The Patient-Centered Approach to Chronic Illness

In order to provide permanent symptomatic relief from chronic conditions, it’s important to gather certain crucial information before we can establish a personalised functional treatment plan. For example:

• What ailments you are suffering from

• The physical and social environment in which they occurred

• Your dietary habits (both the present diet and the pre-illness diet)

• Your beliefs about your illness, and the impact it’s having on your social and psychological functioning.

• What aggravates or ameliorates the symptoms?

• What factors might predispose you to the illness or facilitate recovery?

The average patient visiting a doctor usually has three reasons for doing so. However, sadly, patients are typically interrupted within 18 seconds of telling their stories, and never get the chance to finish.

A collaborative relationship depends upon recognising and acknowledging the patient’s experience of their illness. I will typically ask the following questions at the beginning of a consultation:

(Don’t worry, you’ll get longer than 18 seconds to talk!)

• How are you hoping that I can help you today?

• What do you believe is the source of your problems?

• What kind of treatment are you looking for?

• What do you most fear about your illness?

• What impact have your symptoms had on your life?

• What life events occurred just before or around the onset of your illness?

• When were you last well?

• If you could erase 3 problems with a magic wand, what would they be?

• What do you think might be contributing to your illness?

The genesis of disease can be represented by three words:

Antecedents - what preceeded your illness?

Triggers - what factors, given your antecedent history, tipped you over the edge into a dysfunctional state?

Mediators - given your initial disease or condition, what has kept the process going, so that health is still out of reach?

By recognising these key components of your story, it is easy to see how each persons path to disease (or health) is unique. We need to understand that path in order to modify it and change the momentum away from disease and toward health. Getting your full story is the best place to start.

Useful questions to consider are:

• When is the last time you felt really well for more than a few days at a time?

• During the six months preceding that date, did you experience any illness or major stress, change your use of medication or dietary supplements, or make any significant life changes?

There may even be events in your family health history - perhaps your mother’s health before and during pregnancy or other post-natal developmental factors that have increased your chances of getting a certain illness, such as nutrition, exposure to toxins, trauma, learned patterns of behaviour…

Without doubt, one of the most common causes of chronic disease comes from the microbial ecology of the body, especially the particular balance of microbes that live in your gut, which are greatly affected by psychosocial distress, infections (and subsequent treatment with antibiotics), exposure to environmental toxins at work or home, or severe nutrient depletion related to illness or crash dieting.

It is my job to help you identify important triggers for your ailments and develop strategies for eliminating them or weakening their virulence.

If your main concern is optimal health and prevention, we can look at risk factors for future illness, such as 

• Weight

• Fitness (type and level of physical activity)

• Dietary pattern

• Sleep habits

• Use of alcohol, drugs, tobacco

• Environmental exposures at home and work

• Travel

• Sources of stress and pleasure

• Degree of involvement with others

• Spiritual beliefs and practices

• Sexual relationships

• Hopes and fears for the future

If you have an active health problem, the most important question that needs answering is “What was your health like before this problem began?” 

We can use an intake questionnaire that will help you remember some previous health problems (see below)

If you were really healthy prior to your present illness, we need to look for a precipitating event - i.e. what was the possible cause. 

If we can identify a likely precipitating event, we can then investigate triggers that are perhaps related to this event. 

For example: if the precipitating event is marital or job stress, we can focus on stress-related psychological triggers. 

If the precipitating event was an environmental exposure, we can focus on ongoing exposures to volatile chemicals or mould. 

If your health was poor even before your present illness, it will be necessary to take a detailed, chronological history from birth to the present that includes information about your early life experience (including illness, injury), school and work performance, diet, drug and medication use, leisure activities, travel, family life, sexual experiences, habits, life stressors, and places of residence.

Here is an example of a questionnaire I like to use that you can complete before booking a consultation. The questions can help prompt your recollection of events in your past that could prove to be significant. This is especially useful for those of you who are suffering from chronic health problems, and the answers that emerge from this questionnaire will help address the underlying causes that can lead to a successful treatment plan.

I look forward to working with you and helping you back to the path of optimal wellness and vitality.