Dr. Amy Nett: No, the only thing they fill out before the initial consult is their registration form and then something like, Why do you want to be seen? Some people write, “Constipation, fatigue, thyroid.” Other people give me a five-paragraph essay. So that’s variable, but definitely no intake form.
Then you said, “What form do you use to give them their recommendations for labs, dietary changes, lifestyle, and so forth, after the initial interview and before the case review?” I don’t make any specific recommendations because what I tell people is, “OK, let’s figure out today where you’re at, what are your symptoms,” but I’ve already said, “You tell me your symptoms. I’m not going to guess what your lab tests are going to show.” So the only recommendation I make might be some dietary modifications. If they haven’t tried Paleo before, I’m going to say, “Cool. Try a Paleo diet.” They might have to prepare for the Cyrex Array 3 or Array 4, so I would say, “OK, after you’ve prepared for Array 3 or 4, then do a strict Paleo reset diet. Let’s see how that changes your symptoms.”
It is very rare that I make supplement changes. Lifestyle changes … I don’t do too much. If it’s a really stressed person, I might give them some resources for meditation.
Then labs … I’m going to back up a little bit. I think you also asked how long this takes. You can get them, I think, pretty easily into 30 minutes, but I agree, when I first started doing them, I was probably going more like 35 or 40 minutes, but you learn to just be a little bit more targeted and get the information you need. If you have a patient who’s kind of going on and on about their past—because a lot of these patients are really complicated—I say something like, “This is really helpful information, and just so you know, I want to get a much more detailed past medical history, and so before you and I meet for the case review, I’m actually going to ask you to fill out these case review documents. There are about five different specific questionnaires with a lot of different questions about your diet, your lifestyle, your support system, your beliefs around what happened. So if you could answer those questions because I’m going to read that the night before you and I meet, or the day or weekend before you and I meet, because that’s going to help me better understand where you’re coming from and be a little bit fresher in my mind when I’m putting together some of the initial recommendations for treatment.” So I make sure to let the patient know that they don’t have to fit everything into this initial 30-minute consult. I want big picture. What are your complaints? What are your symptoms? Let’s figure out what tests to order, and let’s get the nuances in the case review documents, and let’s go over it in more detail at the case review appointment. That’s kind of how you get it into 30 minutes or less. Just kind of stay focused. Like, what’s bothering you now? And if someone’s really having a hard time summarizing, then I just say, “Hey, what would you list as your top five complaints? Tell me that.” That’s a good way to do it.
So they don’t really fill out anything before the initial interview. I just take notes as I do that initial consult, and then after they’ve sort of told me, “Here are my complaints. Here’s what I’ve tried, this or that,” then I say, “OK. Based on what you’ve told me, I’m going to recommend this, this, this, and this. How does that sound? Did you have any other testing in mind? Was there something else you were interested in looking at?” So we settle on the tests, and then I put all that information into some templates that I use in terms of SIBO breath tests for this. It’ll measure this and that, something so that they’ll get a summary from me that’s like, “Based on what we’ve talked about, I’m going to recommend this, this, and that.” And then I say, “OK, you’re going to get a message later today from our admins, and they’re going to follow up on all of the tests that you and I just talked about. They’re going to tell you exactly how much everything costs, and then that’s where you’re going to have the chance to sleep on it, let us know if everything still sounds good, and if you want to proceed with all of those tests or some of those tests, let us know. Once you approve those, we order those from the labs. The labs will then ship the test kits directly to you.” And I also let them know, “In that follow-up message that they’ll be sending you later today, they’re also going to give you dates for scheduling the case review appointment because we schedule those about eight to ten weeks out, so we’ll have you get that on the calendar, and that will help you in terms of planning how to get all of the tests done in time.” That’s how we do it.
Then when I’m done with my note that summarizes the recommendations, the admins send a message and they say, “OK. Here’s the summary of recommendations from Dr. Nett. These are the tests you discussed. Here’s how much everything costs. Let us know how it looks to you, if you have any questions, and which of these you’d like to order.” Once the patient approves things, that’s when our admins bill for those tests, order them from each of the companies, and the labs then dropship the kits to the patients so they can collect at home or go get the blood drawn as needed. Then we do sometimes put handouts in their portal. The handouts are going to be Paleo reset diet, how to prepare for Cyrex Array 3 or Cyrex Array 4, and those are really the only specific recommendations, I think, that we would go with. Hopefully that answers your question.