The Architecture of Sustainable Practice:
Three Essential Landscapes
Hi Reader,
Some days, everything flows beautifully in my practice. Other days, I find myself drowning in administrative tasks, struggling to maintain presence with patients, or wrestling with imposter syndrome. What's fascinating, though, is how these challenges themselves have become invitations to deeper learning—not just about running a practice, but about the nature of healing work itself.
I'm Katy, a naturopathic doctor and acupuncturist, and I've come to see healing work as an ongoing invitation to explore and adjust across three essential landscapes: our inner world, our outer systems, and our practical tools. Last week, we explored how our personal stories shape our healing work. Today, I'm sharing this three-part framework not as a perfect solution, but as a lens that helps me navigate both the flowing days and the challenging ones.
When these three territories are in dialogue with each other, they create a kind of feedback loop—each challenge becomes an opportunity to refine our approach, deepen our understanding, and create more sustainable ways of working.
Our Three Landscapes: A Living Laboratory
Every day in practice offers us opportunities to engage with three essential territories:
Inner Landscape: This is the territory of our relationship with ourselves and our work—how we show up, what we bring to each interaction, and how we maintain our center. It's where we navigate the tension between expertise and humility, between holding space and maintaining boundaries. Our inner landscape shapes everything from how we respond to challenging patients to how we define success in our work.
Outer Landscape: Our practices exist within a web of relationships—with our local community, healthcare systems, and the broader world. When climate anxiety shows up in our treatment rooms or local healthcare policy shifts affect our patients' access to care, we're reminded that our work is inherently connected to these larger contexts. Understanding these connections helps us respond thoughtfully rather than react reflexively to the changes around us.
Practical Path: This is where our inner values meet the outer world—the tangible ways we structure our work and care for our patients. I'm a constant tinkerer (sometimes to a fault), always experimenting with new tools and systems. While I love diving into the details of EMRs and scheduling systems, my real quest is to create a practice that authentically expresses who I am as a healer while meeting the real needs of my community. When these experiments work well, they create bridges—between our ideals and reality, between our healing intentions and their practical expression. I share my ongoing experiments not as universal solutions, but as field notes from one practitioner's journey that might spark ideas for yours.
These territories flow into each other:
- Inner work shapes how we show up
- Outer connections influence what's possible
- Practical tools bridge between our intentions and reality
Together, they help us practice medicine in a way that serves both our patients and ourselves.
Join the Conversation
I share these frameworks and experiments not as finished solutions, but as starting points for dialogue. Here's what's currently on my mind:
- I'm testing various systems to support and reduce my mental load. These are small changes that are raising bigger questions about how I can tend to my own mental well-being and the details of patient care.
- Marketing remains my persistent challenge (maybe yours too?) and I'm exploring ways to show up authentically and interact with my community without burning out.
- My biggest win: using Heidi AI for SOAP notes has transformed my practice, freeing up significant mental space for deeper patient connection
What's alive in your practice right now? Your challenges, experiments, and insights matter—not just to me, but to everyone trying to practice medicine more sustainably.
