With the case review questionnaire, it seems like some of the sections are really small for someone’s responses, mostly on page 2. Do you find that to be true? Do you offer additional space elsewhere? In the personal opinion section, why do you ask them what they think about other practitioners’ failure if they have not expressed that they think there have been failures? Isn’t that making assumptions?

Chris Kresser: For the first question, I’d have to look to see. I can’t visualize exactly what section you’re referring to. I’ve never once in all my years of practice had anyone say that there wasn’t enough space, so I don’t think that that’s ever been an issue. We did recently switch our forms to being more free response. It was a fillable PDF or even just a Word document when we started using MD HQ. We switched it to an MD HQ form. I was under the impression that it would just expand on its own in MD HQ and provide them whatever space they need to respond because I’ve never seen anyone complain about that.

In the personal opinion section, yeah, we’ve actually had one or two patients over the years write in that space, “Why do you assume that other clinicians have failed?” So perhaps that should be reworded because it’s not necessarily an assumption that other practitioners have failed, but I will tell you that in my patient population there’s only really a handful of examples of patients who come to me who don’t feel that other practitioners they’ve seen have not been entirely successful, and it can be really revealing to see why the patient thinks that’s the case. Sometimes they might say it’s because they’re not investigating the underlying cause and they’re just prescribing drugs, or they might say, “They didn’t listen to me,” or they might say, “I didn’t get the response I was looking for and I left.” If they say that, that’s kind of interesting to follow up on because you might ask them, “Oh, how long were you with that practitioner?” And if they say, “I was there for a month,” then that could be a little bit of a red flag and something that you might talk to them about because in most cases these patients that we’re treating are pretty sick and they’re not going to get better and wrap things up in a month, and that’s an important discussion to have. Feel free to reword it however you like. Maybe I’ll reword it, but I think the information that can be gained from that kind of question, however you word it, is important.