Practitioner Question of the Month – March 2017

Greg Williams asks:

“I’m interested to know your views on multivitamins. Do you consider them to be worthwhile, almost as an insurance policy against nutrient deficiencies? And if you do, are there any particular brands you recommend? In particular, I’m interested in their use for people with digestive issues (I mainly work with Crohn’s and Ulcerative Colitis sufferers). Thanks.”

Good question, Greg. Patients with IBD do have an increased incidence of deficiencies, for example, anemias of iron and/or B12, so this question has much clinical relevance. I do use multivitamins. I will usually use a multivitamin if someone presents with general signs of malabsorption. The most notable signs are unintended weight loss, being underweight, and/or frank anemia.  Of course, if a patient’s CBC/differential shows deficiency, we will offer whatever nutritional support is indicated, often in conjunction with a multivitamin just to cover our bases.

There are a few other thoughts that are important here also.  A multivitamin will not address the cause of the malabsorption, so it’s essential to obtain a good outcome with whatever underlying GI condition is present: IBD, IBS, GERD, gastritis, ulcers…. If patients are highly reactive, then I usually will forgo a multi to reduce the potential of a reaction.

I usually only use a multi for a few months and then discontinue.  Part of the reason for this is because some studies have shown harm from long-term vitamin supplementation.  So to hedge against this, I prefer a shorter term usage to obtain benefit while mitigating any risk associated with long-term use.

Any reputable brand should be fine.

I ask my staff the following questions at least once per month:

“What are we doing that feels hard, broken, or inefficient?” or

“What is the least favorite part of your job?”

Every office has its strengths and its weakness.  Oftentimes it’s the weakness that you can’t see that are the most problematic.  For example, a weakness that never bothers you because you are not the one doing the work.  But this weakness might be a huge headache for a staff member, causing them to perform inaccurate or inefficient work, either of which will cut into your clinics profitability, customer service, and moral.

When you ask, and make it OK to answer, your staff what is wrong, broken, or inefficient, you have the chance to see what is not working.  In asking this question repeatedly for the past few years, the level of efficiency, customer/patient service, and office moral has increased dramatically.

For example, one time after asking this question it came to my attention that filling out the lab requisition form was tedious for one of the labs we used. I asked, “Why?” The staff commented that every time we order this test, the lab would send us a form with the patient information they had, then our office had to print this form out, fill in the missing information, scan it, and then email it back!  So the answer was simple.  We asked this lab if they could start sending us this form digitally, and they said yes.  So now we receive the form, then fill it all in digitally, and send it right back.  It has saved us 15 minutes per order. If you are doing 10+ of these labs a day, you just saved over 1.5 hours of staff time per day.

These little things add up.  Your staff is done earlier, is happier because they weren’t spinning their wheels, and you saved money on payroll. It’s a win-win.

“Feedback is the breakfast of champions.”