How Do You Structure a Program for a Patient?

Overview

Getting started in complex cases can be difficult, and the temptation to jump right in without listening to what the patient has to say can easily lead to misdiagnosis and waste our and the patient’s time. Integrative medicine needs to flow in a stepwise fashion, building an individual timeline for each patient, using not just academics, but the heart as well.  Looking for the root cause is important and needs to be prioritized. What works for one patient may not work for another patient with the same symptoms. As physicians, we need to take a personal interest with each patient, customizing his or her care based on his or her individual needs. A unique wellness plan is a must for every patient. 

Read the following thoughts from Dr. Cheryl Burdette as she explains the importance of structuring a program for an individual patient.

Introduction

Hello, my name is Dr. Cheryl Burdette, and I am the Creator and Educational Director of Origins Incubator. This week we want to talk about the case of a woman who was having trouble in terms of eyebrows thinning. The real question was, “How do we get started in more complex cases?” 

Case of Eyebrow Thinning

In this case, we walked through ideas and talked about differential diagnosis in terms of eyebrows that were thinning. We began to look at other chief complaints that she was having and to break those down into processes: Are these other problems in the more hormonal area or nutritional area? Then we began to see where most of her complaints were lying. So, we asked the question, “Did we see a common thread through these complaints?” What we began to see is that there was, in fact, an element of hormonal imbalance that could be affecting many of the things that she was experiencing. So, we walked through some specific recommendations that might be helpful for her, like zinc and ashwagandha. 

Getting Started

But the real question in terms of “How do we get started?” was to think in terms of her chief complaints: 

• “What is it that was most important?” 
• “What is it that she was most motivated by to change health?” 

Then we thought about “What is the process behind the chief complaints?” because when we put these two together, this gives us a way to begin in integrative medicine in a way that has a stepwise fashion. Many times, we're struck with the fact that, in a complex patient, there are many things at play. And it gives us hesitation in terms of knowing where to start. We order every single test, or we order gut-based testing, heavy metal testing, environmental toxicity testing, infectious disease testing, and nutrient testing all at the same time. Or is there a way to break it down? So, we examined what lens we would use to put her case in a strategic fashion, building a timeline to talk to her about, in terms of what tests we would do next and how we would progress with her. Clinically and diagnostically having all the information that we could want at one particular time is optimal, until we come to “How do we put it in place?” Since patients can't do everything at once, understanding where to start and how to peel back the layers, like that of an onion, is one of the hardest questions that we find ourselves facing. 

Clinical Curriculum

In our clinical curriculum, we work to think not just about the actual interventions, but how do we put a wellness program in place for this patient that captures the individualization that we need, while at the same time, letting them know that there's not one bullet, one pill for a single ill, and really introduces them to the concepts of integrative medicine. This is the challenge, helping our patients to know that it won't be just one visit, and it won't be one stop, putting that program together. Initially for me, I often had hesitations with programs because I thought, “Well, they will never be able to address the individuality of each patient.” And so, we see many programs out there that will teach this protocol, and you do this protocol first, and that protocol next. But at Origins, we really want to move beyond that because the reason that we become dissatisfied with medical practice is because we get tired of not looking for root cause, such as when we always decide it's a statin for every elevated cholesterol, and we are not asking the question, “Why the cholesterol is high in the first place?” This leaves many of us feeling like we are not reducing, not engaging in the kind of medicine that we would like to have our own family encounter, the kind of medicine that we would like to deliver from our heart. 

Conclusion

If it's not going to be protocol-driven, then how do we master all the individuality of what's going on? At Origins Incubator, we are not here to just teach another protocol, but we want to always think about how you look at a case, how you organize a case, and how you take certain protocols that you might know but layer them and individualize them for each patient. So, we looked at the kind of questions we would ask:

• What is the diagnosis? 
• What is the major process behind that diagnosis? 
• What motivates the patient in terms of wellness? 
• Where do we thrive as a clinician? 

When we answer these questions for each patient, it puts us on a roadmap that allows us to build an individualized program that will meet their needs, that will treat root cause, and that helps us to feel aligned in terms of our academics and our heart working together to find an individualized best solution for each patient that we meet with.