The Difference Between a NP and a MD Explained

The Difference Between a NP and a MD Explained

One of the biggest challenges I’ve encountered since moving to Portland and starting a practice here has been one that I never would have expected. I’ve been shocked at how many people here don’t know what a Nurse Practitioner (NP) is.

In Indiana, this never came up, not once.

When I tell someone here that I’m a NP, there’s the (now familiar) blank stare. They don’t want to tell me they have no idea what I am and what I do, so they sort of nod awkwardly. I then ask, “Do you know what a Nurse Practitioner is?” and they admit to not really knowing.


Explaining what a Nurse Practitioner is and does is complicated.

Yes, we are licensed to make diagnoses, order labs and radiology testing, and prescribe medications. We can manage a patient’s overall care and serve in the role as primary care provider (PCP).

This might cause some people to compare us to medical doctors. While we do share similar licensing privileges, it’s not the best comparison.



First, it undermines the level of education of medical doctors (MD)s. These professionals spend countless hours in education. They earn a 4-year undergraduate degree, followed by 4 years in medical school, followed by several years in residency, generally averaging around 12 years of advanced education.

Nurse Practitioners become Registered Nurses first and then go on to get a graduate degree as a Master of Science in Nursing. NPs usually spend 6-7 years in advanced education.



Next, there’s a difference in approach. MDs are taught to be scientists. They focus on lab and other test results and treat with a scientific approach in all that they do.

Nurses are groomed to be caregivers, treating not just the physical aspects, but also the emotional, mental, spiritual, and social parts of people’s lives.

Of course, nurses use science and critical thinking every day as well, but are more likely to look outside the box for an emotional or spiritual “root cause” of a symptom.

Evidenced-based practice is extremely important for NPs. It’s just not the only factor in our care.

At FLOURISH, I look at all causes of symptoms: physical, emotional, spiritual, financial, and social.



Another other big difference between NPs and MDs is specialization. Many MDs become a specialist, such as a Gastroenterologist, Pulmonologist, Cardiologist, or surgeon. They receive rigorous training in the specialty area.

There are NPs who specialize also but with less and less MDs training in family practice or primary care, NPs are often filling the shortage as family practice and primary care providers.


So then, you might ask why would you want to see a NP over a MD?


Compassionate Care

First, as stated above, we are caregivers. We listen fully to our patients and we believe what they tell us. We trust that our patients know their bodies better than we do and we give them time to tell us what they know to be true about themselves.

We are trained in empathy and compassionate care. We know you’re not just a test result, but a complicated system and that many factors are affecting your level of wellness.

We’ve spent time at the bedside with the sickest of people, held the hands of terrified patients, comforted loved ones facing the worst moments of their lives, and cleaned up body fluids with deep respect for dignity.

We know what’s it like for our patients to lie in a hospital bed feeling helpless and hopeless in the middle of the night.

We get it, and we bring a personal touch to healthcare that’s often lacking in today’s systems.

My patients appreciate that I deeply care about them. They become like family to me.



Next, we are teachers. We want you to completely understand what’s happening with you and we take the time to explain everything in detail. We focus on disease prevention, health education, and wellness counseling.

We see ourselves as a guide to help you navigate your path to feeling your best. We don’t see ourselves (or medications or surgery) as the solution.

We believe that each person has the innate power inside themselves to heal and we will support you fully to get where you want to go.

At FLOURISH, I take the time to explain every result and every treatment, so you know what you’re doing and why!



Last, and perhaps most important is that we have ruthless determination. We will go the extra mile for our patients every time.

We know that we will never know everything, so we spend our free time researching and educating ourselves to be the best we can be.

When we don’t know the answer for someone, we won’t stop until we find it, and we will fight for you.

We are a brave and stubborn group of people. If you want help, ask a NP and you will get it!

I’ve been called a “medical detective”. I love working with people who’ve been to see a bunch of different people and no one can figure out what’s wrong with them.


Sometimes MDs are frustrated that NPs are being compared to them and I respect this. I will be the first one to refer a patient to a MD if I feel their situation is out of my scope.

The other side of this is that I rarely need to refer. I can handle almost every situation that shows up in my office and because my care is thorough, holistic and compassionate, patients often prefer working with me over a MD.


I hope this helps to explain the differences between a MD and a NP a little better for you. I’d love to keep this discussion going.

What questions do you have about the role of a Nurse Practitioner?

Have you seen a NP? I’d love to hear your feedback about the care you received.


Please comment below and be sure to share this post with anyone else who might be feeling confused or with anyone who’s looking for a different healthcare experience.

And, if you know you’re ready for a Nurse Practitioner experience for yourself, learn more about FLOURISH here.

How to Handle All the Strain and Drain

How to Handle All the Strain and Drain

Are you feeling strained and drained? Those are the best words I can find to describe what I’m feeling myself, and also seeing in my patients.

We’ve had so much to deal with this year and some days it feels like it’s only getting worse.

How are you coping? How are you keeping away the strain and drain?


There are three specific effects of the strain and drain I’m seeing right now and I’m seeing them in most everyone: foggy thinking, trouble sleeping, and feeling tired. This makes a lot of sense.

Most of us are running around in fight-or-flight. If you don’t know what I’m talking about, start here. This causes elevations in the stress hormone cortisol. Short-term elevation of cortisol affects our sleep and our energy, and long-term elevation of cortisol can actually reduce the number of brain cells and/or stop new brain cells from being made.

The best way to handle this is to do everything we can to keep cortisol levels down. This can be done in several ways. You can do deep breathing and meditation. You can add an adaptogen herb as I discuss in this article. And, here are some specific tips for each of the three main areas of strain and drain.

The 3 Effects of Strain & Drain:


#1: Trouble Sleeping

As you can imagine, all the extra cortisol is affecting our sleep. My patients are describing fitful sleep and waking up for no reason and not being able to fall back asleep.

If this is you, too, it’s more important than ever to practice sleep hygiene. This means getting off of technology at least an hour before you want to be asleep, making sure your room is as dark as possible, maybe taking a warm bath or long shower before bed, and considering a nice cup of relaxing tea.

We have to allow the body time to let the cortisol levels reduce. If we go to bed when they’re still high, we won’t be able to fall asleep or stay asleep.

So, just like Peter Rabbit’s mother, why not try a nice warm cup of chamomile tea?

Science has yet to definitively prove that chamomile actually does something in the body that induces sleep, yet herbalists have been using the herb for centuries for this very purpose.

With very few side effects, it’s worth a try.

Add 1 T. dried flowers per cup of water, cover, and let it steep 20-30 minutes. Then strain and enjoy.


#2: Feeling Tired

If we’re feeling more stressed in general and not sleeping, it makes sense that we’d be feeling tired during the day.

One way to get more energy is through B-vitamins. B vitamins help you convert your food into energy. Without a proper amount, we can feel low in energy.

I always recommend more mindful eating of vitamins first and add a supplement only if needed. Foods high in B-vitamins include whole grains, nuts/seeds, dark green leafy greens, meat, poultry, seafood, and eggs.

If you need more support, you can visit a health food store like New Seasons and purchase a Vitamin B-Complex. Some people have genetic issues which make it difficult to properly assimilate B-vitamins, so taking large amounts could cause anxiousness. Be sure to come and see me or another expert for advice on which supplement would be best for you.


#3: Brain Fog

The last effect of these times I’m seeing frequently is brain fog. This can be helped with all the above, as well. Here’s another fun tip… rosemary.

Rosemary has gotten a decent amount of press for its effect on memory. Small studies have proven that when people smell the oil, they remember things better. Interesting.

What I find with rosemary is that is makes me think better in general. It’s like a mini mental stimulant. You can use the essential oil and smell it as you start to feel foggy or you can simply use the plant. It grows everywhere here in Portland. Simply cut a small sprig and keep it near you. When the brain fog hits, rub your fingers along the leaves and smell. It’s that simple.

Here’s some rosemary oil I have brewing right now. I’ll use it on food and to rub it on my skin on days when I need a little boost.


Right now, it’s the simple things that seem to make a big difference. Slow down and stay in your body. Try not to let you mind run wild all the time. This doesn’t support healthy cortisol levels and can cause all the effects we’ve discussed.

Staying out of your mind means staying grounded. On the Sacred Sundays Blog this week, I’ll talk about what it means to be grounded and how to stay grounded. If you’re not on that newsletter list, you can sign-up here.

Then, on my Wednesday at Noon Facebook Live, I’ll show you an easy exercise for getting grounded quickly and effectively. Make sure you’re following The FLOURISH page so you don’t miss it!


I’d love to hear from you. How are you handling the strain and drain? Is there anything else I can do to support you?


Herbs for Lung Health After Smog

Herbs for Lung Health After Smog

It looks like we’re finally starting to feel some relief from the oppressive smog that’s been hovering over Portland the past 9 days. We’ve almost made it through and now it’s time to take care of our lungs.


Today I’m going to discuss my favorite lung herbs starting with my two favorites, mullein and coltsfoot.


Mullein leaf (Verbascum thapsus)

Mullein has a strong affinity for the lungs. It’s a normalizer for the lungs as well as a demulcent (soothes and relieves irritable mucus membranes). It’s used for all conditions associated with inflammation in the respiratory tract.


Mullein is very common in the United States. For lung health, we use the leaves as an herbal infusion (like a tea).


Note: If you’re not sure how to make a herbal infusion, check out this live video on the FLOURISH Facebook page to learn how.


Coltsfoot leaf (Tussilago farfara)

Coltsfoot also has an affinity for the lungs. It acts as a gentle expectorant (loosens and promotes the gentle flow of mucus), as well as also being a demulcent. It’s great for dry coughs, shortness of breath, hoarseness, and bronchitis.


Coltsfoot is also easy to find and is prepared as an infusion.


*The combination of mullein and coltsfoot is an old standby in herbal medicine and quite effective.


Consider taking 1 quart of this combination as an infusion for the next two weeks.


Be advised: While mullein has no contraindications, coltsfoot is not for use in pregnancy or breastfeeding or by anyone with known liver disease. Coltsfoot should be used only for a short time due to the presence of pyrrolizidine alkaloids (PA’s), which may harm the liver with long- term use.


Other lung herb choices:


Licorice root (Glycyrrhiza glabra):

Licorice is a relaxing expectorant (brings up the mucus without causing drastic coughing) for unproductive coughs with dry throat and for all irritable lung conditions.


Licorice root is also very common and easy to find. The root is used as a decoction (simmered in water for 30 minutes).


Licorice should also not be used during pregnancy and only under professional supervision if you have diabetes or high blood pressure.


Marshmallow root (Althea officinalis)

Marshmallow is a soothing demulcent. It’s helpful for any irritation of mucus membranes, dry cough, and bronchitis.


The best way to make it is to put the chopped root into cold water and let it set for several hours. It will be gooey, so you can add it to other teas once it’s infused if that makes it more palatable.


The only thing to watch for with marshmallow root is that it can block absorption of other medications and supplements, so don’t take it at the same time as your other remedies.


Thyme leaf (Thymus vulgaris)

Thyme is known for its ability to fight all infections, including viral, bacterial, and fungal, and has an affinity for the respiratory tract. If irritation from the smoke has morphed into a possible infection, thyme can be helpful.


Thyme is best taken as an infusion.


It is not recommended for pregnancy and should not be taken for long-term use.


If you’re my patient, you can contact me to get any of these herbs. If you’re in Portland, you can support local business by getting your herbs from Dragon Herbarium or Herb Stomp. It looks like they both have these herbs in stock. And, I always love to order online from Mountain Rose Herbs.


Here’s a live video on the FLOURISH Facebook page if you’d like to do some breathing with me.


As always per our terms of use, this blog is not meant to serve as medical advice and you should always consult your own healthcare provider for personal advice.


Any questions? Please comment below.

I Lost 10 pounds and Here’s How

I Lost 10 pounds and Here’s How

I don’t know about you, but the “COVID 15” was really real. If you don’t know what I’m referring to, there’s a saying that kids go away to college and gain the “Freshman 15” since they’re away from home, eating more junk food, and no longer on a regular schedule. A lot of people joked that the “stay-at-home orders” caused them the same problems, and the same subsequent weight gain.

It truly did happen to me. My gym closed, so I wasn’t going to my regular three-day-a-week exercise class and potato chips seemed to taste better than ever. Add that to beginning peri-menopause and voila, I was heavier.

Despite all I’ve learned about Intuitive Eating from my good friend Coach Tiffany Thoen, RN, I found myself thinking negatively about my body and turning to traditional dieting regimens to solve this weight gain. I tried counting calories and points and all that stuff. Most tries only lasted 2-3 days and I got mad and quit. I didn’t want to feel deprived and I really didn’t want to track every morsel that entered my mouth.

Luckily, I hosted Tiffany for an interview about her work in my NP practice development training program. I heard her say again the things I’ve heard her say so many times. She said things like, “Diets don’t work” and “Trust your body and what it needs”.

I took a careful look at how I was feeling about my body, the foods I was eating, and the lack of movement. I made four simple changes and easily lost 10 pounds.

Now, before I tell you what those four things were, I want to say something really important. I didn’t want to lose weight because I want to be super thin or because I felt ugly or anything of the sort. I wanted to lose weight because I felt inflamed, tired, and my body aches and pains had increased. I wanted to feel vibrant, energetic, and have less pain, and I knew that holding the extra weight was contributing.

Okay, here’s what I did:

1~I looked in the mirror and I said to myself, ‘I love you at any size. Let’s do this to feel more fit, strong, and stable!’

2~I took a look at what time of day I was craving those chips…late afternoon. We were eating dinner around 8pm and I was getting kind of hangry around 5:30-6. So, I moved our dinner time up to 6:30-7 and I eat a little fruit and/or nuts if the hangry sets in. It actually doesn’t very often, because I’m already cooking and my body knows that great food is on the way.

3~When I get hungry through the day, I ask myself, ‘What sounds really good’ and then I eat that. We always have lots of fruits and vegetables around, so often I eat those. Sometimes popcorn sounds good, so I eat that. I actually haven’t been buying chips since they usually make me feel bad when I eat them anyway. Now, if a food feels bad after I eat it, I take note of that, and it’s easier to avoid later.

4~I started going for a walk every morning in the gorgeous woods by my house and felt inspired to add bursts of running on the trails to get my heart rate up. After my meditation/visualization and goal-setting for the day, I now go right out the door and get my walk done. This is what feels great, not what I think I “should” be doing. (And, I get my nature time in, too!)

And, that’s it!

I don’t plan to keep weighing myself, because it’s not about the number on the scale. I did it more out of curiosity to see if all of this “worked”.

I still have a long way to go to understand exactly how to eat intuitively. I’m sure there are even things in this very blog that still don’t follow a true “body-positive” way of looking at things. And, I’m open to learning.

If food feels like a struggle for you, I invite you to check out Tiffany’s work. She’s hosting an online meet-up on September 9 that is open to all. She also offers coaching if you want even more help.

I’m writing this mostly to say to you, you are beautiful no matter what shape or size you are or despite what any scale says.

What if you slowed down and listened to what your body wants you to eat and how it wants you to move?

What if we all stopped “shoulding” ourselves around food and exercise?

What if we based our health on how we feel and not on what the scale says?

I love that I now have this “proof” that this is exactly what works to bring my body to the weight that is most optimal for me and to feel as energetic and fit as I’ve been longing to feel.

I’d love to hear from you about any of this. Please comment below with any thoughts or questions.

Happy eating intuitively!

Stop and Breathe…

Stop and Breathe…

One of the most common things I’m seeing in almost every patient right now is shallow breathing.

And, wearing a mask everywhere isn’t helping.

Take a moment right now and notice your own breathing. Are you breathing deep down into the bottom of your lungs?

Before you read on, I want you to take three deep breaths in and out. Stop right now and do it.

Breathe deeply (your lungs go all the way down into the bottom of your rib cage).

See and feel your rib cage moving up and down.

Did you do it?


Now, notice how you feel now as opposed to before you took the breaths. Better, right?

Perhaps your breathing is a little slower, maybe your shoulders relaxed a bit, maybe you don’t feel so stressed?

Deep breathing is free and easy and the benefits are many. It also only takes a couple of minutes to make a big difference.

One of my favorite breathing techniques is 4:7:8 Breathing.

I learned this technique from Dr. Andrew Weil many years ago when I was working night shift. I would do this breathing technique any time I needed to sleep. It gave my body the cue that it was time to sleep no matter what time of day or night it was.

And, 4:7:8 Breathing isn’t just for sleep. It can be done any time during the day for a refresher, especially with all the sitting most of us are doing. Getting oxygen deep into your lungs helps to bring more oxygen to your entire system and keeps the bottom lobes of your lungs healthy. When the bottom lobes aren’t getting enough oxygen, you might feel short of breath or anxious.

Here’s how to do it:

~Place the tip of your tongue to the roof of your mouth on that place that separates the teeth from the roof of your mouth (even if you forget this step, you’ll still get benefits).
~Breathe in as you slowly count to 4.
~Hold that breath for a slow count of 7.
~Exhale all the air with a little force for a count of 8.

Repeat this cycle 4 times.

That’s it!

Try it now and see how you feel after you do it. It seems to take people from the fight-or-flight mode into the rest and digest mode quickly and easily (learn more about this here). Want to watch a live demo? Here’s one for you on the FLOURISH Facebook page

I recommend doing this at least a couple of times a day if you sit a lot and during stressful times. It’s also very helpful to do before bed if you struggle with sleep issues.

An Integrative approach to healthcare always includes practical tools like this breathing technique. Instead of always going right for a medication, we look for underlying causes. Lack of proper breathing is a very common cause of anxiety and stress, and even gastrointestinal issues.

If you’d like to experience an Integrative Medicine appointment first hand, I invite you to see me in my clinic. You can find more information here.

I’d love to hear how more deep breathing goes for you!

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