people come in, and they just need a regular doctor. And it doesn’t really matter. Sometimes I see people with pretty advanced disease, and the fact that I’m a naturopathic doctor doesn’t matter to them at all. They just need help in whatever way.
In a great number of other cases, they’re just very excited to find out that I’m not just going to give them medications, but that I might offer them a range of different options to help them achieve their health and wellness goals. What is always most exciting for me, is when I’ve been working with somebody for a couple of years, and they’re just used to me as their doctor. And then something comes up and I say, “We could perhaps try this medication, or we could perhaps try these natural options”. And then they’ll say, “Oh, maybe I’d better talk to my naturopath about that”. And I say, “You know, I am a naturopathic physician,” and they say, “What?” Then I pull out my badge and remind them, “You’ll recall that I told you on our first visit, I’m a naturopathic doctor. So even though I’ve been making sure you’re getting your Pap smears and colonoscopy and cholesterol tests, now that we’ve got this thing that we want to work on, yes, I can do the natural medicine part of this too.” They’re often quite excited by that. It’s always fun to realize, even a couple years into a relationship, that they’re just so used to me being their regular old doctor, that it doesn’t even occur to them that I’m their naturopathic doctor.
ALB: That’s a really important point because by the time a patient comes to see you, they may have already seen a number of different types of health care practitioners. And that’s certainly a mark in your favor that as you say, they simply come to see you as their doctor, to the point where they’re actually wondering if they can see a naturopathic doctor about their issue. That’s a really interesting relationship that you can develop with them that way.
BW: I think it’s neat. For me, I think it normalizes the idea that of course a naturopathic doctor can do general primary care work.
ALB: And that’s really the question. I think there are a lot of either existing or potential patients [of NDs] out there who may think that a naturopathic doctor is the person you see only for certain things. And as you mentioned, perhaps they’re not realizing that as a Primary Care Physician, you’re dealing with a number of health issues using the naturopathic approach. Thank you for mentioning that.
Dr. Walter, what do you think that naturopathic medicine has to offer the increasing number of patients who are looking for more natural ways to manage chronic pain?
BW: There are a number of tools that naturopathic medicine can offer patients with chronic pain, whether we’re talking about dietary supplements such as fish oil (which can reduce inflammation), glucosamine (which can help with reducing some of the pain associated with arthritis), botanicals (such as bromelain or turmeric), or mindfulness, so that people can better manage some of the emotional responses that they’re having to pain. I don’t practice as an acupuncturist, but I can refer to one. Manual therapies…. the list goes on and on and on. I would have to work very hard to exhaust the options that I have in the natural medicine realm for chronic pain patients.
I’m going to go past that though, because there’s what happens in the exam room and then there’s what happens in policy. Because it’s not just about what I can do for my individual patients. And I’ve got a panel of about 1,000 people. In Lane County where I’m at, our Medicaid organization handles about 100,000 patients with Medicaid. For your listeners who don’t know, Medicaid is the government health insurance system that primarily takes care of people with low-income or limited means. In my community, I’ve worked very closely with the Medicaid organizations, and this has partly come from the state level as well. But we’ve got coverage for chiropractic, acupuncture, physical therapy, behavioral health, and pain psychology, specifically. As well as access through the Medicaid program for a number of supplements that can be helpful in pain, including, like I mentioned, fish oil, magnesium, and CoQ10. So, it’s not just about me doing what I’m doing. Because of my space, in terms of the people I’m working with, I’ve been a part of helping expand what people have access to.
ALB: I really appreciate you making that differentiation, because you’re right. Amongst the conventional medical community, there has been a great deal of interest over the last decade or more, in looking at how naturopathic modalities may come into play and that do not hold the same risks in terms of addiction, or some of these side effects as well. I can only imagine that brings quite a relief to many of your patients coming in – that there are other ways to deal with this very recalcitrant situation in terms of chronic pain.
Now, moving to a bit of a different topic. You have, for quite a long time, done work with the HIV Alliance’s Needle Exchange Program. I know that you haven’t been doing this work since the pandemic began, but you did quite a bit of work with them before that. And from my understanding you were doing a few things. You were offering wound care, triage, and counseling.
I want to briefly mention what some of the goals of the program are, because I think it’s really important to provide this context. First and foremost, stopping the spread of HIV and Hepatitis C. This kind of speaks to some of your other work as well: increasing access to health care, drug treatment, and detox for people that do inject drugs; and of course, decreasing the presence of contaminated syringes in the community. That’s a very, very important public health aspect. Unfortunately, we know people who do inject drugs face a lot of discrimination, not only in society in general, but particularly when encountering the health care system.
Dr. Walter, from your experience in this program and from what you’re seeing with your patients: What health challenges were the patients in this program facing? What can naturopathic medicine offer such patients?
BW: The health issues that people who inject drugs face are numerous. They range from the physical, like getting an abscess at an injection site, which can then of course become systemic or get into the heart valves. Or it could be viral infections, such as HIV and Hepatitis C. Mental health issues, homelessness, the list goes on and on. Their health challenges, really the core of them, is the fact that they’re stigmatized. They’re so highly stigmatized and they have a hard time accessing services. There’s a lot of shame that they experience. And then when they walk into a health care setting, they’re already primed to be nervous about it. This creates friction as soon as they’re in the room, with the first nurse or the healthcare provider.
One of the things that we’ve tried to do through the HIV Alliance’s Needle Exchange Program (and this is really coming from my background in naturopathic medicine, but I hope doctors and health care professionals of all stripes can bring this with them), is just understand that we’re there with that individual person and offer whole person care. Hear their story, understand it. You know, nobody wakes up one day and says, “I really want to spend the rest of my life injecting heroin.” That has never happened in the history of heroin. What we tend to see is that people have had highly traumatic lives. They get an introduction in one way or another to something that helps ease the pain, however temporarily, and then this spirals forward. And as it is spiraling forward, they’re going to lose any number of things in their life that would otherwise be stabilizing factors, whether that’s a job, a home, family, financial security, or access to health care. And so, by the time they are injecting and when I was seeing them on the street (not all of them are homeless, not all of them have lost their relationships), they’ve lost a lot of things.
As a naturopathic physician, just being centered on who they are as a whole person, and saying, “OK, what’s happening with you right now? How do we help support that?” That’s what I can bring them. Whether I’m giving them herbs or a supplement for anxiety, that’s really quite secondary to just being with them as a person.
One of the things that I’m aware of in that process, is what the power dynamic is. And if you really wanted to do a deep dive into power dynamics, you can look at 20th century postmodern theory, you can start with Foucault and all of that stuff. And that’s its own set of discussions, and I think you’re familiar with that. We don’t have time to cover power structures in depth. But I intentionally de-power myself when I’m on the street. I don’t wear a stethoscope. I don’t wear a white coat. I show up in beaten up jeans and a t-shirt, and I introduce myself as Bill. I do as much as I can to just be a guy who happens to know things that might be able to help, which I think is a really powerful way to engage them. So that they’re not walking into, for instance, an emergency room with the lights and the badges and the stethoscopes and all of the trappings of institutional power that go with healthcare.
ALB: That is very well said, Dr. Walter, I’m grateful to you for mentioning a couple of things. First, I’m grateful to you for mentioning the broader impacts that people who inject drugs can face in their lives. And by that, I mean the losses that you mentioned. They could lose their home, they could lose their job, they could lose any number of other relationships, they can lose themselves, in fact, in the process of this. I appreciate you drawing our attention towards those larger issues of financial insecurity, homelessness, etc.
And I really appreciate, as you mentioned, that you de-power yourself. I’m always thrilled when somebody mentions Foucault. For anybody out there that has not done some reading into Foucault, I encourage you to do so because he does talk about the power of the institution. As you just mentioned, Dr. Walter, what do the trappings of that institution look like from the healthcare perspective? As you said, sometimes it is the badge, sometimes it is the stethoscope, sometimes it is the white coat. And the fact that when you were actively on the streets in this program, that you would take certain steps to de-power yourself is important. You would introduce yourself as Bill, you weren’t out there wearing an Armani suit, you were trying to just make yourself more approachable. Surely in your practice as well, there are ways that you are implementing similar approaches.
I really appreciate you mentioning that, because there is a power dynamic, naturally, between a patient and any physician. And I do think it’s important, as you mentioned, that when there are individuals that you’re dealing with who are already occupying a marginalized space in society, then that power dynamic, that idea of the de-power dynamic, becomes a lot more important. In terms of having the patient feel that they are being truly heard, that you’re really seeing, as you mentioned, the patient in front of them. You’re not seeing them as a diagnosis, you’re not seeing them as an addiction. You’re seeing them as a person that, as you have mentioned, perhaps has had some quite traumatic things happen in their lives. They didn’t just wake up one day and decide to become addicted to heroin.
Dr. Walter, as much as I would love to continue chatting about these issues, that’s about all the time we have for today. You’ve brought a lot of things to our attention. You’ve talked about what you’re hearing from patients that you’re seeing at Lane County about the naturopathic approach. You’ve told us what naturopathic medicine has to offer patients who are experiencing chronic pain and looking for some non-opioid solutions, and also about how naturopathic medicine modalities and the approach you’re using is really helping people who inject drugs to reap the full benefits of medicine.
For listeners, you may be wondering where you can find a transcript. Take a look at the podcast notes, you will find not only the transcript, but some links to learn more about Dr. Walter’s work. Dr. Walter, do you have any final words to leave us with today?
BW: The final thing that I would point any listeners to, especially listeners who are working in health care, has to do with trauma, and the importance of taking a trauma-informed care approach. In our clinic, we used to ask our patients to fill out the Adverse Childhood Events (ACEs) questionnaire. For those who aren’t familiar with this, this is a questionnaire that was developed in the 1990s in San Diego. What they found was that when people had a lot of adverse childhood events (on a 1- 10 scale), they’re more likely to have health problems.
We actually quit doing it, because we found that the vast majority of our patients had health scores of six or higher. Health outcomes are notably worse than when it’s four or higher. At a certain point, we just reasonably assumed that anybody who’s walking in the door has a substantial history of trauma. I can’t recommend highly enough, if you’re a health care provider, to educate yourself about adverse childhood experiences. There’s a ton of data on it, there’s a ton of web resources about it. Everything that I do, I come at with that lens of a trauma- informed approach. Whether I’m on the street or I’m in the clinic, I’m not thinking, ‘What is wrong with this person?’ who might have challenging behaviors. I’m thinking, ‘What has happened to this person, that this is how they’re responding to their world?’
It’s been a real pleasure and an honor, Anna-Liza. Thank you so much.
ALB: Thank you, Dr. Walter. It has been such a pleasure. I’m grateful to you for taking the time to speak to us about this. Thanks again for joining us! To all of you listening, thank you so much for joining us as well. And we’ll see you next time!
This article is provided by the Institute for Natural Medicine, a non-profit 501(c)(3) organization, partnered with the American Association of Naturopathic Physicians. INM’s mission is to transform healthcare in America by increasing both public awareness of naturopathic medicine and access to naturopathic doctors for patients. INM believes that naturopathic medicine, with its unique principles and practices, has the potential to reverse the tide of chronic illness that overwhelms existing healthcare systems and to empower people to achieve and maintain their optimal lifelong health. INM strives to achieve this mission through the following initiatives:
- Education – Reveal the unique benefits and outcomes of naturopathic medicine
- Access – Connect patients to licensed naturopathic doctors
- Research – Expand quality research of this complex and comprehensive system of medicine