Chris Kresser: Okay. Liz asked, “Curious why you wait until a case review to get a detailed comprehensive history symptoms and background. I would think that those details might help determine which tests to order.”
Not usually. A case review is only the first step. Doing this over 10 years, we’ve experimented with a lot of different approaches and we found that an abbreviated focused intake during the initial consult is usually enough to determine which tests to order, and the tests that we tend to order in that first round are 80 percent for all patients. We’re going to do the gut testing. We’re going to do a case review blood panel. We’re going to do some HPA [hypothalamic-pituitary-adrenal] axis function testing, and sometimes we will add heavy metals, sometimes we’ll add mold-related tests, sometimes we’ll add chronic infection testing, but usually we wait to do those until after the case review in the first place.
Liz, you just hopped on; I’m answering your question about when the order detailed intake in case review testing.
It’s sequenced this way for a reason because in Functional Medicine, usually even if someone is dealing with infection, mold, heavy metal toxicity, it’s important to get the basic systems of the body functioning well first, like, addressing nutrient deficiency, gut issues, HPA axis use, because all that stuff’s going to be critical for helping them to recover from the more complex issues. You’re free to change things based on what you think will work best for your patient population, but the case review process has worked incredibly well. We’ve tried to change it in different ways several times over 10 years, and I keep coming back to this format.