Step 1: Referral
Step 2: Meet and Greet
Step 3: Homework
1. Complete the baseline lab work immediately (if you wait until after you have started to make dietary change, we will miss the opportunity to measure your baseline laboratory profile).
2. Buy The New Atkins for a New You by E. Westman and read to at least page 115.
3. Watch the MetabolicHealth Program Patient Video Series
4. Read the MetabolicHealth Program Handbook twice, cover to cover
5. Complete the First Appointment Questionnaire in The MetabolicHealth Program Toolkit or using Oceans by CognizantMD platform.
Step 4: Consultation
1. Discuss your past medical and surgical history
2. Discuss your previous lifestyle change strategies
3. Ask questions that arose during reading and video watching
4. Talk about low carb recipes and "instead-ofs".
1. Collect completed Informed Consent
2. Review First Appointment Questionnaire responses
3. Review lab work
4. Perform physical exam
5. Assess patient preparation for lifestyle change
6. Medication management
7. Set goals for next follow-up appointment:
- Emphasis on recovery from metabolic sickness over weight loss (ie. Decreased blood pressure, reduced central obesity, lower blood sugars, lower triglycerides, higher HDL)
- Arrange follow-up appointment interval (~2 months)
- Send note back to referring provider
Step 5: Follow-up Appointments (At least 1 Every 2 months for 3 Appointments)
1. Complete self-assessment Pre-Appointment Questionnaire before each appointment
2. Be prepared to share concerning symptoms as well as successes and struggles
1. Be sure to distribute your patient self-assessment Pre-Appointment Questionnaires about 7 day before the follow-up appointment. This can be done in a number of ways:
- By giving the patient printed copy to complete at the previous appointment,
- By emailing a PDF,
- By sending a link to Oceans by CognizantMD platform Pre-Appointment Questionnaire e-form (my EMR does this automatically for me 7 days before appointments).
2. Discuss the patients Pre-Appointment Questionnaire answers, help the patient troubleshoot common complaints (See the MetabolicHealth Minute and MetabolicHealth Program Handbook's Self-Serve Problem Solving for solutions to the most common problems my patients encounter), offer motivational counselling to help the patient stay on tract and arrange a follow-up appointment (~every 2 months).
Step 6: Maintence/Ongoing Support
For Patients and Providers:
- When does a patient with alcoholism stop being at risk of relapse? I suspect the answer is never.
- If you had a patient who had stopped smoking but subsequently restarted, what counselling would you provide? I suspect you would help the patient explore the reasons for relapse, listen supportively, encourge the patient to make another quit plan and arrange a follow-up appointment.
It is important for us as patients and providers to understand that those who are trying to recover from obesity and diabetes will always be at risk of relapse and will require our ongoing support to stay on the wagon.
Arrange regular follow-up with your patient to check-in, offer support and troubleshoot those forces trying to pull him or her off the low-carb wagon
Licensing: All work on MetabolicHealth.ca is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
- The content on MetabolicHealth.ca is for your information only, should not be taken as a medical prescription and does not replace the individualized care and direction provided by your doctor or nurse practitioner.
- Please consult a regulated healthcare provider prior to making any significant lifestyle changes, especially if you are on medications that may be affected by a change in your dietary pattern like those that lower blood pressure or blood sugar.