Amy Nett: Next question from Amber. She says, “Chris has mentioned that you do a physical exam on all of your new patients. Can you briefly explain what you do and the usefulness of it in Functional Medicine? A friend of mine recently saw a Functional Medicine provider for free consult. They checked her pupillary response and stated that it was slow, which is likely related to HPA axis dysfunction. She was asking me if this was true or useful.”
To address the last part of that question first, I’m not sure about the slow pupillary response being related to HPA axis dysfunction. That’s not one that I’ve heard before. It might be worth looking into that a little bit further.
Do I do a physical exam on all of my new patients? I would say at this point pretty limited physical exam for the most part and in part because I’m not a primary care provider. We recommend that all of our patients have a primary care practitioner as well. If I know that they just saw their primary care doc for an annual physical or something like that, I don’t always do a really complete physical. I tend to do more limited physical exam, depending on the concerns that we’re looking for, and some of that I’m looking for signs of nutrient insufficiencies, so I might look at the nails, I might look at the tongue, get any evidence whether there’s scalloping, geographic tongue, which is pretty rare, if there’s a white coating on the tongue that might suggest issues with digestion, or if there’s pallor in the tongue. These are sort of the things I am looking at or some of the physical exam findings for nutrient insufficiencies in particular.
I might also look for pitting edema, particularly the lower extremities, or edema more generally if you’re thinking about thyroid or inflammation. You can sometimes just get information from the eyes. Is there a yellow tint to the eyes? Are the eyes clear? Again, I am probably tailoring the physical exam a little bit more based on the clinical questions that we’re addressing. Of course, if this is a cardiovascular patient, I’m probably going to include blood pressure, and I try to get blood pressure and heart rate on almost all of my patients. I still find that I run out of time sometimes during these appointments, so it’s I think a really good habit to get into and just know what are your patients’ blood pressure or heart rate, just get an idea. I do think it’s an important habit, and your question is a good reminder that I should be more consistent about it.