Practitioner Question of the Month – May 2019

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

Practical Solutions for Practitioners

Practitioner Question of the Month - May 2019 - help circle

Practitioner Question of the Month

Keri asks, “Is having elevated ASCA and taking S. boulardii a concern for you? If not, why?

Was it the reduction in gas that prompted you to stop the digestive enzymes? I’m still trying to figure out when to pull them out of protocols.

In the last visit, the impression says she will continue EPA/DHA and the recommendations say she will stop. Which one and if stopping, why? Thanks!”

First, regarding S. boulardii: In my opinion, no. Mainly because those with IBD (Crohn’s) have shown benefit with S. boulardii.

Next, I look to risk factors for HCl (age, autoimmunity, history of anemia) and response to treatment to dictate. In those with suspected histamine intolerance, I am much more cautious.

Finally, it’s optional, can’t hurt but also not essential.


Alberto asks, “I´m relatively new to the group. I practice in Mexico. Just wondering what´s the rationale behind the visit flow in your practice. I’ve noticed that you have an initial consultation and then some days later testing and recommendations, why is that? Why not make those in the initial consultation? Are you reviewing the case?”

Great question. In my opinion, it’s important to take some time with all the data from the exam visit and spend some time thinking and constructing your therapeutic hierarchy for the patient. So I take time right after the exam and construct our big picture plan/map.

Practitioner Question of the Month - May 2019 - practice tip

Practice Tip

Reminder, take time to step away from the minutia and think about your practice.

Every time I do this something significant comes to my attention and I make a meaningful change. Schedule time once per quarter for this.

If you have found this information helpful please share with a friend using this link: https://drruscio.com/review/

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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Discussion

I care about answering your questions and sharing my knowledge with you. Leave a comment or connect with me on social media asking any health question you may have and I just might incorporate it into our next listener questions podcast episode just for you!

8 thoughts on “Practitioner Question of the Month – May 2019

  1. I am beginning to `rethink`my visitor flow as well. Often times, I hear from my first time clients that although they find the initial consult extremely eye opening, its also information overload`. I like this idea of an initial assessment followed by a Customized Diet and Healthy Daily Routine, leaving the `Protocol` until the following week.

  2. I am beginning to `rethink`my visitor flow as well. Often times, I hear from my first time clients that although they find the initial consult extremely eye opening, its also information overload`. I like this idea of an initial assessment followed by a Customized Diet and Healthy Daily Routine, leaving the `Protocol` until the following week.

  3. Hey Dr. Ruscio –

    I’m thinking of changing my visit structure, or experimenting with a different flow. Would you be willing to expand on your current patient flow?

    Initial History & Exam: $430, 20-45 minutes
    – From what I gather after you do your H&P you then write a note and create a ddx (15 – 30 mins?)
    – Do you go over a patient’s intake prior to this visit – or does staff input into a chart?

    Report of Findings: $225, 15-30 minutes
    – “During your first follow up visit Dr. Ruscio will provide you with a Report of Findings.”
    – Is this a formal document, or informally presented?
    – Is this emailed to the patient to review prior to the visit?
    – How long does it take you to create this?

    Follow Up Visits: $225, 15-30 minutes

    Lab Report Analysis: $65
    – Are you creating a pdf report of your lab findings that you send to patients? – Is this an additional charge to review a patients previous workup?

  4. Hey Dr. Ruscio –

    I’m thinking of changing my visit structure, or experimenting with a different flow. Would you be willing to expand on your current patient flow?

    Initial History & Exam: $430, 20-45 minutes
    – From what I gather after you do your H&P you then write a note and create a ddx (15 – 30 mins?)
    – Do you go over a patient’s intake prior to this visit – or does staff input into a chart?

    Report of Findings: $225, 15-30 minutes
    – “During your first follow up visit Dr. Ruscio will provide you with a Report of Findings.”
    – Is this a formal document, or informally presented?
    – Is this emailed to the patient to review prior to the visit?
    – How long does it take you to create this?

    Follow Up Visits: $225, 15-30 minutes

    Lab Report Analysis: $65
    – Are you creating a pdf report of your lab findings that you send to patients? – Is this an additional charge to review a patients previous workup?

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