Step-By-Step Guide To Appointments

by Julie Tran

This chapter is a free excerpt from The Best Book on Naturopathy.

Highlights

  • During a patient's first visit, you should get a detailed medical history.
  • Check everything, not just obviously affected body parts.
  • Naturopathic medicine takes patience. Lifestyle changes take time to significantly improve a patient's health.
I spend most of the day with my patients. Because I take inventory of every part of the patient’s health (mental, emotional, physical), an office visit can last as long as 1.5 hours for new patients.

In between patients, I reply to emails and speak with patients on the phone. I also use this time to order treatments, supplies, and supplements for patients.

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Highlights

  • During a patient's first visit, you should get a detailed medical history.
  • Check everything, not just obviously affected body parts.
  • Naturopathic medicine takes patience. Lifestyle changes take time to significantly improve a patient's health.
I spend most of the day with my patients. Because I take inventory of every part of the patient’s health (mental, emotional, physical), an office visit can last as long as 1.5 hours for new patients.

In between patients, I reply to emails and speak with patients on the phone. I also use this time to order treatments, supplies, and supplements for patients.

There’s no single prototype of a visit because each appointment might differ depending on the patients’ needs. Here are 2 examples of a first visit and a return visit.

A New Patient Appointment

The situation: A new patient with diabetes comes in for his first visit.

1. Paperwork

The new patient must fill out extensive questionnaires, just as he does for his general physician. I ask for basic contact information, demographics, and health history. Health history includes previous illness as well as medications and supplements the patient is currently taking.

2. Question And Answer: Getting To Know The Patient

Once the patient comes in to see me, I ask about the history of his present illness. How long have you had diabetes? What are the symptoms? Have you experienced fatigue, low blood sugar, or numb feet?

My questions go beyond the basics. I want to know how they feel in different hypothetical situations. I ask questions like: If you were out in the cold, would your symptoms be better or worse? Would this change if you were in a warm place? What have you tried to alleviate your symptoms? What were the outcomes?

The questioning period takes up the bulk of the time.

3. Physical Exam

I check everything. Even if the patient isn’t complaining about a certain part of his body, and even if he’s just seen his regular doctor, I don’t skip anything. I listen to the heart and lungs, and listen to his bowel sounds, examine his eyes and ears, and more.

I do a whole physical for each new patient. Doctors sometimes miss things, so I have to do my own thorough examination.

4. Homework Assignment

When a patient comes in with diabetes or obesity problems, I usually send the patient home with a food diary assignment. He must write down what he ate for every meal and snack. He also must record how he felt after everything he ate.

5. Question and Answer Round 2: Getting To Know The Doctor

Questioning goes both ways. This is not just a time for me to ask questions. Visits are conversations, not lectures.

Docere: doctor as teacher. The mark of a good relationship with a patient is how comfortable the patient feels asking questions. A visit is a chance for the doctor to educate the patient.

I want the patient to leave with no qualms or confusion about the health procedures. Many patients are afraid to ask questions at visits with their regular doctors because they’re either intimidated or they don’t want to impinge on the doctor’s time. I always leave time for the patient to turn the scrutiny back on me.

The Return Visit

The situation: The same patient with diabetes returns after a week.

1. Reviewing The Food Diary

The patient walks me through the food diary. I look at how they ate during the week (and whether this changed during the weekend).

I take stock of the nutritional content. Is he getting enough protein? Is he eating vegetables? Should he be eating pie so many times a week? I need to find the nutritional gaps in their diet and replace harmful foods with healthy foods.

2. Recommending Lifestyle Changes

I might suggest that he eat more vegetables and take a certain herb to stabilize the blood sugar. The results might take a while because we need to see how these changes slowly take effect on his body.

Stepping Back

Being a naturopathic doctor requires patience and determination. I absolutely love getting to know my patients, but prospective NDs should keep in mind that naturopath’s appointments are also a huge time investment.

Because I look for the least invasive treatment, I don’t always see results immediately. Naturopathic physicians need to be flexible and willing to try different strategies with each patient.
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