Why follow up?

Why do we ask you to revisit?  The art of the follow-up…

It is just as necessary for a follow-up visit to our office as it is for other health services. Often allopathic (conventional) doctors are unfamiliar with nutritional methods, products, and what we do here.  Since we are very familiar with conventional medicine, it is often up to us to do more when it comes to coordinating care. This is particularly true when it comes to potential interactions of drugs and drugs, drugs and food, drugs and supplements, and even when it comes to side effects of prescriptions. In addition, conventional medical visits are extremely short, and many lifestyle and nutritional issues are not reviewed. In addition, many lifestyle and nutritional issues are neglected in busy lives. Health is complex, and ultimately, comes back to personal responsibility and the practitioner. Health is more than trying 6 prescription drugs in a row, to “see” how you do with each of them sequentially. We review your personal lifestyle and assist you in being certain it keeps you in the best shape possible, minimizes future health mishaps, and optimizes your physical and mental well-being.

A face-to-face assessment is absolutely necessary. Subtle changes in cognition, attention span, energy levels, and in fact function of all organ systems may be apparent to a skilled examiner, but often not to the person involved. Sometimes it is necessary to ask probing questions to decide about a health issue, and whether complications have arisen that are not obvious. Part of the “art” in biomedicine is also observing body language and voice tones when clients/patients are personally present. Many studies confirm the absolute advantage of a face-to-face visit before a provider, and that is why medical organizations, oversight guidelines, savvy consumers, and insurers insist upon them. Telephone and email exchanges are wonderful for brief follow-ups, but the gold standard is the actual visit, one on one.

Example one: A woman was concerned about  shoulder and hand weakness and stiffness, and sought a consultation about natural relief. However just looking at her fingers and palms revealed she was extremely pale, confirmed by her eyelids… she was bleeding actively from her stomach, due to her own use of aspirin and ibuprofen, was referred to her PCP immediately, and eventually had endoscopy by GI.  After she was finished with that, we did find natural substances that helped her hands considerably.

Example two: A gentlemen had been to the health store, and was given a number of items and was told it was a good “substitute” for what we had given him. Over the next 3 months, his health suffered, and the improvements we made were gone. After review of the “substitutes,” during a follow-up visit, it turned out he was sold supplements that had nowhere near the amounts of what did him so much good before, and the quality was so poor, it was a waste. In addition, there were 4 ingredients in each of the supplements that were duplicated—also a poor arrangement, since doses of each could not be adjusted alone. He never looked at the labels, and after reading some information about quality in supplements, resumed the correct doses, again improved markedly, and was thankful. In addition, another problem had arisen, and we were able to suggest a remedy that he said worked in just a couple of days.

What we do during that revisit:

1. Take additional health history about your health developments since the previous visit, and re-discuss details of the main “problem list”, and new issues, symptoms, or signs that may have arisen
2. Review new research in the medical literature which apply to you, how they fit in, and make appropriate changes
3. Find out the progress on prior recommendations, including barriers to adherence which often present themselves
4. Adjust amounts (dose), type, and form of agents nutrients, herbs, and other modalities used for best absorption and results
5. Assess changes in body composition and vital signs since previous visit
6. Refine plan for greater improvement
7. Adjust lifestyle approaches to remaining health issues
8. Review diet diary and/or typical dietary intake
9. Answer questions and give supporting scientific reasons and references for our courses of action
10. Amplify and review other information which you may have gathered in the interim from other providers, periodicals and the internet
11. Review potential interactions and depletions
12. Discuss trends and the significance of health records received since the previous visit
13. Negotiate changes and additions to the health optimization plan to bring even greater success
14. Review interfacing—past and upcoming—with other health practitioners, and provide suggestions
15. Coordinate changes in your condition and cae with what your PCP and subspecialists do
16. Provide a revised written chart of all therapies, both conventional (allopathic), naturopathic, nutritional, herbal, dietary, physical, with commentary, to give a holistic, panoramic view of your status
17. Review all vitamins, supplements, antioxidants, anti-inflammators, and other agents with both prescription and OTC drugs and dietary constituents to be certain there are no interactions, nutritional depletions, or potential adverse effects
18. Provide personalized handouts, and reinforcing, motivating reprints from the medical literature