105 | Lab Testing for Herbalists: How to Discuss Results and Stay in Scope

0:00 Hi there. Welcome to In the Clinic with Camille. My name is Camille Freeman. I'm an herbalist and nutritionist. And in this podcast, I share little tips and tidbits that might be helpful for other practitioners. Today, I wanted to answer a question that came in in response to one of my practitioner notes newsletters. As a side note, if you would like to receive these in your inbox, you can just go to my website, camillefreeman.com. There's a sign up for my newsletter on pretty much every page of the website. So in this newsletter, I have a recommendations section, and each week I recommend three things that I found interesting, delightful, tasty, what have you. And in this particular newsletter, I had recommended a service called GoodLabs, which is direct-to-consumer lab testing.

0:40 You can, you know, pay a pretty nominal amount and go in and get various labs and regular Quest centers, and then they will send you the results. As a side note, this lab also offers for people in certain areas some free basic labs when you donate blood, which is kind of cool. Anyway, I received a question following that newsletter, and here is the question. It says, your recommendation of good labs brought up a question for me. I'm an advanced clinical herbalism student just starting to put pieces in place to begin practice with real people in the real world, and my maybe basic question is this. I'm learning about functional blood work in a couple different schools right now, but since we as herbalists are unlicensed and must be mindful about how we communicate with clients, so as not to practice medicine without a license, how do you work with clients around labs?

1:29 Outside of using lab results to inform a protocol, do you ever discuss labs with a client or is this outside of an herbalist scope? If the client isn't working with a GP, would recommending that they go get some labs B outside of our scope? So these are really great questions. And I certainly want to mention that I am not a health care lawyer. This is not my area of expertise. I will just share with you how I have approached this as somebody who's been in practice for a while. So first of all, I think that labs are really valuable, and they certainly provide some important context that we aren't able to get in other ways. And you do start to veer into territory that is outside of our scope if you get into interpreting labs or implying any sort of diagnosis or treatment associated with the labs.

2:19 So we want to provide the best care that we can, but we also want to make sure that we are staying safe, we are staying ethical, we are being legal in the way that we're doing the work we're trained to do. So my approach to this is generally that I find... Basic labs such as lipid panels, thyroid, ferritin, iron screening, these types of things, I find that they can be really helpful. And if somebody hasn't had them in a while, I do think it's worth keeping an eye on many of these things, especially if they have some symptoms and they haven't been given a reasonable explanation for those symptoms that are continuing on. I think it can be worth investigating to find out more about what's going on.

3:02 I'm going to do a whole separate podcast episode at some point in the future about some of the kind of functional labs and those types of testing. But what I'm talking about today is just our kind of basic conventional labs that you might get at the doctor's office, either as part of a regular screening or if they are trying to diagnose or investigate further something that's going on with somebody. All right. So let's just say we're sticking with those for today. So if somebody has those, I would like to see them. Usually they are, it's just confirming. But what I find is that sometimes when people say their numbers by recall, it's not actually the same as what's on the labs. Not that I think people are intentionally lying or misleading me, but just, you know, these numbers are hard to remember.

3:45 And it's good to double check because sometimes what people remember as the numbers is not what the actual numbers show. Or sometimes you get additional information about, well, this is what it is now. But the history of the numbers is a little bit different. and it gives us some important context about where we are now and where things are going. Okay, so I think it's useful to see them. So if somebody has them, I do say, hey, I'd love to see them. I work through Practice Better so they can upload them in a secure environment. I can take a look. I make a note of them and we go from there. The question beyond that, though, is how do we. How do we think about working with those labs and how do we think about the talking about the labs and or requesting additional labs if we think they might be needed.

4:27 So generally speaking, I very rarely am going to say to a client, oh wow, you know, your thyroid numbers are borderline, so we're going to do a bunch of work on your thyroid and see if we can get those numbers back up. First of all, that is practicing in a different model than I use. I'm not, again, And it implies that we are treating their thyroid, which is not really how I work. My model is that I am supporting the overall health of the person with the idea that the body will then and can then return to. Balance or return as much to center as it can based on what we're doing. So I would never say something like that. I can sometimes mention to people like, hey, you know, you're doing all of this work to include whatever they're doing with their conventional, you know, their doctor, their primary care, the herbs, etc.

5:13 It's usually great to retest every three to six months. But I'm not implying that we need that to know if what we're doing is working. Because again, And I consider that outside of my scope. When it comes to how do I think about requesting a lab, this will happen sometimes if a client's primary care or whoever they're working with is reluctant to order specific labs for various reasons. I have, you know, sometimes I think they're pretty legit and it's like, oh, this seems like perhaps excessive or maybe wasteful testing that isn't really needed. Or sometimes they're just, I don't know, they feel like their authority has been challenged by the client or a different practitioner and they just don't want to order it for whatever reason. They have a different philosophy on what's happening, etc. I've seen this before with things like iron.

5:58 You know, if somebody's had their hemoglobin and hematocrit done, then they're like, well, we don't need to look at ferritin. Sometimes people are reluctant to look at anything beyond TSH, which I understand, but at times it may make sense to dig a little bit deeper. Sometimes people want lipid panels at a more frequent schedule than they are offered through primary care, whatever it is. So if I think that some additional lab testing might be helpful, the very first step I'm going to take is I'm going to say, hey, the next time you're going into your primary care, you might want to see if they are willing to order these labs for you, and here's why. And oftentimes they will or they order a subset of those, and I'm like, great, Again, I don't base my practice entirely on these labs, and it's not that common that I'm like, I really need this number before we can keep going.

6:47 So first step, say, hey, here's some labs that I think could be helpful. Here's why you may want to ask your primary care if they would be willing to order them. If the answer is no, or if the person doesn't have a primary care and they really want these numbers, I do think it's important to recommend and document in your notes that somebody have a primary care if they don't. Even if they choose not to get one, at least you have documented that you recommended it, which seems less likely if there was a time where you needed to turn over your records for any reason. at least it will say in there, I recommended that they see primary care. If they didn't, that's their choice. So anyway, I will then sometimes say like, hey, you know, there is a self-pay option if you wanted to do X, Y, Z. And that's where I might recommend something like GoodLabs.

7:32 Quest Diagnostic does, you know, direct to consumer as well. There's a bunch of different options. I'm not saying GoodLabs is the automatic best one. Sorry, my dog is here with us. But there's options if you want to pay out of pocket and go direct to consumer. The other time that I might recommend these types of lab services is if somebody has really crappy insurance. This is a problem for us here in the United States, but sometimes people have very high deductibles and they may not have coverage for these labs or they may have limited coverage for even a basic lipid panel or something like that. Sometimes it is way cheaper for the person overall to just get it direct through one of these other services than it is to pay whatever they're going to be charged if they go through their primary care and their insurance.

8:17 So for a financial perspective, it can sometimes be valuable to just do it yourself directly. The problem is, of course, that then you don't have integration of your labs, and it's going to be your job to send these labs to your various providers. It's not going to have gone through MyChart or whatever other, you know, EMR your doctor is using, and so it can be a little bit. You know, a little bit more of an integration problem. But financially speaking, a lot of times it comes out better for the client, even if they have insurance and they have a PCP, sometimes it's better to just go through the Goodlaps. So if I'm going to say something like that, again, I will say something like, hey, I recommend going through your primary care or even Teladoc, you know, if they have a Televisits or whatever, sometimes they can order them through there.

9:03 But I'll say usually go through there. However, it's worth looking to see if it's more affordable or, you know, if you don't have access to your primary care, this is another option for people. So I don't necessarily say, I think you need these labs. I will say something like, hey, if you wanted to get this lab, here is another option that some of my clients have used. Okay. So I think that the biggest thing for me is like, I don't want to recommend or imply that I would like to see a lab if I don't actually think that it would meaningfully change what I'm doing with the client, then that I consider that just a waste of their time and their money and also implying again that I'm working in a way that I'm not working.

9:45 So I try to be pretty circumspect about how often I'm doing this but there are times when a client feels really strongly and or when their you know medical care is not adequate that it may be useful to go down one of these routes. All right so I hope that's helpful. It provides a little bit of perspective. Again, I will do a different episode later on some of the functional tests and my opinions about those because they're pretty different and I have some, I think, contradictory opinions to what many people think about these types of tests. So there you go. Thank you so much for submitting a question. If you have a question that you would like to share with me, I would love to hear it. I love answering questions on the podcast and elsewhere. You can submit a question on intheclinic.com. You can reply to any Practitioner Notes newsletter, or you could just email me.

10:31 My contact information is on my website, camillefreeman.com. All right, thanks for listening. I hope you have an amazing day, and I'll be back soon with another episode.