One of the most common questions I’m asked is whether I have a ‘set list’ of tests that I request for every patient. Of course there is no ‘one size fits all’ in health & each patient presents with their own novel combination of issues & investigative challenges, however, years of clinical experience have taught me which pathology parameters are the most clinically meaningful.
Asking yourself, ‘Will the results of this test determine my thoughts about treatment & therefore ultimately the clinical outcome for my patient?’, before referring for any investigation is a good habit to get into.
Many of us are increasingly aware of the changing environment around pathology testing, which includes reduced access to some tests in mainstream pathology. Rbc folate has had its subsidy withdrawn which means if we request this we’re now likely to receive a serum value or nothing. But does this matter? Many of us had realised over the last few years that rbc folate had several limitations and I personally would prefer a fasting homocysteine as my ‘first glance’ at methylation than either folate value. This is because it is a functional marker – it speaks of impact. It’s clearly important that we be discerning & stay up to date, especially when our patients are being asked to spend more of their own dollars on the investigation process.
Our understanding of the potential biological/chemical drivers behind mental illness has grown enormously in the last decade &, as in other areas, we have an increasing number of markers we can assess to better understand these & identify the best therapeutic approach.
Rather than requesting ‘one of everything’ though, we need to know which are the most appropriate, accurate ones on offer and target those with the greatest impact on our treatment decisions. I just recorded a 40 minute audio covering my top 10 tests in mental health patients, which includes the rationale and optimal reference ranges, as well as some suggestions about what to do next with both treatment & further investigations, should your top 10 strike gold!
To purchase your own copy of this essential top ten follow this link http://rachelarthur.com.au/product/premium-audio-top-10-investigations-in-mental-health-patients/