This week, I explain how herbalists can responsibly discuss conventional labs with clients. We'll go over my thoughts on what’s useful, how to stay within scope, and when to recommend primary care or direct-to-consumer options like GoodLabs.
It's important to consider accurate documentation, financial implications, and practical steps for requesting or reviewing labs without interpreting results as a medical diagnosis if you decide to work with labs in your practice.
If you have a question you'd like me to answer in a future podcast, please reach out via In the Clinic or my website.
Thanks for listening.
I'd love to hear from you. Leave me a voicemail with feedback or submit a question (click the pink "Send Camille a Message" button on the side of the page) 💚
Camille's Helpful Links for Practitioners
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Hi there. Welcome to In the Clinic with Camille. My name is Camille Freeman.
00:00:03.537 --> 00:00:04.937
I'm an herbalist and nutritionist.
00:00:05.317 --> 00:00:09.277
And in this podcast, I share little tips and tidbits that might be helpful for other practitioners.
00:00:10.017 --> 00:00:11.537
Today, I wanted to answer a question
00:00:11.537 --> 00:00:14.697
that came in in response to one of my practitioner notes newsletters.
00:00:15.077 --> 00:00:18.017
As a side note, if you would like to receive these in your inbox,
00:00:18.197 --> 00:00:20.357
you can just go to my website, camillefreeman.com.
00:00:20.457 --> 00:00:24.017
There's a sign up for my newsletter on pretty much every page of the website.
00:00:24.017 --> 00:00:28.937
So in this newsletter, I have a recommendations section, and each week I recommend
00:00:28.937 --> 00:00:33.137
three things that I found interesting, delightful, tasty, what have you.
00:00:33.317 --> 00:00:36.937
And in this particular newsletter, I had recommended a service called GoodLabs,
00:00:37.177 --> 00:00:40.217
which is direct-to-consumer lab testing.
00:00:40.877 --> 00:00:45.437
You can, you know, pay a pretty nominal amount and go in and get various labs
00:00:45.437 --> 00:00:51.017
and regular Quest centers, and then they will send you the results.
00:00:51.557 --> 00:00:57.277
As a side note, this lab also offers for people in certain areas some free basic
00:00:57.277 --> 00:00:59.277
labs when you donate blood, which is kind of cool.
00:01:01.164 --> 00:01:05.064
Anyway, I received a question following that newsletter, and here is the question.
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It says, your recommendation of good labs brought up a question for me.
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I'm an advanced clinical herbalism student just starting to put pieces in place
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to begin practice with real people in the real world, and my maybe basic question is this.
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I'm learning about functional blood work in a couple different schools right
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now, but since we as herbalists are unlicensed and must be mindful about how
00:01:23.624 --> 00:01:26.964
we communicate with clients, so as not to practice medicine without a license,
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how do you work with clients around labs?
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Outside of using lab results to inform a protocol, do you ever discuss labs
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with a client or is this outside of an herbalist scope?
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If the client isn't working with a GP, would recommending that they go get some
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labs B outside of our scope? So these are really great questions.
00:01:43.564 --> 00:01:48.084
And I certainly want to mention that I am not a health care lawyer.
00:01:48.404 --> 00:01:52.524
This is not my area of expertise. I will just share with you how I have approached
00:01:52.524 --> 00:01:55.524
this as somebody who's been in practice for a while.
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So first of all, I think that labs are really valuable, and they certainly provide
00:02:01.424 --> 00:02:04.944
some important context that we aren't able to get in other ways.
00:02:05.264 --> 00:02:11.604
And you do start to veer into territory that is outside of our scope if you
00:02:11.604 --> 00:02:19.124
get into interpreting labs or implying any sort of diagnosis or treatment associated with the labs.
00:02:19.584 --> 00:02:23.904
So we want to provide the best care that we can, but we also want to make sure
00:02:23.904 --> 00:02:27.384
that we are staying safe, we are staying ethical, we are being legal in the
00:02:27.384 --> 00:02:29.644
way that we're doing the work we're trained to do.
00:02:29.804 --> 00:02:33.344
So my approach to this is generally that I find...
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Basic labs such as lipid panels, thyroid, ferritin, iron screening,
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these types of things, I find that they can be really helpful.
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And if somebody hasn't had them in a while, I do think it's worth keeping an
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eye on many of these things, especially if they have some symptoms and they
00:02:53.806 --> 00:02:58.466
haven't been given a reasonable explanation for those symptoms that are continuing on.
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I think it can be worth investigating to find out more about what's going on.
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I'm going to do a whole separate podcast episode at some point in the future
00:03:07.086 --> 00:03:11.886
about some of the kind of functional labs and those types of testing.
00:03:11.986 --> 00:03:15.366
But what I'm talking about today is just our kind of basic conventional labs
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that you might get at the doctor's office, either as part of a regular screening
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or if they are trying to diagnose or investigate further something that's going
00:03:23.606 --> 00:03:26.286
on with somebody. All right. So let's just say we're sticking with those for today.
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So if somebody has those, I would like to see them.
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Usually they are, it's just confirming. But what I find is that sometimes when
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people say their numbers by recall, it's not actually the same as what's on the labs.
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Not that I think people are intentionally lying or misleading me,
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but just, you know, these numbers are hard to remember.
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And it's good to double check because sometimes what people remember as the
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numbers is not what the actual numbers show.
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Or sometimes you get additional information about, well, this is what it is now.
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But the history of the numbers is a little bit different. and it gives us some
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important context about where we are now and where things are going.
00:04:00.326 --> 00:04:03.266
Okay, so I think it's useful to see them. So if somebody has them,
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I do say, hey, I'd love to see them.
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I work through Practice Better so they can upload them in a secure environment.
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I can take a look. I make a note of them and we go from there.
00:04:14.406 --> 00:04:17.486
The question beyond that, though, is how do we.
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How do we think about working with those labs and how do we think about the
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talking about the labs and or requesting additional labs if we think they might be needed.
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So generally speaking, I very rarely am going to say to a client,
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oh wow, you know, your thyroid numbers are borderline, so we're going to do
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a bunch of work on your thyroid and see if we can get those numbers back up.
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First of all, that is practicing in a different model than I use.
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I'm not, again, And it implies that we are treating their thyroid,
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which is not really how I work.
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My model is that I am supporting the overall health of the person with the idea
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that the body will then and can then return to.
00:04:56.267 --> 00:04:59.807
Balance or return as much to center as it can based on what we're doing.
00:05:00.287 --> 00:05:05.567
So I would never say something like that. I can sometimes mention to people
00:05:05.567 --> 00:05:09.367
like, hey, you know, you're doing all of this work to include whatever they're
00:05:09.367 --> 00:05:13.667
doing with their conventional, you know, their doctor, their primary care, the herbs, etc.
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It's usually great to retest every three to six months. But I'm not implying
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that we need that to know if what we're doing is working.
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Because again, And I consider that outside of my scope.
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When it comes to how do I think about requesting a lab, this will happen sometimes
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if a client's primary care or whoever they're working with is reluctant to order
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specific labs for various reasons.
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I have, you know, sometimes I think they're pretty legit and it's like,
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oh, this seems like perhaps excessive or maybe wasteful testing that isn't really needed.
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Or sometimes they're just, I don't know, they feel like their authority has
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been challenged by the client or a different practitioner and they just don't
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want to order it for whatever reason.
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They have a different philosophy on what's happening, etc. I've seen this before with things like iron.
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You know, if somebody's had their hemoglobin and hematocrit done,
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then they're like, well, we don't need to look at ferritin.
00:06:03.807 --> 00:06:06.887
Sometimes people are reluctant to look at anything beyond TSH,
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which I understand, but at times it may make sense to dig a little bit deeper.
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Sometimes people want lipid panels at a more frequent schedule than they are
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offered through primary care, whatever it is.
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So if I think that some additional lab testing might be helpful,
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the very first step I'm going to take is I'm going to say, hey,
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the next time you're going into your primary care, you might want to see if
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they are willing to order these labs for you, and here's why.
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And oftentimes they will or they order a subset of those, and I'm like,
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great, Again, I don't base my practice entirely on these labs,
00:06:42.427 --> 00:06:46.907
and it's not that common that I'm like, I really need this number before we can keep going.
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So first step, say, hey, here's some labs that I think could be helpful.
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Here's why you may want to ask your primary care if they would be willing to order them.
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If the answer is no, or if the person doesn't have a primary care and they really
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want these numbers, I do think it's important to recommend and document in your
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notes that somebody have a primary care if they don't.
00:07:06.865 --> 00:07:10.285
Even if they choose not to get one, at least you have documented that you recommended
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it, which seems less likely if there was a time where you needed to turn over
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your records for any reason. at least it will say in there, I recommended that
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they see primary care. If they didn't, that's their choice.
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So anyway, I will then sometimes say like, hey, you know, there is a self-pay
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option if you wanted to do X, Y, Z. And that's where I might recommend something like GoodLabs.
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Quest Diagnostic does, you know, direct to consumer as well.
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There's a bunch of different options. I'm not saying GoodLabs is the automatic best one.
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Sorry, my dog is here with us. But there's options if you want to pay out of
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pocket and go direct to consumer.
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The other time that I might recommend these types of lab services is if somebody
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has really crappy insurance.
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This is a problem for us here in the United States, but sometimes people have
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very high deductibles and they may not have coverage for these labs or they
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may have limited coverage for even a basic lipid panel or something like that.
00:08:05.105 --> 00:08:10.445
Sometimes it is way cheaper for the person overall to just get it direct through
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one of these other services than it is to pay whatever they're going to be charged
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if they go through their primary care and their insurance.
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So for a financial perspective, it can sometimes be valuable to just do it yourself directly.
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The problem is, of course, that then you don't have integration of your labs,
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and it's going to be your job to send these labs to your various providers.
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It's not going to have gone through MyChart or whatever other,
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you know, EMR your doctor is using, and so it can be a little bit.
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You know, a little bit more of an integration problem. But financially speaking,
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a lot of times it comes out better for the client, even if they have insurance
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and they have a PCP, sometimes it's better to just go through the Goodlaps.
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So if I'm going to say something like that, again, I will say something like,
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hey, I recommend going through your primary care or even Teladoc,
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you know, if they have a Televisits or whatever, sometimes they can order them through there.
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But I'll say usually go through there. However, it's worth looking to see if
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it's more affordable or, you know, if you don't have access to your primary
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care, this is another option for people.
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So I don't necessarily say, I think you need these labs.
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I will say something like, hey, if you wanted to get this lab,
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here is another option that some of my clients have used. Okay.
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So I think that the biggest thing for me is like, I don't want to recommend
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or imply that I would like to see a lab if I don't actually think that it would
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meaningfully change what I'm doing with the client,
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then that I consider that just a waste of their time and their money and also
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implying again that I'm working in a way that I'm not working.
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So I try to be pretty circumspect about how often I'm doing this but there are
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times when a client feels really strongly and or when their you know medical
00:09:53.969 --> 00:09:59.629
care is not adequate that it may be useful to go down one of these routes.
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All right so I hope that's helpful. It provides a little bit of perspective.
00:10:04.489 --> 00:10:07.649
Again, I will do a different episode later on some of the functional tests and
00:10:07.649 --> 00:10:10.309
my opinions about those because they're pretty different and I have some,
00:10:10.529 --> 00:10:15.529
I think, contradictory opinions to what many people think about these types of tests.
00:10:15.749 --> 00:10:18.769
So there you go. Thank you so much for submitting a question.
00:10:18.769 --> 00:10:21.129
If you have a question that you would like to share with me,
00:10:21.189 --> 00:10:24.329
I would love to hear it. I love answering questions on the podcast and elsewhere.
00:10:24.709 --> 00:10:29.609
You can submit a question on intheclinic.com. You can reply to any Practitioner
00:10:29.609 --> 00:10:31.829
Notes newsletter, or you could just email me.
00:10:31.949 --> 00:10:35.389
My contact information is on my website, camillefreeman.com.
00:10:35.849 --> 00:10:38.009
All right, thanks for listening. I hope you have an amazing day,
00:10:38.129 --> 00:10:40.089
and I'll be back soon with another episode.
00:00:00.017 --> 00:00:03.357
Hi there. Welcome to In the Clinic with Camille. My name is Camille Freeman.
00:00:03.537 --> 00:00:04.937
I'm an herbalist and nutritionist.
00:00:05.317 --> 00:00:09.277
And in this podcast, I share little tips and tidbits that might be helpful for other practitioners.
00:00:10.017 --> 00:00:11.537
Today, I wanted to answer a question
00:00:11.537 --> 00:00:14.697
that came in in response to one of my practitioner notes newsletters.
00:00:15.077 --> 00:00:18.017
As a side note, if you would like to receive these in your inbox,
00:00:18.197 --> 00:00:20.357
you can just go to my website, camillefreeman.com.
00:00:20.457 --> 00:00:24.017
There's a sign up for my newsletter on pretty much every page of the website.
00:00:24.017 --> 00:00:28.937
So in this newsletter, I have a recommendations section, and each week I recommend
00:00:28.937 --> 00:00:33.137
three things that I found interesting, delightful, tasty, what have you.
00:00:33.317 --> 00:00:36.937
And in this particular newsletter, I had recommended a service called GoodLabs,
00:00:37.177 --> 00:00:40.217
which is direct-to-consumer lab testing.
00:00:40.877 --> 00:00:45.437
You can, you know, pay a pretty nominal amount and go in and get various labs
00:00:45.437 --> 00:00:51.017
and regular Quest centers, and then they will send you the results.
00:00:51.557 --> 00:00:57.277
As a side note, this lab also offers for people in certain areas some free basic
00:00:57.277 --> 00:00:59.277
labs when you donate blood, which is kind of cool.
00:01:01.164 --> 00:01:05.064
Anyway, I received a question following that newsletter, and here is the question.
00:01:05.284 --> 00:01:08.104
It says, your recommendation of good labs brought up a question for me.
00:01:08.204 --> 00:01:11.624
I'm an advanced clinical herbalism student just starting to put pieces in place
00:01:11.624 --> 00:01:16.544
to begin practice with real people in the real world, and my maybe basic question is this.
00:01:17.044 --> 00:01:19.884
I'm learning about functional blood work in a couple different schools right
00:01:19.884 --> 00:01:23.624
now, but since we as herbalists are unlicensed and must be mindful about how
00:01:23.624 --> 00:01:26.964
we communicate with clients, so as not to practice medicine without a license,
00:01:27.184 --> 00:01:29.144
how do you work with clients around labs?
00:01:29.144 --> 00:01:32.764
Outside of using lab results to inform a protocol, do you ever discuss labs
00:01:32.764 --> 00:01:35.084
with a client or is this outside of an herbalist scope?
00:01:35.424 --> 00:01:39.444
If the client isn't working with a GP, would recommending that they go get some
00:01:39.444 --> 00:01:43.044
labs B outside of our scope? So these are really great questions.
00:01:43.564 --> 00:01:48.084
And I certainly want to mention that I am not a health care lawyer.
00:01:48.404 --> 00:01:52.524
This is not my area of expertise. I will just share with you how I have approached
00:01:52.524 --> 00:01:55.524
this as somebody who's been in practice for a while.
00:01:56.224 --> 00:02:01.424
So first of all, I think that labs are really valuable, and they certainly provide
00:02:01.424 --> 00:02:04.944
some important context that we aren't able to get in other ways.
00:02:05.264 --> 00:02:11.604
And you do start to veer into territory that is outside of our scope if you
00:02:11.604 --> 00:02:19.124
get into interpreting labs or implying any sort of diagnosis or treatment associated with the labs.
00:02:19.584 --> 00:02:23.904
So we want to provide the best care that we can, but we also want to make sure
00:02:23.904 --> 00:02:27.384
that we are staying safe, we are staying ethical, we are being legal in the
00:02:27.384 --> 00:02:29.644
way that we're doing the work we're trained to do.
00:02:29.804 --> 00:02:33.344
So my approach to this is generally that I find...
00:02:34.166 --> 00:02:41.946
Basic labs such as lipid panels, thyroid, ferritin, iron screening,
00:02:42.366 --> 00:02:45.226
these types of things, I find that they can be really helpful.
00:02:45.226 --> 00:02:50.126
And if somebody hasn't had them in a while, I do think it's worth keeping an
00:02:50.126 --> 00:02:53.806
eye on many of these things, especially if they have some symptoms and they
00:02:53.806 --> 00:02:58.466
haven't been given a reasonable explanation for those symptoms that are continuing on.
00:02:58.626 --> 00:03:02.886
I think it can be worth investigating to find out more about what's going on.
00:03:02.886 --> 00:03:07.086
I'm going to do a whole separate podcast episode at some point in the future
00:03:07.086 --> 00:03:11.886
about some of the kind of functional labs and those types of testing.
00:03:11.986 --> 00:03:15.366
But what I'm talking about today is just our kind of basic conventional labs
00:03:15.366 --> 00:03:19.306
that you might get at the doctor's office, either as part of a regular screening
00:03:19.306 --> 00:03:23.606
or if they are trying to diagnose or investigate further something that's going
00:03:23.606 --> 00:03:26.286
on with somebody. All right. So let's just say we're sticking with those for today.
00:03:26.686 --> 00:03:29.486
So if somebody has those, I would like to see them.
00:03:30.126 --> 00:03:33.806
Usually they are, it's just confirming. But what I find is that sometimes when
00:03:33.806 --> 00:03:38.706
people say their numbers by recall, it's not actually the same as what's on the labs.
00:03:38.866 --> 00:03:42.606
Not that I think people are intentionally lying or misleading me,
00:03:42.686 --> 00:03:44.686
but just, you know, these numbers are hard to remember.
00:03:45.086 --> 00:03:48.106
And it's good to double check because sometimes what people remember as the
00:03:48.106 --> 00:03:49.726
numbers is not what the actual numbers show.
00:03:49.986 --> 00:03:52.986
Or sometimes you get additional information about, well, this is what it is now.
00:03:53.086 --> 00:03:56.846
But the history of the numbers is a little bit different. and it gives us some
00:03:56.846 --> 00:03:59.806
important context about where we are now and where things are going.
00:04:00.326 --> 00:04:03.266
Okay, so I think it's useful to see them. So if somebody has them,
00:04:03.426 --> 00:04:05.606
I do say, hey, I'd love to see them.
00:04:05.906 --> 00:04:09.986
I work through Practice Better so they can upload them in a secure environment.
00:04:10.186 --> 00:04:13.886
I can take a look. I make a note of them and we go from there.
00:04:14.406 --> 00:04:17.486
The question beyond that, though, is how do we.
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How do we think about working with those labs and how do we think about the
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talking about the labs and or requesting additional labs if we think they might be needed.
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So generally speaking, I very rarely am going to say to a client,
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oh wow, you know, your thyroid numbers are borderline, so we're going to do
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a bunch of work on your thyroid and see if we can get those numbers back up.
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First of all, that is practicing in a different model than I use.
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I'm not, again, And it implies that we are treating their thyroid,
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which is not really how I work.
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My model is that I am supporting the overall health of the person with the idea
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that the body will then and can then return to.
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Balance or return as much to center as it can based on what we're doing.
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So I would never say something like that. I can sometimes mention to people
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like, hey, you know, you're doing all of this work to include whatever they're
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doing with their conventional, you know, their doctor, their primary care, the herbs, etc.
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It's usually great to retest every three to six months. But I'm not implying
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that we need that to know if what we're doing is working.
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Because again, And I consider that outside of my scope.
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When it comes to how do I think about requesting a lab, this will happen sometimes
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if a client's primary care or whoever they're working with is reluctant to order
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specific labs for various reasons.
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I have, you know, sometimes I think they're pretty legit and it's like,
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oh, this seems like perhaps excessive or maybe wasteful testing that isn't really needed.
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Or sometimes they're just, I don't know, they feel like their authority has
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been challenged by the client or a different practitioner and they just don't
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want to order it for whatever reason.
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They have a different philosophy on what's happening, etc. I've seen this before with things like iron.
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You know, if somebody's had their hemoglobin and hematocrit done,
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then they're like, well, we don't need to look at ferritin.
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Sometimes people are reluctant to look at anything beyond TSH,
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which I understand, but at times it may make sense to dig a little bit deeper.
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Sometimes people want lipid panels at a more frequent schedule than they are
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offered through primary care, whatever it is.
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So if I think that some additional lab testing might be helpful,
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the very first step I'm going to take is I'm going to say, hey,
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the next time you're going into your primary care, you might want to see if
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they are willing to order these labs for you, and here's why.
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And oftentimes they will or they order a subset of those, and I'm like,
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great, Again, I don't base my practice entirely on these labs,
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and it's not that common that I'm like, I really need this number before we can keep going.
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So first step, say, hey, here's some labs that I think could be helpful.
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Here's why you may want to ask your primary care if they would be willing to order them.
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If the answer is no, or if the person doesn't have a primary care and they really
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want these numbers, I do think it's important to recommend and document in your
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notes that somebody have a primary care if they don't.
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Even if they choose not to get one, at least you have documented that you recommended
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it, which seems less likely if there was a time where you needed to turn over
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your records for any reason. at least it will say in there, I recommended that
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they see primary care. If they didn't, that's their choice.
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So anyway, I will then sometimes say like, hey, you know, there is a self-pay
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option if you wanted to do X, Y, Z. And that's where I might recommend something like GoodLabs.
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Quest Diagnostic does, you know, direct to consumer as well.
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There's a bunch of different options. I'm not saying GoodLabs is the automatic best one.
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Sorry, my dog is here with us. But there's options if you want to pay out of
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pocket and go direct to consumer.
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The other time that I might recommend these types of lab services is if somebody
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has really crappy insurance.
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This is a problem for us here in the United States, but sometimes people have
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very high deductibles and they may not have coverage for these labs or they
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may have limited coverage for even a basic lipid panel or something like that.
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Sometimes it is way cheaper for the person overall to just get it direct through
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one of these other services than it is to pay whatever they're going to be charged
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if they go through their primary care and their insurance.
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So for a financial perspective, it can sometimes be valuable to just do it yourself directly.
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The problem is, of course, that then you don't have integration of your labs,
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and it's going to be your job to send these labs to your various providers.
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It's not going to have gone through MyChart or whatever other,
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you know, EMR your doctor is using, and so it can be a little bit.
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You know, a little bit more of an integration problem. But financially speaking,
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a lot of times it comes out better for the client, even if they have insurance
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and they have a PCP, sometimes it's better to just go through the Goodlaps.
00:08:52.589 --> 00:08:56.789
So if I'm going to say something like that, again, I will say something like,
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hey, I recommend going through your primary care or even Teladoc,
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you know, if they have a Televisits or whatever, sometimes they can order them through there.
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But I'll say usually go through there. However, it's worth looking to see if
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it's more affordable or, you know, if you don't have access to your primary
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care, this is another option for people.
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So I don't necessarily say, I think you need these labs.
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I will say something like, hey, if you wanted to get this lab,
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here is another option that some of my clients have used. Okay.
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So I think that the biggest thing for me is like, I don't want to recommend
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or imply that I would like to see a lab if I don't actually think that it would
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meaningfully change what I'm doing with the client,
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then that I consider that just a waste of their time and their money and also
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implying again that I'm working in a way that I'm not working.
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So I try to be pretty circumspect about how often I'm doing this but there are
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times when a client feels really strongly and or when their you know medical
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care is not adequate that it may be useful to go down one of these routes.
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All right so I hope that's helpful. It provides a little bit of perspective.
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Again, I will do a different episode later on some of the functional tests and
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my opinions about those because they're pretty different and I have some,
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I think, contradictory opinions to what many people think about these types of tests.
00:10:15.749 --> 00:10:18.769
So there you go. Thank you so much for submitting a question.
00:10:18.769 --> 00:10:21.129
If you have a question that you would like to share with me,
00:10:21.189 --> 00:10:24.329
I would love to hear it. I love answering questions on the podcast and elsewhere.
00:10:24.709 --> 00:10:29.609
You can submit a question on intheclinic.com. You can reply to any Practitioner
00:10:29.609 --> 00:10:31.829
Notes newsletter, or you could just email me.
00:10:31.949 --> 00:10:35.389
My contact information is on my website, camillefreeman.com.
00:10:35.849 --> 00:10:38.009
All right, thanks for listening. I hope you have an amazing day,
00:10:38.129 --> 00:10:40.089
and I'll be back soon with another episode.