How important are labs? Certainly in Functional Medicine we try to use more progressive lab testing to prevent disease and treat the underlying cause of illness. However, treating based on labs alone often leads to disappointing results. So what to do? Let’s discuss how to get the most out of your lab results.
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Dr. Michael Ruscio: How important are lab findings?
Hi, this is Dr. Ruscio, and I recently got back from teaching a weekend seminar to practitioners in London. Sometimes when you have a chance to teach, it helps you realize things in a deeper level than maybe you had previously realized, and for me, I really had a renewed respect for the importance of not making decisions solely based on labs. This is an important concept for both patients and clinicians to understand.
Oftentimes, I think, both for patients and for clinicians, labs can be looked at as this end-all, be-all, and I don’t fully agree with that. I’m sure many of you have heard something along the lines of, “We treat the patient, not the lab values,” and I think that’s really important. I’d like to briefly share with you the way I look at this, which has really helped me not get misled by labs that have been later shown to be inaccurate and also stay true to helping patients as quickly and as effectively and efficiently as possible.
I look for a few things to guide the clinical process, and this is important, I think, for patients to look for in their doctor and for, hopefully, clinicians to use this sort of guiding principle. I look at the patient history, I look at the symptomatic presentation of the patient, and I also look at the context of the patient.
The history would be potentially that someone has IBS and all the symptoms associated with IBS, and they started after menopause. Now we see a history that indicates that there may be a female hormone component to the IBS.
The symptoms would be all the symptoms of IBS, which may be gas, bloating, and constipation.
And the context may be that this person is sleeping enough, exercising enough, and eating a healthy, maybe paleo-type diet. Because we see this context, then going to another level of performing labs makes sense because we’ve already satisfied the introductory steps, if you will, of making sure that someone that has IBS doesn’t have a poor diet or lifestyle that might be contributing to that. So we’ve qualified this patient to move to the next step.
Again, whether doctor or patient, it would be intelligent, maybe, to look at these things, especially for patients from your doctor. If you present to your doctor with IBS-type symptoms and you’re not eating a really healthy diet and not sleeping enough and maybe drinking three cups of coffee a day and they want to go into $3000 worth of lab testing, that may not be the most efficient clinical model that you as a patient could find your way to.
Now, the other thing that’s really important here is we have the history, we have the presentation, and we have the context. We then add to that lab work, and now we look at all of these together to guide the next step, which is treatment, and it’s not just one of these, because sometimes the three other boxes—the history, the symptoms, and the context—will suggest a certain treatment that may not be supported by the labs. In that case, I would try that treatment, and if the patient responds to it well, I would continue with the treatment.
Vice versa, sometimes the labs may show something that nothing else reinforces. Today was actually a nice example of that, where I think there were three patients in the clinic that had SIBO that was still partially positive, but all of their symptoms were gone, and this wasn’t just a transient having a good week. These patients had been maintaining improvements for quite a while, which is really reaffirming to me the fact that we have to look at multiple points of evidence before making a decision, not just lab values.
So we have all this, and the other piece, as I just mentioned, that kind of ties into this is the patient response to treatment. If we have a lab value that is not fully positive but everything else supports treatment, we then treat the patient, the patient responds well, I would continue with that treatment, and the positive response to that treatment reinforces the need for that treatment. And vice versa, if a lab is positive, like I was mentioning with these other SIBO patients, but nothing else supports it, then I wouldn’t continue to treat.
I hope this isn’t too deep of a concept for many of us, but I think this just illustrates an important concept, which is thinking critically and reflecting on our patient results, or if you are a patient, hopefully you get the sense that your doctor is reflecting on the experience that you’re having and looking at that rather than just having a kind of standard protocol that you are walked through. I think as clinicians and as a patient trying to evaluate if you’re working with the right clinician, by reflecting on the patient experience, you can learn a whole heck of a lot. I think that’s unfortunately something that sometimes gets lost in today’s day and age that is very science based, and while, of course, I am very science based and trying to be very evidence based—as I hope is evident through everything that I do with my teaching and my writing and my speaking and everything else—there’s also another really important part to this, which is just good clinical decision making, reflection on results, and I guess it would be a form of kind of clinical introspection. You can learn a lot from that.
Again, I’m fearful that this video may be a little bit too deep of a concept for many patients, but I’m also hoping that it helps patients, and I certainly hope that for the clinicians listening this helps.
Anyway, this is Dr. Ruscio, and hopefully this helps you get healthy and get back to your life. Thanks.
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