When a new patient presents their history, please know my brain is listening, and there are thousands of neuronal synapses firing.  As I listen, I look at you and notice the quality of your skin and hair, your general color, puffiness in your eyes/body, whether or not you have broken capillaries in your cheeks, do you have a glow or do you look dry, etc. — so I am doing a physical, even before I do a physical exam.  There is a saying in Internal Medicine, that 80% of the diagnosis is in the history.  The patient will always tell you the diagnosis, if we listen.
Initially I order a complete hormonal workup, tests telling me how well your liver and kidney are functioning, immune markers if indicated, vitamin levels, tests that tell me if you are overeating, or undereating, tests that tell me if you are absorbing what you ingest, tests for anemia, tests for Diabetes or percolating Diabetes, and Thyroid tests that go well beyond the traditional Thyroid workup.  Of course I am concerned about your Cholesterol, but I also order many other markers of Cardiac function. I order a VAP test which tells me if you have the good or the bad LDL cholesterol.  Homocysteine is ordered.  Homocysteine is an amino acid that nicks the arterial highways.  That’s not good.  And the only way to lower Homocysteine is to take B12 and Folic Acid (read B12/Folic Acid Injections) and B6.  There is no medication to lower Homocysteine.  I also order hsCRP which tells us how inflamed you are.  Harvard scientists published that CRP is a more important marker than Cholesterol years ago in the New England Journal of Medicine.  High quality fish oils (read Why You Need Fish Oils) will lower CRP, so will getting the crap out of your diet, and so will Statin medications.  Sometimes, Statin medications are necessary.  There is no one answer.  I also order Estrogen and Progesterone levels on men (read Testosterone section).  And I order SHBG (Sex Hormone Binding Globulin) which is often elevated if someone took oral contraceptives, and/or has a clogged liver. Depending on your history, I order what I think will help you achieve your goals.
I ensure your PAPs, Mammograms/Thermography, DEXA Scan, Transabdominal and Transvaginal Pelvic US, upper and lower Endoscopy, etc. are up to date — and I flowchart those as well.  This takes time, so all of this is not accomplished in the first visit.
Your tests are flowcharted so we see you getting better on paper and in real life.  I do look at your test results the way I was trained.  I also look at your tests with a different perspective.  I am looking at what is percolating, what may go astray in the next couple of years, or decades — unless I help you make some lifestyle changes.
Personally, I like to practice with a panoramic agenda.  I love to create order from chaos.  But my real joy is to teach you how to Pro-Age.  My goal is to die old, feeling as young as possible.  Although I am happily sliding into 60 years chronologically, I feel 20.   Hormonally balancing a patient often produces dramatic results, but that is just the beginning.   Just doing one thing is not necessarily my passion.  But I do as you request.  Not everyone wants me to think panoramically about their health.
Physicians of the l950s……knew the entire picture, knew the entire family.  You were not sent to a different doctor for every organ, and prescribed a pharmaceutical for each aberrant number and/or symptom.  Someone knew the entire picture.  Please know I am quite decent at providing acute crisis care as I was trained as a family doctor.  I can treat sinusitis, urinary tract infections, do minor surgical procedures, treat dermatological conditions, etc.  I do prescribe medication when necessary. And I have a good sense of when it is prudent to send you to specialists. Three of the most important words I need to utter are “I don’t know.”  If I have not studied something, I cannot medically counsel you correctly.   I am  pleased if you see other physicians and tell me their thoughts. I am  happy to speak with  other physicians caring for you.  I like to know who the thinkers are, so I may refer patients to them.
For example, I send my patients to a local gastroenterologist who knows that the gut is the second brain, who knows that 70% of your immune system is in your gut, who knows how important probiotics are, who knows it is necessary to have at least one “bowel evacuation” every day.  There are more brain chemicals in your gut than there are in your brain.  This was brilliantly described  in The Second Brain by Michael Gershon, MD.  Dr. Gershon is a neurogastroenterologist in NY.
So I order lots of tests, send you for appropriate testing, and try to know who the finest specialists are in the event we need their expertise and wise counsel.
Updated by Roberta Foss-Morgan, DO on March 5, 2008