These days, it can feel like a luxury to be able to sit down and talk to your doctor for more than 10 minutes. In fact, most doctor’s visits last only 20 minutes on average time, a November 2017 review inBMJ shows. That’s not to mention that most people speak only for about 11 seconds before their doctor interrupts them, according to a July 2018 study in the Journal of General Internal Medicine . If you’re at a regular check-up, chances are, your doctor will ask you only a few questions about your health. But it’s rare that they’ll go the extra mile to ask you about how your job might be affecting your sleep , or even what stresses you’re experiencing with your relationships.
“All doctors strive for a relationship and a rapport with their patients, but functional medicine allows doctors to take care of their patients through their lens. It’s about finding out the root causes of their issues and identifying the tipping points in their life to get a full picture of the current state of their health,” Rachael Gonzalez, MD , a board-certified physician in family medicine and integrative medicine at Parsley Health Los Angeles, explains.
Dr. Gonzalez says it’s important for doctors to take a much more extensive look at a patient’s health history, which is why at Parsley Health, patients fill out a questionnaire even before their first appointment. These questions don’t read like a basic clinical survey, though. They dive deep into a patient’s lifestyle, family, and history.
“People often look to their genetics for answers to their health, but many times, it’s epigenetic, which means it’s a consequence of their environment. And by making changes to their environment, it gives people more control over their health. Functional medicine provides patients with more hope,” Dr. Gonzalez says.
Here are some of the most important questions Dr. Gonzalez and the doctors at Parsley Health ask their patients during their first visits—and why they’re so important.
“The emotional state of the mother during pregnancy deeply affects the child she is carrying, so asking this question taps into how a patient’s health history is shaped,” Dr. Gonzalez says. According to a September 2016 review in The Lancet Psychiatry , depression as well as nutrient deficiencies and infection during pregnancy can reduce the ability of a child’s immune system to fight disease and can contribute to a child’s mental health problems later in life. By asking this question, Dr. Gonzalez draws links to how her patient deals with stress or is affected by it, plus how stressors can affect their eating habits and sleep. “The mother’s mental state can affect the child’s stress response and resilience,” Dr. Gonzalez says. “Medications for mood taken during pregnancy can also affect the child’s ability to feed successfully and their sleep-wake cycles,” she says. From here, she can recommend her patient adopt certain habits and behaviors that will improve their stress response , including what they eat, their activity level and their social connections.
“Some moms are exposed to certain challenges, traumas and toxins during pregnancy that can affect the child. For example, early exposure to antibiotics can wipe out the benefits of being born vaginally. Exposure to antibiotics during childhood is associated with obesity,” Dr. Gonzalez says. A July 2016 study in Gastroenterology suggests that children exposed to antibiotics before age two have an increased risk of early childhood obesity. Research also suggests that antibiotics early in life can alter the bacteria composition in the gut, predisposing children for obesity, allergies , autoimmune conditions and inflammatory bowel disease .
“Exposures mom may have had during pregnancy may affect her offspring due to epigenetic changes,” Dr. Gonzalez explains. “When a mom exposes herself to toxins, plastics and pesticides, there is a potential to affect the health of three generation,” she says. Identifying these exposures give Dr. Gonzalez insight into how to apply epigenetic measures—not changing the gene but turning some genes on or off—for her patient. In other words, she may recommend certain lifestyle changes to turn off certain genes that predispose her patient for disease.
Dr. Gonzalez says she asks her patients this question because studies have shown that babies born via C-section have a higher risk of developing allergies and atopic diseases than those born vaginally. “We know that vaginal flora plays a large role in determining the gut health of infants. Moreover, whether a child is born premature or full-term can affect their body composition later in life,” she explains. A September 2019 study in Nature suggests that babies delivered vaginally come into contact with their mother’s gut bacteria, which is responsible for creating the foundation for a child’s microbiome. Babies born via cesarean had less of their mother’s gut bacteria. Instead, researchers found that babies born through cesarean had more bacteria typically found in hospitals, making them more likely to have antimicrobial resistance. “If a patient was born via C-section and now has allergies and asthma, I can show the cause-and-effect relationship between the method of delivery and their current health challenges,” Dr. Gonzalez says.
“Breast-fed children tend to have stronger immune systems that prepare them to fight off viruses and tend to have less allergic diseases than those who aren’t breastfed,” Dr. Gonzalez says. The bacterial diversity found in breast milk is thought to support an infant’s gut, protecting them against respiratory and gastrointestinal infections and allergic diseases, a July 2017 study in JAMA Pediatrics reports. Breast milk has also been shown to help reduce the risk for chronic diseases, like diabetes and obesity. “The microbiome is the seat of the immune system and its healthy establishment has far-reaching impacts on a person’s health, so even if there are not GI symptoms, I may still investigate and do microbiome testing and look to see if there is a good balance of microbes,” Dr. Gonzalez explains.
“It’s important to know whether a patient achieved puberty early or late because it allows us to tap into whether they were exposed to certain toxins and chemicals,” Dr. Gonzalez says. “Certain socioeconomic factors as well as genetics and nutrition can play a role into whether someone has a central precocious puberty,” she says. Central precocious puberty is a condition that causes early sexual development in girls and boys, according to the National Institutes of Health . Kids who have an early puberty are also at higher risk for anxiety and depression, a January 2018 study in Pediatrics finds. “Understanding a patient’s tipping points in health that can go back to early childhood can allow me to identify areas to heal and bring back into balance,” Dr. Gonzalez says.
“We want to create a full history of our patient’s life and that includes the losses and traumas. This will help us understand their current state of health,” she explains. Dr. Gonzalez says experiencing adverse childhood events and abuse, including psychological abuse can increase risk for autoimmunity and inflammatory diseases like heart disease and obesity. Knowing these challenges help Dr. Gonzalez understand how they affect a patient’s ability to heal and fight stress and infection. She will recommend certain treatments that turn down their cell danger response, which is their body’s way of fighting disease. “By knowing who may be at risk by asking questions about early stressful exposures, we can offer a way to truly heal people,” she says.
Dr. Gonzalez asks her patients this question to understand the type of stressors they face or have struggled with in the past, so she can advise them on how to make changes to their lifestyle. “Are they intensely connected to their phones? Do they suffer from anxiety, nervousness and sleeplessness ? There are also agricultural concerns, like exposures to pesticides and toxins in cleaning and skincare products,” Dr. Gonzalez says. Asking these particular questions also helps give patients the rationale for the testing that Parsley does. “We’re not just gathering info but allowing patients to tell their story. It helps explain questions like, ‘Why am I a 35-year-old woman who suddenly has eczema and allergies now?’”
This particular question taps more into a patient’s lifestyle and how well they handle stress, including the stress they face at work and in their relationships. “We want to help them get their balance again and create a plan that gives them interventions to find healthy ground. We want to know what stress management strategies they do. Do they get enough sleep? What do they do to relax? How do they like to exercise?” Dr. Gonzalez says.
Doctors at Parsley Health ask their members these questions and dozens of others through a thorough questionnaire and during their extended first visit to form the entire picture of what makes each patient unique. It’s these factors that guide doctors to create personalized health plans that help patients meet their goals.
Tiffany Ayuda is a New York City-based editor and writer passionate about fitness, nutrition, health, and wellness. She has held previous editorial roles at Prevention, Eat This, Not That, Daily Burn, and Everyday Health. Tiffany is also a certified personal trainer through the American Council on Exercise. When she's not writing or breaking up a sweat, Tiffany enjoys cooking up healthy meals in her Brooklyn kitchen.
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