NEW Dear Doctor – Upskilling in Referral Writing & Inter-Professional Communications

 

Our knowledge is subject to constant change, and it is oh so necessary to stay up to date in our field for a bazillion reasons, give or take a few 😉 So sometimes we can feel like we need eight arms (for the visual amongst us) to manage and keep up with it all. However, if we ‘use the force’ together we are stronger, learn faster and can stop with the whole ‘recreating the wheel thingo’ that so many practitioners find themselves doing out there in solo practice.  Like, like…well, how confident do you feel about putting pen to paper? How good are you at your inter-professional communicating?  

 

*Cue* the release of a brand spanking new version of our
 “Dear Doctor – Upskilling in Referral Writing & Inter-Professional Communications”

 

Referrals and inter-professional communication are just lightly touched on in the current undergraduate degrees (if at all!). But it’s actually such an important way to grow your own professional reputation while simultaneously the credibility of our whole profession.  One might even argue, a pillar that stabilises the castle of shared patient-centred care & the future of true integrative health. I hear from my “New Graduates” as well as seasoned mentees about the unease that starts to creep in at the thought of writing the dreaded referral letter.  I’ve been writing referral letters for 20+ years and it’s given me a lot of time to think! And refine.  And refine again!  To make inter-professional care a positive experience for everyone, we need to correct some misperceptions and ensure that our patients are everyone’s priority. And to fulfil our duty of care, communicating with the other practitioners on your patient’s healthcare team is fundamental. Sometimes, as you’ll learn, it’s about modelling the best kind of shared care to boot and being the bigger person 😉

 

Better still, positive experiences of inter-professional communication will bring collaborators out of the woodwork.  Medicos and other allied health professionals you may never have been aware of otherwise, with a desire and openness to shared care tend to rise to the surface.

 

To get you even more excited about referral letters (you didn’t think that was going to be possible, right?!) and unlearn that Pavlovian procrastination you may have developed, Rachel has completely redesigned an older presentation to ensure it’s truly reflective of the contemporary healthcare landscape (oh yes, RACGP position statement included!). Expect to roll up your sleeves and get seriously practical advice with loads of examples about how to medico-speak naturopathic concepts, explain your role in the patient’s care, provide rationale for consideration of investigations and present ‘red flags’ with punch but minus the sensationalism.  And above all else, reveal yourself as the asset you really are to the rest of the healthcare team.

“Thank you so much for a wonderful presentation yesterday, Rachel. It gave me a new perspective on how it must feel as a GP to receive incessant demands from Naturopaths/Nutritionists to order pathology for their clients. I am in awe of your integrity, desire for patient empowerment, humility and respect for other professionals in the mainstream health arena. I felt that every single naturopath and nutritionist out in the big wide world ought to have listened to your insightful words of wisdom when it comes to shared care of our clients. We are blessed to have you as our teacher.”  – Michelle Blum (Mentee 2019) 

If you’re interested in integrative care, want to learn the language of letter writing and follow Rachel’s SMART objectives to craft your comms and communicate clearly then you should take a listen to “Dear Doctor – Upskilling in Referral Writing & Inter-Professional Communications”

It’s Not Rocket (Dental) Science!

With the increasing weight of evidence pointing to a potent pathogenic portal between our mouths and every other part of the body, whether that be in terms of cardiovascular disease, rheumatoid arthritis, appendicitis, even a growing case for Alzheimer’s disease, we need to ensure we’re not overlooking the condition of each patient’s oral cavity.  I got very excited about the recent Medscape article: A rapid non-invasive tool for periodontitis screening in a medical care setting. It’s true, I live a quiet life 😉 But seriously, a validated tool for all non-dentists to accurately pick up on the likelihood of this condition would be a nifty little thing indeed, so we can narrow down just who we quick-march off the dentist as well as understand their whole health story. But then I read the 8 actual questions which included gems such as: Do you think you have gum disease? and Have you ever had treatment for gum disease such as scaling and root planing, sometimes called “deep cleaning”? I thought, ok, this is not rocket (dental) science.

But that’s the point, I guess, right?

So while I encourage you to check out & employ this screening tool by all means, we can also be reassured that just by ensuring that when we ask about someone’s digestion (and when don’t we?!) we start at the very top of the tube, we’re doing a good job!! As my new grad mentees learnt this year…following the patient’s GIT from mouth to south anatomically, is my rather simplistic way of guaranteeing I cover everything digestive..without using formal consultation script. So in the case of the mouth, my questions include things like: last trip to the dentist; any prior dental diagnoses, number of amalgams, implants, root canals etc & their routine dental care techniques, any signs of bleeding on brushing & all foods they avoid for dental or oral reasons? Look, it hasn’t undergone the rigorous validation that the Self-Reported Oral Health Questionnaire has..but I think it’s a good start.

Whether we’re being picky about pathogens and exactly how they got access to the rest of the body (and gums make a great entry point!!) or just concerned about chronic low level inflammation, a ‘gurgling’ CRP between 1-5 in an otherwise ‘healthy adult’, picking up on periodontitis is a pivotal.

Oh and if you’ve ever wondered about possible health implications from mouth metals other than amalgams…don’t worry, soon I’ll be getting to that with a forthcoming UU30.  

Want to hear more about how certain microbiota (from the mouth to the south) are being implicated in joint diseases such as rheumatoid arthritis and ankylosing spondylitis and how we can investigate these individuals? Getting to the Guts of Women with Joint Pain is a recent UU30 instalment that gets down & dirty on the detail. 

Is This Your Month to Start Mentoring?

We’re ready to begin another year of group mentoring from this Tuesday and we’ve got just 6 spots in total still available across all our time slots! Maybe you’ve heard the buzz about the sessions from some of our mentees over the past few years & are tempted but have been holding back or deliberating…now’s the perfect time to join in, while we’re all coming back from a break and the groups are reforming and settling.  To boot we’re offering newcomers, a special 6 month package to get you started: attend yourself (or if necessary receive an audio recording when you’re unable to) all sessions from January to June at a reduced price https://rachelarthur.com.au/product/special-6mth-group-mentoring-package/ (more…)

End of Year CD Clearance

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…)

Mental Health – The Real Story

“Two great speakers – inspirational in the first half and bang on in the second – I now know how much I don’t know”

Just out now in time for Christmas…no seriously though… this year I had the good fortune to team up with Biomedica and in particular Rachel McDonald and we delivered a 3 hour seminar called Mental Health in Holistic Practice.  The intention behind this collaboration was to shift the education focus for practitioners from a prescription based approach, to one really about the clinical reality of managing mental health clients.  Probably most of you will agree that the ‘treatment’ counts for only a portion of the positive outcomes in your patients and this is particularly true in clients challenged with mental health issues. After more than 20 years in practice working in this area, I’m keen to share what I’ve learned so other practitioners can get there much much faster! (more…)

I’m coming to Sydney!

So far this year I’ve been doing most of my presenting online which has been fantastic because we can all be in our PJs and no one’s the wiser (except now!!) but I do miss the face to face seminars where sometimes the real magic happens thanks to the two-way dynamic between you and me!

So guess what?  I’m coming to Sydney on the 31st August (and then Brisbane 6th September and then Melbourne 13th September) to touch base with many of you again.  I’m joining forces with Rachel McDonald from Biomedica to talk about the real world application of naturopathy in mental health conditions.  (more…)

Dear Doctor …

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

Happy writing :)