I finished a long consulting day, bookended by fertility-related discussions. Starting at 8am with a patient’s new job side-tracking her motherhood plan and ending after-hours with a compassionate plea to my patient that her current pattern of eating may prevent ovulation and impact her goal of pregnancy.
In between these two women, I explained to a patient that her seemingly all clear endoscopes on closer inspection actually showed significant inflammation – all found on the requested histology report. A little pep talk followed with the next patient who had extremely elevated triglycerides – better check the fasting insulin.
My next patient knows who I am but has forgotten my name with her creeping dementia and reminds me that this mind and body that I depend so heavily on is never to be taken for granted. I’m delighted to see my next patient who has a surprise pregnancy. She comes with confirmation bloods and her TSH is looking a little low. A referral letter to her GP to make sure thyroid hormones are OK will need to be written. Thyroid seems to be the theme as the next patent has a suddenly elevated TSH. Something not right about the last prescription or is there an issue with the lab – it’s just so different? New bloods before making prescribing decisions.
My next patient (menorrhagia) within the consultation, mentions that mood has been consistently low. A DASS – 21 (Depression Anxiety Stress Scale) coupled with discussion highlights that mood requires active support (counselling already in place). I finish with a fertility patient as mentioned, deeply concerned about her dietary revelation and seeking assurance it is discussed with her current psychologist who she is too embarrassed to tell. She is open to the possibility of working with a nutritionist to help her achieve her goals and form a ‘team’ of support around her.
The day before this consulting day was the final Endeavour student clinic for the semester. Over the course of a semester, we highlight the benefits of a well-indicated Patient Reported Outcome Measures (PROMs) and we engage other health professionals with a referral letter or request further investigations such as pathology. These are all part of a regular consulting day but for students it can sometimes seem like ‘box-ticking’ for assessments. Review discussions with students were fresh in my mind and the consulting day had me reflecting on the deep roots of knowledge that informed the decisions I made that day.
It isn’t just naturopathic study that resources me for decisions. An undergrad in environmental science underpins so much of what I discuss with patients, including topics brought up with my fertility patients. A masters in women’s health honed the research skills needed to form clinical questions quickly. The PROM I used that day had foundations in an NHAA conference I attended in 2017 (see McIntyre & Glastonbury, 2017). In that same year I happened to start group mentoring with Rachel Arthur and pathology application/interpretation took an exponential leap and influenced the suspicion that odd TSH reading was probably a lab anomaly (it was by the way).
This year’s NHAA conference discussed the scope and impact of naturopathic practice in Australia. Half of naturopathic patients visit their naturopath for most of their health issues, with almost 60% using their naturopath as their primary provider, either as their sole primary care provider or in conjunction with other health providers (Wardle, 2019). All of the patients I saw that day had presented pathology from either a GP or specialist. Three of the eight patients were seeing a psychologist. One I was hoping to refer to a nutritionist. We do patient-centered, collaborative care very well. It may be under-recognised by the government and at times other health professionals but if we all reflected occasionally on the scope of what we do, we’d realise our roots and reach of practice are far-reaching and every now and then you have a day when you’ve almost (but elusively never) have it covered.
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