At least, not in our office. On its face, a question may appear to be a simple one. The patient asking the question might think it’s simple. But it’s probably not.
To be clear, the type of question I’m referring to are those that start with phrases such as “should I (do this or that)?”. Or, “what type of (supplement, massage, exercise, food, etc) should I choose?”
- “Which type of fish oil should I take?”
- “Should I take the leaky gut supplement before meals, or after meals?”
- “What re-tests should we run this time around?”
- “How long should I work out?”
And so on.
For some of those questions, there is indeed a fairly quick answer. Sometimes, that answer is something along the lines of, “there’s no exact science; try a few variations and see what works best for you. Above all, listen to your body”.
And other times, there’s a clear answer, such as which particular detox regimen someone should follow (including which particular supplements to take), based on their nutrient levels and genetic variants, but it might not be a decision that can be readily arrived at.
This is particularly true for, say, the example I just used: detox.
If someone says, “which detox supplements should I take?” or “should I take Detox Supplement A or Detox Supplement B?”, then from the patient’s point of view, the question should be a quick one, and it should result in a quick answer–emphasis on quick.
Except that it doesn’t work that way.
Every detox supplement is a little different, and so is every patient. If I used the same supplement on all patients, I’ll certainly make some of them better, but I’ll also make others worse.
A better idea would be to consult their file. What were the pertinent nutrient levels? Were they running low from the beginning? Or were they high because the body wasn’t able to utilize them well? Or were they just right?
I have no choice but to pull the file and find out. That in itself isn’t a big deal. But that’s only part of the picture.
Juxtapose that information with determining the type of detox we need to do. There are several types of detox, which are optimal for different types of toxins. These are known as pathways. If I’m trying to encourage the body to kick out excess hormones, I’m going to need to stimulate specific pathways; if I’m trying to nudge the body into purging food additives or heavy metals, these are each going to use their own pathway, or a combination thereof.
Now I might need to consult other test results in the patient’s file, such as environmental toxicology screenings, or perhaps their intake forms and 15-to-20-page health autobiography that may provide some clues about which toxins they’ve been exposed to.
I might need to research those toxins; I might not. Research itself could take anywhere from minutes to hours.
Intersect the individual nutrient profile of the patient with the list of nutrients needed for the type of detox we’re about to do.
At this point, I might need to a flowchart or diagram as a refresher. Which nutrients are needed for sulfonation/transsulfuration again? Oh yeah… L-Cysteine, alpha-lipoic acid, Magnesium, Taurine, Vitamin B6, and a few others. That’s different from methylation, which needs Vitamins B2, folate, and B12, Magnesium, SAMe, TMG, Biotin, and Choline, etc.
Now I probably need to re-consult the patient’s individual nutrient levels and other lab test evidence of each of these, to try to determine how much support they need.
Even once I’ve determined all that, my work isn’t done; I now have to figure out how we’re going to put different individual nutrients and formulas (combinations of nutrients) together in the most efficient, effective, and cost-effective way possible.
This involves consulting the online catalogues of at least four–but up to 15–different supplement companies, identifying the formulas available from each, and comparing and contrasting each formula or even combination of individual nutrients would best meet this patient’s anticipated needs.
This involves logging onto the websites of each company, navigating through the interface, and obtaining information on each single agent and/or formula they offer, making note of what’s on each ingredient label, comparing each against the patient’s profile and the other single agents/formulas (both those offered by the same company or by other companies), and finally arriving at a decision.
And even then, it’s just an increasingly-educated guess. This process has taken as little as 15 minutes, or as long as an entire workday. It’s also time that I don’t get paid for, but instead, I choose to include that in the time actually spent with me during routine checkup visits or the slight markup on the supplements themselves.
A patient might (understandably) get frustrated while awaiting my response. “What’s taking so long? What’s so hard about my simple question?”
Although those questions don’t take long to ask on the phone or type in an email, they can be much more complicated than they look.
So, I encourage patients to feel free to ask the questions they have. I also often explain to patients what I need to do in order to properly answer their questions, and I’ve trained my staff to parrot these explanations as reminders when needed. This is known as managing expectations, which I’ll probably write about more thoroughly in a separate post in the near future.
I’ve prepped my patients for the average “wait time” by eluding to it in the initial intake paperwork, where the clinic policies and commitment statements to patients are covered. I find that doing this will set the stage and sets the expectation levels where they should be. After all, I want to be sure that I have the time to prepare and gather the information I need in order to give them an accurate and correct answer.
Seems to work fairly well.