Dr. Ruscio's Practitioner Question & Tip April 2018

Does your gut need a reset?

Yes, I'm Ready

Do you want to start feeling better?

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Do you want to start feeling better?

Yes, Where Do I Start?

Practitioner Question of the Month – April 2018

Dr. Michael Ruscio’s Monthly – Future of Functional Medicine Review Clinical Newsletter

Practical Solutions for Practitioners

In Today’s Issue

Practitioner Question of the Month

Practice Tip

Practitioner Question of the Month - April 2018 - help circle

Practitioner Question of the Month

Joe asks:

For your next practitioner of the month tip, perhaps you could comment on how you put together your online store. I assume that you are working with a company that manages inventory and shipments? Any thoughts about things to avoid when setting up your online storefront?

Good question Joe. I use Shopify for our POS (point of sale) systems. POS is essentially how you will accept payments and it’s the interface for the patient/customer. The nice thing about Shopify is once we set up our store, it can be used both online by our patients and by our office staff via an iPad during patient checkout.

Our clinic store and the store you access via our homepage are two different stores. The clinic store is password protected since many companies no longer allow practitioners to sell online without a password wall. We handle shipping and inventory in-house, meaning we do not use another company for inventory and shipping. I never felt the fees these companies took to be worth it. Also, since I used a few different lines, I was never able to find one operation that carried all my desired products. Not to mention, we also need to ship some patient lab kits, which none of these companies were able to do.

If you are organized, good at systems development, proficient at hiring and work to update your systems until they run smoothly – you can do this all in-house with minimal ongoing time/effort required on your part, and do it while retaining a better margin than if you were to outsource. However, if you don’t do well with systems, organization, and hiring, then you are probably better off paying someone else to do to this for you and thus hiring a company makes sense.

Be careful not to overstock yourself. We only stock items that I routinely use. For products that are only used occasionally, or for ones that I am just starting to experiment with, we drop ship.

When deciding whether or not to do this in-house or to outsource you should also consider how much available staff time you have. At my office, our staff was happy to take this on and pick up additional hours. However, if your staff is already working the max amount of hours they would like, this might not be a good maneuver.

Finally, make sure to keep things as simple as possible in every aspect of your store and operations.  Business has a tendency to creep toward complexity unless you are constantly moving with the objective of simplicity.

Practitioner Question of the Month - April 2018 - practice tip

Practice Tip

Don’t Try to be Something You’re Not

It can be intimidating and distracting when a patient presents with unusual history, diagnoses or symptoms.  On the one hand it’s important to always be attentive and open-minded. However, it’s also important to avoid trying to be all things to all patients.

For example, if a patient comes in with genetic and organic acid testing that reveals accelerated metabolism of serotonin, it would be tempting to try and bolster production of serotonin with precursor and co-factor support – even though this is not something you normally do.  This patient is depressed, so this makes sense. Right?

Doing so might distract you from the other areas you typically focus on, let’s say gut and thyroid.  OK, so you depart from your normal course because it seems appealing and makes sense. Here is what might happen.

Firstly, we know from Dr. Jeff Moss’s review (see the previous podcast on organic acid testing) and from Dr. Kara Fitzgerald (see the previous podcast also) that neither organic acid testing nor most gene tests provide a direct and clinically actionable path to treatment.  So, you end up treating, but you are treating a meaningless marker, making it extremely likely the patient will have no response.

This distracted you from observing that this person is eating a whopping amount of histamine in their diet and tends to have bloating and loose stools (both can suggest histamine intolerance).  A simple one-week trial on a low histamine diet could have produced sizeable improvements. In addition to this, addressing any underlying gut dysbiosis could ameliorate the cause of histamine sensitivity.

So, when someone comes in and is looking for you to treat the stuff they are currently excited about, yes be open but also don’t get thrown off your fundamentals in the pursuit of the new and novel.

I’d like to hear your thoughts or questions regarding any of the above information. Please leave comments or questions below – it might become our next practitioner question of the month.


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