Getting Started Ordering Your First Functional Medicine Lab Tests: The 4 Most Common Mistakes Practitioners Make

My goal is to show you how to avoid the four most common mistakes doctors make when it comes to ordering their first round of labs.  These mistakes include testing the wrong patients, ordering the wrong test, not explaining the test well and not knowing how to design a protocol.

To avoid these mistakes you’ll need to address these for items: (1) You need to figure out the best patients to order your first set of labs on, (2) which test is best for which patient, (3) how to explain the test to a patient and (4) how to design a protocol once the lab results are back. 

As one becomes curious about how functional medicine lab testing works, there can be a sense of overwhelm with the sheer volume and types of testing available. From this general sense of overwhelm, doctors can make their first mistake. They choose  their most complex patient to order their first labs on, creating a likelihood of failure from the outset. Just think of any other real-life example of learning a new skill. Would you start to learn how to cook by choosing to make the most complex French meal requiring a high level of cooking skill? That would be unnecessarily challenging. 

So it is with functional medicine. It turns out to be easiest to start with a simple case, a person that will be easy to help. Find someone with a newly formed problem like fatigue or insomnia that centers around high stress levels. Starting with testing the HPA axis using an adrenal stress test is a time tested way to begin your career in functional medicine lab assessments. Stress is a well researched and well accepted factor in health problems ranging from anxiety and depression to disrupted sleep cycles. Testing and correcting the HPA axis not only improves how people feel, but it’s a perfect starting point for more advanced testing.

The second most common mistake is to start off by ordering an overly complex test like screening for mold or Lyme disease or heavy metals, rather than an essential or entry level test. Advanced tests are extremely challenging to interpret and require several years of in-depth and one-on-one training with an expert to master. We, as practitioners, always think about and are looking for solutions for the  patients we work with that aren’t getting better. So, it’s natural and even inevitable, that when you come upon a new area of study like mold or heavy metals you’d want to apply that test to the challenging cases that haven’t responded to any other treatments you’ve used in the past.

Wait until you are really good at what you are doing before you go to maximum complexity with your test kits. Master the basics first. To avoid the second most common mistake made, simply start with an easy to  interpret but hugely impactful test kit, and run it on  a patient that has only recently developed a problem. Many patients have heartburn or constipation or GI upset and a GI test kit is a perfect place to start for them. 

Let’s say you’ve now decided what test to do and you have a few patients in mind to run the test on, the third common mistake made is that doctors aren’t sure how to explain the value of the test to the patient. You need to communicate to the patient what the test is for and how the results will lead to a program that will be of benefit to them. If a  cash paying patient thinks it’s kind of expensive or just not worth doing, you have failed to communicate the value of the test to the patient. One needs to be able to articulate the real value and purpose of these types of functional medicine lab tests in such a way that the patient enthusiastically embraces the idea of paying cash for the lab kit on the spot so they can do the test and get started on a program as soon as possible. 

The barrier here has a lot to do with the reality that you want to order a test, but it’s a test you don’t have that much experience using. You don’t yet have a hundred patients that have had life changing results to bolster your confidence that this will work. To address this issue I regularly teach free webinars demonstrating the value and purpose of these tests. Watching these classes will give you the confidence to explain the testing to patients. 

So ideally you’ve found a simple yet widely applicable test you can order on the new patient, testing the stress response through cortisol and DHEA, or the GI/microbiome and you’ve found the right patient to order the test for, someone with a relatively recent and not overly complex health concern and you’ve explained the value of the test to the patient, so they have bought the test kit and are heading out the door of your clinic to do the test the next day. The fourth and final issue everyone new to Functional Medicine confronts is that they aren’t really sure how to interpret the lab results once the report comes back. This is why Kalish Institute created lab interpretation bootcamps! If you aren’t ready for one of our courses yet you may well find a free webinar we’ve posted on the topic you’re needing to study. 

In summary, to avoid the most common pitfalls to getting a functional medicine clinic off the ground, (1) very carefully choose an easy patient, someone who has recently developed a problem and the problem is not that severe; (2) start with the most impactful and simple tests you can order: adrenal stress profile with CAR or a GI test would be my first choices; (3) learn how to communicate the value of the lab test; and (4) get a basic interpretive model in place so you have an action plan to provide to the patient when the results come in.

At the Kalish Institute we offer extensive coursework addressing all these issues, to get started check out our free classes at https://www.kalishinstitute.com/classes.