We should all be as skilled in investigating & treating male hormone imbalances as we are female ones, yet this is often not the case. A lack of confidence in this area, which seems to be an issue for many, in particular will compromise our ability to question male clients comprehensively and effectively about their reproductive health and ultimately reduce our capacity for making good clinical decisions and achieving the best outcomes for them. If you’re female, how would you feel seeing a male practitioner who doesn’t ask you about your menstrual cycle in detail?
Many of us are at risk of committing similar crimes but we need not be.(more…)
So often in mentoring I hear about patients practitioners have struggled to treat primarily because of irregular points of contact….you know the type, the client who is an Irregular Regular or Random Regular, booking in to see you just once or twice a year or just in acute situations & never doing the follow-up you so want them to do, in order to address the real underpinning causes. A case I heard the other day would sound familiar to many of us, about a patient who saw the practitioner only when she experienced cramping. Each time she’d have an appointment, buy some magnesium which relieved the issue and then disappear again, only to re-emerge with the same issue at a later time. During one of these subsequent visits, the patient mentioned that she was ‘exhausted’. Following the practitioner’s insistence that the patient bring in any pathology she had had done, the practitioner realises much to her horror, the patient has been suffering from macrocytic anaemia for some years but no one had bothered to tell the patient and accordingly, the practitioner has been none the wiser as well. The practitioner of course felt terrible because she’s thorough and conscientious but is she to blame? Where does the patient’s autonomy end and the practitioner’s duty of care begin?
Sometimes patients themselves can be a big barrier to their own wellness for all sorts of reasons and we can’t always resolve this but perhaps we need to consider introducing clinic protocols to try and better manage the Irregular Regulars.(more…)
As we head rapidly towards the change over of our calendars we would like to offer you a special on the very best educational recordings from 2014 – buy 2 CDs before Jan 31st and receive one complimentary Premium Audio Recording of your choice OR purchase 4 CDs and receive a 3 month Premium Audio subscription for free.
It’s been a busy year during which Rachel has delivered 7 very successful new seminars in the area of mental health and beyond, most notably fortifying her role as a leader in the field of diagnostics and pathology interpretation. This has included collaborations with ACNEM, Biomedica, Health Masters Live, MINDD and Nutrition Care, however, each recording is classic Rachel – full of fresh perspectives on diagnosis & treatment, colourful analogies & humour. In case you missed some of these this year or want a copy for keeps – here’s a quick summary of the 2014 recordings included in this end of year offer: (more…)
I’ve received so much lovely feedback (fan mail!) recently I just had to share some with you (note I look much more excited than Meg does when I get mine!). It’s so exciting to be a part of our burgeoning naturopathic & integrative network. From Alyssa Tait a Brisbane based naturopath, clinical nutritionist & physiotherapist: “I am so appreciative of your mentoring and your professional development (e.g. recent Health Masters Live webinars). You make me really enthusiastic about being in this field, and you actually help me feel like I sort of know what I’m doing…most of the time!!”(more…)
As most of you know, I’m a big fan of establishing good communication with the other practitioners (GPs, psychologists, osteopaths, specialists etc.) also caring for my patients and what began as occasional letters that I found exasperatingly difficult & time consuming to write has become second nature. That’s not to say every letter I write now hits the spot & evokes the desired response but I think I’ve got a pretty good run rate. So I put together some tips that I thought might help you either get started or get SMARRRTer at it!
S – Service
M – Medical language & conventions
A – Accuracy
R – Reasonable
R – Rationale
R – Respectful
T – Time-conscious
Service
A summary of the most important medical aspects of the case is a great time saver for other health professionals & assists them in making better informed clinical decisions
Summarise key points of reference
e.g. Betty Smith (BMI 36kg/m2, Waist 92cm)
e.g. Depression (diagnosed 2010, Zoloft 100mg/d)
Pick out the salient features of the case
What are the absolute must-knows in the case?
Medical language & conventions
Only use medically accepted terms & diagnoses
e.g. avoid naturopathic speak such as dysbiosis, adrenal fatigue etc.
Quantify EVERYTHING relevant
e.g. weight loss/gain (7kg in 3mo), DASS scores, stool Bristol type & frequency
Include all units of measurement
e.g. 4.6 mmol/L, 129/84 mmHg
Summarise medical hx in table form for easy reference
Accuracy
Clarify which details you have first-hand Vs second hand – be careful not to be part of Chinese whispers
e.g. patient reports being diagnosed with lactose intolerance
When including patients’ own words – use quotation marks
e.g. patient reports feeling “dizzy & vague with brain fog most days”
Clarify if some things have been self-prescribed – otherwise the assumption will be that you gave/recommended it to them
Reasonable
Don’t use a scatter gun approach when suggesting investigations
Try not to ask for subsidised testing that the GP is simply unable to do under subsidy
e.g. Full thyroid function test can’t be subsidised without a prior diagnosis of thyroid disease or TSH outside of reference range…WEIRD BUT TRUE
Rationale
Present a brief, clear justification for any requests
e.g. Iron studies (vegetarian diet)
Include appropriate references when the justification is likely to be beyond expected knowledge
e.g. as a deficiency of this vitamin has Vitamin D – both 25 (OH)D & 1,25(OH)2 D, been implicated in a large number of autoimmune conditions assessment of both forms is recommended (Smieth et al. Vitamin D in Autoimmunity. Am J Clin Nutr. 2013)
Respectful
Ask for their assistance/insight/review/guidance
Don’t forget – you want & need it!
Keep in mind also how the relationship your patient shares with this practitioner may be positively or negatively impacted by the respect & tone of your letter
Time-conscious
How far in advance should the GP receive your letter in order to give him/her adequate time to read & digest the content?
e.g. too close to consult – GP might understandably feel ambushed/rushed/unprepared
How much time does a GP or other professional have to spend with each patient?
In summary the less words the better – look for ways to reduce your word count, cut to the chase and ideally get most letters down to 1 page
