The Confident Clinician Podcast

This past month we covered hair loss inside the Confident Clincian Club.    If you are not on our email list. You can sign up for the wait list for future membership opportunities here: https://confidentclinicianclub.com/   This podcast covered the importance of universal screening for iron deficiency (not iron deficiency anemia) in patients with hair loss, and how a ferritin reading might influence what diagnosis we assign a patient with presenting with hair loss.   Cheng, T. et al. The Diagnostic Value of Serum Ferritin for Telogen Effluvium: A Cross-Sectional Comparative Study. Clin Cosmet Investigational Dermatology 14, 137–141 (2021).   Salinas, M., Leiva-Salinas, M., Flores, E., López-Garrigós, M. & Leiva-Salinas, C. Alopecia and Iron Deficiency: An Interventional Pilot Study in Primary Care to Improve the Request of Ferritin. Adv Hematology 2020, 7341018 (2020).

This month's clinical podcast focus on studies looking at the impact of dietary patterns on the pain in arthritis. It's difficult to separate the research on weight loss (which is the dominant standpoint currently) and diet quality (executed through the Med diet) in any topic and arthritis is no different.  We also talked about why the integrative medicine space makes mistakes applying the theories of biological plausibility to arthritis, and why the research on lectins, the keto diet and nightshades are either non existent or not a useful way of supporting patients.  If you missed our enrollment for practitioners in July, you'll want to get on the waitlist for The Confident Clinician Club when we reopen in the winter of 2023. Our mailing list gets alerts about podcasts and other free offerings, as well as early bird pricing on our courses. You can join the wait list and download our free resources here www.confidentclinicianclub.com  1.Sadeghi, A., Zarrinjooiee, G., Mousavi, S. N., Sabet, S. A. & Jalili, N. Effects of a Mediterranean Diet Compared with the Low-Fat Diet on Patients with Knee Osteoarthritis: A Randomized Feeding Trial. Int J Clin Pract 2022, 7275192 (2022).

I this podcast episode, we welcome one of our educators, Dr. Kara Dinisio ND. Dr. Dinisio is one of the facilitators of our menopause hormone therapy course (which can be accessed here). When asked what she wanted to share with our audience, she chose a study by the Mayo Clinic published in Maturitas in 2016 that explores the knowledge base, attitudes and beliefs of practitioners about hormone therapy. Kara admitted she was nervous about choosing this paper, it is certainly not a type of study high on the hierarchy of evidence. However, she wanted to explore if it could serve as fodder for clinical self-assessment.  Can we use these studies to self-audit our knowledge, both as evidence-based practitioners and as a profession?  Can they help us identify our blind spots? Have a listen.      REFERENCES 1.  Files JA, Kransdorf LN, Ko M, et al. Bioidentical hormone therapy: An assessment of provider knowledge. Maturitas. 2016;94:46-51. doi:10.1016/j.maturitas.2016.08.014 2.  Yu Q, Lin L. The promotion of menopausal hormone therapy might be determined by the attitude of health-care professionals. Climacteric. 2022;25(3):213-214. doi:10.1080/13697137.2022.2057038

Is it the ED that kills patients or their low testosterone? This month's module of The Confident Clinician covered sexual health and libido, including a 90 minute lecture on treating erectile dysfunction.  The 90 minute webinar we shared with our community covered the nutrition and nutraceuticals that are effecacious for erectile dysfunction and how to assess ED as a marker for cardiovascular disease.  A 2022 study by Antonio (2022) stratified men by number of sexual symptoms, hormone levels and age to try and answer the age-old question about which is the chicken and which is the egg in our male patients.  Is it low testosterone that is the main issue? Or is ED an independent predictor of early death? This podcast reviews what was found in this study and how to think about the stratification of evidence to help us understand where to place focus.    Enjoy the episode!    Erectile dysfunction predicts mortality in middle-aged and older men independent of their sex steroid status Leen Antonio  PMID: 35429269 DOI: 10.1093/ageing/afac094 Abstract Background: erectile dysfunction is associated with mortality, whereas the association between low testosterone (T) and higher mortality remains controversial. Sexual dysfunction and low T often coexist, but the relative importance of sexual symptoms versus low T in predicting mortality is not known. We studied the interrelationships between sex steroids and sexual symptoms with all-cause mortality in a large prospective cohort of European men. Design: survival status was assessed in 1,788 community-dwelling men, aged 40-79, who participated in the European Male Ageing Study (EMAS). Sexual symptoms were evaluated via a validated questionnaire (EMAS-SFQ). Sex steroids were measured by mass spectrometry. Cox proportional hazard models were used to study the association between hormones, sexual symptoms and mortality. Results: about 420 (25.3%) men died during a mean follow-up of 12.6 ± 3.1 years. Total T levels were similar in both groups, but free T was lower in those who died. Men with three sexual symptoms (erectile dysfunction, reduced morning erections and lower libido) had a higher mortality risk compared with men with none of these symptoms (adjusted hazard ratio (HR) and 95% confidence intervals: 1.75 (1.28-2.40, P = 0.001)). Particularly, erectile dysfunction and poor morning erections, but not lower libido, were associated with increased mortality (HR 1.40 (1.13-1.74, P = 0.002), 1.28 (1.04-1.59, P = 0.023) and 1.12 (0.90-1.39, P = 0.312), respectively). Further adjusting for total T, free T or oestradiol did not influence the observed risk. Conclusions: sexual symptoms, in particular erectile dysfunction, predict all-cause mortality independently of sex steroids and can be an early warning sign of a poor health status.

In this short introductory episode, Dr Jordan Robertson, Naturopathic Doctor and the CEO of The Confident Clinician shares what our mission, vision and values are and how we'll be using our podcast platform to share evidence based information with clinicians every month.  The Confident Clinician Club for Naturopathic Doctors opens the doors twice per year, with our next enrollment happening July 2022. Learn more at www.confidentclinician.com 

Infant Vitamin D requirements of 400 IU are only being met a fraction of the time, as compliance postpartum remains an issue with this busy and challenging phase of life.  In this podcast, we discuss the most recent systematic review by Coresello (2022) discussing various Vitamin D supplementation strategies postpartum, and potential alternatives to infant dosing strategies. We take a deep dive into two of the studies discussed that provide different maternal Vitamin D dosing strategies, one that includes daily dosing (Hollis 2015) and the other that utilizes monthly dosing (Chandy 2016). We also discuss the Cochrane Review on this topic (Tan 2020) which covers their review of Vitamin D dosing in exclusively breastfed infants.    References:  Chandy, D. D., Kare, J., Singh, S. N., Agarwal, A., Das, V., Singh, U., Ramesh, V., & Bhatia, V. (2016). Effect of vitamin D supplementation, directly or via breast milk for term infants, on serum 25 hydroxyvitamin D and related biochemistry, and propensity to infection: A randomised placebo-controlled trial. The British Journal of Nutrition, 116(1), 52–58. https://doi.org/10.1017/S0007114516001756   Corsello, A., Milani, G. P., Giannì, M. L., Dipasquale, V., Romano, C., & Agostoni, C. (2022). Different Vitamin D Supplementation Strategies in the First Years of Life: A Systematic Review. Healthcare (Basel, Switzerland), 10(6), 1023. https://doi.org/10.3390/healthcare10061023   Hollis, B. W., Wagner, C. L., Howard, C. R., Ebeling, M., Shary, J. R., Smith, P. G., Taylor, S. N., Morella, K., Lawrence, R. A., & Hulsey, T. C. (2015). Maternal Versus Infant Vitamin D Supplementation During Lactation: A Randomized Controlled Trial. Pediatrics, 136(4), 625–634. https://doi.org/10.1542/peds.2015-1669 Tan, M. L., Abrams, S. A., & Osborn, D. A. (2020). Vitamin D supplementation for term breastfed infants to prevent vitamin D deficiency and improve bone health. The Cochrane Database of Systematic Reviews, 12(12), CD013046. https://doi.org/10.1002/14651858.CD013046.pub2

Everybody eats, but when is it concerning? How do we define “healthy eating behaviour”? What’s the opposite of disordered eating? This episode with Dr. Sylvi Martin RN & ND opens up the conversation about the landscape of eating behaviour in general, exploring eating disorders, disordered eating behaviour, “normal” eating and introduces evidence-based intuitive eating and mindful eating.   Dr. Sylvi Martin, ND is offering an Eating Behaviours Workshop on February 10, 2023, inside the Confident Clinician. Make sure you are on our mailing list to be the first to know when registration opens at the end of January.    Dr. Sylvi Martin BScN RN ND (she/her) Sylvi is a naturopathic doctor, registered nurse psychotherapist, Certified Intuitive Eating Counsellor and Mindfulness Based Eating Awareness Training (MB-EAT) facilitator based in Toronto. Sylvi applies a weight-inclusive approach to helping individuals experiencing mental health related challenges and disordered eating behaviour.  Sylvi maintains dual practises in nursing and naturopathic medicine. After completing her Bachelor of Science in Nursing at Laurentian University in 2004, she practised acute care psychiatric nursing at St. Michael’s Hospital in Toronto where she also completed a nursing research fellowship. She went on to graduate from the Canadian College of Naturopathic Medicine in 2009 after which she began her private naturopathic practice in Toronto. In addition to her naturopathic practise, Sylvi maintained her nursing practise by working on a mental health team for an Ontario health regulator where she was also part of a mental health response team for individuals in crisis. She has also completed additional training in Cognitive Behavioural Therapy for Eating Disorders. When she’s not furthering her training or working on her latest workshop or course, she can be found perfecting her chocolate-savouring skills, feeding her “trust fund squirrels” at the cottage in between dips in the lake, or on the hunt for more scarves in some corner of the world with her partner Dave.   References American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596 Bergner, L., Himmerich, H., Kirkby, K. C., & Steinberg, H. (2021). Descriptions of Disordered Eating in German Psychiatric Textbooks, 1803–2017. Frontiers in Psychiatry, 11, 504157. Retrieved from https://doi.org/10.3389/fpsyt.2020.504157 Kristeller, J. L., & Hallett, C. B. (1999). An Exploratory Study of a Meditation-based Intervention for Binge Eating Disorder. Journal of Health Psychology, 4(3), 357–363. Retrieved from https://doi.org/10.1177/135910539900400305 Mason, A. E., Epel, E. S., Kristeller, J., Moran, P. J., Dallman, M., Lustig, R. H., … Daubenmier, J. (2016). Effects of a mindfulness-based intervention on mindful eating, sweets consumption, and fasting glucose levels in obese adults: data from the SHINE randomized controlled trial. Journal of Behavioral Medicine, 39(2), 201–213. Retrieved from https://doi.org/10.1007/s10865-015-9692-8 Ralph, A. F., Brennan, L., Byrne, S., Caldwell, B., Farmer, J., Hart, L. M., … Hay, P. (2022). Management of eating disorders for people with higher weight: clinical practice guideline. Journal of Eating Disorders, 10(1), 121. Retrieved from https://doi.org/10.1186/s40337-022-00622-w Satter, E. (2021). Normal Eating. Available at: https://www.ellynsatterinstitute.org/wp-content/uploads/2021/01/Normal-Eating-1-up-with-EC-2021-secure.pdf Tribole, E. & Resch, E. (2020). Intuitive Eating, 4th Edition. St. Martin’s. Tylka, T. L., & Diest, A. M. K. V. (2013). The Intuitive Eating Scale–2: Item Refinement and Psychometric Evaluation With College Women and Men. Journal of Counseling Psychology, 60(1), 137–153. Retrieved from https://doi.org/10.1037/a0030893  

Certain intervention trials studying nutrition and depression have intentionally included recommendations to include animal protein. In turn, this leads to the question about the particular role of animal protein on mood. In particular, if there is an association between diets that exclude animal protein and depressive symptoms? In this podcast, I dive into a large cohort study that was looking at this question and discuss the interesting findings they (didn’t) find around the vegan diet and what they did find around food exclusion as a variable.    Matta, J., Czernichow, S., Kesse-Guyot, E., Hoertel, N., Limosin, F., Goldberg, M., … Lemogne, C. (2018). Depressive Symptoms and Vegetarian Diets: Results from the Constances Cohort. Nutrients, 10(11), 1695. https://doi.org/10.3390/nu10111695   Are you a practitioner and are you interested in Dr. Antonella's Mediterranean Diet Workshop? Registration is open now! Grab your spot here 

A recent meta-analysis (Bytyçi 2022) determined that the prevalence of statin intolerance is around 9%. Given the high rate of statin discontinuation in this group, intolerance should be identified and addressed to better support those who require lipid-lowering to reduce their cardiovascular risk.   Today’s podcast will touch on this recent meta-analysis before focusing on the National Lipid Association’s new scientific statement on statin intolerance outlining key considerations and practical tips to systematically approach your suspected intolerant patients.    References discussed in this episode: Bytyçi, I. et al. Prevalence of statin intolerance: a meta-analysis. Eur Heart J (2022) doi:10.1093/eurheartj/ehac015 Cheeley, M. K. et al. NLA scientific statement on statin intolerance: a new definition and key considerations for ASCVD risk reduction in the statin intolerant patient. J Clin Lipidol 16, 361–375 Jacobson, T. A. et al. The STatin Adverse Treatment Experience Survey: Experience of patients reporting side effects of statin therapy. J Clin Lipidol 13, 415–424 (2019)  

Recently a review article from 2020 caught my eye; Reconsidering the Role of Melatonin in Rheumatoid Arthritis. Sleep is a major issue for RA, and many patients and clinicians are turning to melatonin to aid with sleep issues, are we causing more harm than good? Melatonin has been known:  as a powerful antioxidant and anti-inflammatory properties to help with regulating T cell responses, T helper (Th)1, Th17, and regulatory T cells (Tregs). to help modulate the circadian rhythm and enhance sleep On the flip side, there is evidence from animal studies showing there are receptors for melatonin on synovial macrophages which promote the release of some Th-1-type proinflammatory cytokines. It has also been pointed out that the higher blood concentrations of melatonin in arthritic patients, especially in the early morning, might explain the morning stiffness and joint swelling experienced by patients - but does that mean that melatonin should be completely avoided? So far most of that evidence is coming from animal studies but are they translating with similar outcomes in human RCT? Let’s dive into 2  human trials to see how melatonin impacts your RA clients. Save the Date! Dr. Alison Danby, ND will be running a 1-day Autoimmune 101 Workshop for clinicians on Friday, October 21, 2022. Registration opens September 21st. Join our mailing list to make sure you are in the know to grab those Early Bird Savings.  References: https://confident-clinician-club.s3.ca-central-1.amazonaws.com/The+Expert+Clinician/Autoimmune+101/TCC+Podcast/RA+%26+Melatonin+2007++(1).pdf https://confident-clinician-club.s3.ca-central-1.amazonaws.com/The+Expert+Clinician/Autoimmune+101/TCC+Podcast/RA+and+melatonin+-+2020+RCT+(1).pdf

In November 2022 we tackled Hashimoto’s Thyroiditis and looked deeply at how to interpret thyroid lab work from an evidence-based perspective.  In my lecture (we had an amazing guest expert speak on prescribing for thyroid in the second webinar of the month) I reviewed studies that look at the relationship between hypothyroidism and obesity.  Have a listen. You can join the membership twice per year, and the doors are open right now for July 2022 enrolment.  The club is the most economical way to support your practice this year, with our members paying under $15 per hour or resource for the year (we give you a TON of resources for your practice!).  Enjoy the podcast. It’s about 12 minutes long. A quickie to help you think more critically about your thyroid patients.  Learn more here: www.confidentclinicianclub.com  

In this episode, our founder, Dr. Jordan Robertson ND, shares a key paper in the nutritional management of Graves' disease that explains why patients experience rapid weight gain after treatment.  She discusses the metabolic rate changes that happen at diagnosis, 1 and 6 months after treatment, and how patients can be euthyroid but experience weight gain after ADT.  This episode is a snapshot of our full Graves' medical topic that supports clinicians with decision-making around supplementation, exercise and conventional treatments.  The Confident Clinician membership supports hundreds of practitioners every day in practice through our integrative medicine database and standards of care. Our membership opens twice per year, with July 2024 being our next enrolment opportunity for Naturopathic Doctors, Medical Doctors and Nurse Practitioners who practice evidence-based Integrative Medicine.    Hayashi, A. et al. Short-term Change in Resting Energy Expenditure and Body Compositions in Therapeutic Process for Graves’ Disease. Intern. Med. 59, 1827–1833 (2020).

In this episode, Dr. Stephanie Bayliss, a Naturopathic Doctor based in British Columbia, reviews how we assess and manage sexual side effects from SSRI’s. Up to 80% of SSRI treated patients can experience sexual side effects. This may include changes to desire, arousal or satisfaction. Dr. Bayliss explores both the conventional care guidelines on managing these sexual side effects, and promising up and coming integrative solutions, including Saffron and Probiotics.    References: Hashemi-Mohammadabad, N., Taghavi, S.-A., Lambert, N., Moshtaghi, R., Bazarganipour, F. & Sharifi, M. (2024). Adjuvant administration of probiotic effects on sexual function in depressant women undergoing SSRIs treatment: a double-blinded randomized controlled trial. BMC Psychiatry, 24(1), 44. https://doi.org/10.1186/s12888-023-05429-w  Izadi, S., Mohammad-Alizadeh-Charandabi, S., Yadollahi, P., & Mirghafourvand, M. (2024). Effect of vitamin E with and without saffron on the sexual function in women of reproductive age with sexual dysfunction: a randomized controlled trial. BMC women's health, 24(1), 143. https://doi.org/10.1186/s12905-024-02980-w  Kashani, L., Raisi, F., Saroukhani, S., Sohrabi, H., Modabbernia, A., Nasehi, A. A., Jamshidi, A., Ashrafi, M., Mansouri, P., Ghaeli, P., & Akhondzadeh, S. (2013). Saffron for treatment of fluoxetine-induced sexual dysfunction in women: randomized double-blind placebo-controlled study. Human psychopharmacology, 28(1), 54–60. https://doi.org/10.1002/hup.2282 Modabbernia, A., Sohrabi, H., Nasehi, A. A., Raisi, F., Saroukhani, S., Jamshidi, A., Tabrizi, M., Ashrafi, M., & Akhondzadeh, S. (2012). Effect of saffron on fluoxetine-induced sexual impairment in men: randomized double-blind placebo-controlled trial. Psychopharmacology, 223(4), 381–388. https://doi.org/10.1007/s00213-012-2729-6  Perlis, R. H., Laje, G., Smoller, J. W., Fava, M., Rush, A. J., & McMahon, F. J. (2009). Genetic and clinical predictors of sexual dysfunction in citalopram-treated depressed patients. Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology, 34(7), 1819–1828. https://doi.org/10.1038/npp.2009.4   

In this episode, Dr. Sylvi Martin, a naturopathic doctor and registered nurse psychotherapist based in Ontario, delves into the often overlooked realm of body image and eating disorders in men. Despite common misconceptions, a significant portion of individuals affected by eating disorders are men, comprising 10 to 25% of those affected. Dr. Martin highlights the challenges in identifying and addressing eating disorders in men, citing gaps in research and diagnostic tools that fail to capture the unique experiences and concerns of male individuals. Drawing from a qualitative study, Dr. Martin explores themes such as critical self-perception, societal influences, and the impact of media representations on men's body image. She emphasizes the importance of understanding men's experiences with body image and eating disorders to ensure proper assessment and support, calling for greater awareness and research in this often neglected area of healthcare. Dr. Martin will be one of the speakers at The Confident Clinician's Men's Health Grand Rounds happening May 02-May 03. Learn more here.   Be sure to check out Dr. Sylvi Martin, ND Eating Behaviour Workshop, from DSM to Diet Culture here   Reference: Paphiti, A., Newman, E., & Collin, P. (2024). “It’s a Lot Deeper than the Way It Looks”: An Interpretative Phenomenological Analysis of Body Image for Men With Eating Disorders. The Journal of Men’s Studies. doi: 10.1177/10608265231225400  

In this podcast, Antonella Aguilera-Ruiz, ND discusses the most evidence based way to talk about depression with our patients. And what can be the implications of attributing causation to the chemical imbalance theory. We take a look at two trials that give insight on why complexity is likely the name of the game and how causal attribution affects patient outcomes.  References:  Kemp, J. J., Lickel, J. J., & Deacon, B. J. (2014). Effects of a chemical imbalance causal explanation on individuals’ perceptions of their depressive symptoms. Behaviour Research and Therapy, 56, 47–52. https://doi.org/10.1016/j.brat.2014.02.009 Nolan, A., & O’Connor, C. (2019). The effect of causal attributions for depression on help-seeking and treatment preferences. Journal of Affective Disorders, 257, 477–485. https://doi.org/10.1016/j.jad.2019.07.017 Zimmermann, M., & Papa, A. (2020). Causal explanations of depression and treatment credibility in adults with untreated depression: Examining attribution theory. Psychology and Psychotherapy: Theory, Research and Practice, 93(3), 537–554. https://doi.org/10.1111/papt.12247

In this episode, our founder, Dr. Jordan Robertson, uses chronic pancreatitis as an example to show why we need to read standards of care with a critical eye, especially when they make nutrition recommendations.  Nutrition recommendations in SOC guidelines are often aged (old studies), small studies or singular studies, or studies that look at an adjacent audience, not the audience in question.  We discuss the single study that has been the reference for not using a "high fibre" diet in patients with chronic pancreatitis and why we need to be critical of this recommendation, given that many patients with CP have a significant diabetes risk.  The study in question is this one:  Dutta, S. & Hlasko, J. Dietary fiber in pancreatic disease: Effect of high fiber diet on fat malabsorption in pancreatic insufficiency and in vitro study of the interaction of dietary fiber with pancreatic enzymes. Am. J. Clin. Nutr. 41, 517–525 (1985).  

The episode featuring Dr. Kara Dionisio, ND,faculty member at the Confident Clinician Club and facilitator of the Menopause Fellowship, discusses the role of naturopathic doctors in menopause care and explores potential for interdisciplinary collaboration in treatment. Key discussions included analyzing menopause healthcare delivery through naturopathic and conventional means, the increasing openness of conventional doctors to hormone therapy, and the unique value naturopathic practitioners bring through their holistic approach and time investment in patient education. Emphasis was placed on the importance of lifestyle changes, patient education, and nuanced treatment plans beyond hormone therapy, with the future of menopause care envisioned as systematic and collaborative, akin to pregnancy care models. Acknowledging both the possibilities and the complexities within current and future practices, the podcast encourages clinicians to consider their roles and foster partnerships in menopause management. Action Points  Recognize the role of naturopathic doctors in menopause care and strengthen interdisciplinary collaboration.  Understand the evolving acceptance of hormone therapy among conventional practitioners and leverage it to enhance patient care.  Emphasize the significance of comprehensive patient education on lifestyle changes, health screenings, and non-hormonal treatment options.  Promote the benefits of naturopathic care, such as personalized attention and education, for midlife women.  Encourage collaboration with conventional doctors to facilitate access to a full spectrum of healthcare services, including diagnostics and prescriptions.  Explore innovative approaches and research in menopause management, especially concerning lifestyle interventions and patient-specific care models.  Enhance communication with other healthcare professionals to create a unified, patient-centered approach to menopause care.     After a productive year inside the Confident Clinician Menopause Fellowship, with 14 standout naturopathic doctors, we held rich discussions on menopause, critically appraised research, and also engaged in broader deliberations on menopause healthcare advancement. An upcoming menopause practicum, April 11-13 will feature a comprehensive update on menopausal hormone therapy. Here, we're delving into our ongoing role in menopause care, exploring our impact amid the evolving healthcare landscape.   Interested in the Menopause Practicum? This limited capacity opportunity happening Apirl 11-13, 2024 is for practitioners who have purchased and completed the MHT Advanced Practice Training with Dr. Kara Dionisio, ND with the Confident Clinician. You can learn more about the pre-requisite here, or if you have already completed it, be sure to check you inbox for exclusive invite to the practicum!   

In today's podcast, we have Dr. Kim Bretz, ND, our GI fellowship facilitator, joining us to share the significant updates in the field of SIBO testing that will shape how we diagnose patients with this condition in the future.  She calls out one particular paper (referenced below) that calls into question many of the standard SIBO tests that practitioners use and explains where we go from here as practitioners who have relied on these outdated forms of testing in their practices.  Dr. Bretz is running a 1-day Advanced Training, SIBO Demystified, which is an essential training for practitioners who test and treat for SIBO in their practices. You can register for the course here to gain access to the live session, the recordings and the practice resources you need to be an up to date practitioner.  Join here.    Dervin H, Zarate-Lopez N, Sweis R,et al. Low prevalence of positive hydrogen breath tests inpatients with functional gastrointestinal conditions andhypermobile Ehlers–Danlos syndrome. Neurogastroenterology& Motility. 2023;35:e14570. doi:10.1111/nmo.14570

We don’t want your patients to be satisfied. What do your patients expect when they see you? Do they expect a diet plan and a supplement? Probably. When people see a Naturopathic Doctor or an Integrative Doctor they expect to leave with a nutrition plan and a supplement. So when they get that, they are satisfied.  But satisfied people rarely refer, rarely come back and rarely write reviews. We want your patients to be ecstatic.  In today’s special podcast episode, our founder, Dr. Jordan Robertson shows you 3 ways to stop meeting patient’s expectations, and how to start exceeding them. We’ve built our entire framework for The Confident Clinician around exceeding expectations.  You can do this too.  By leveraging our resources (which based on our membership rate is about $1 each) you can be exceptional in your work every day.  Join now. 

Today's podcast episode is broadcast on both of our podcast platforms, Women's Health Unplugged, which is our public-facing podcast. It has over 500,000 downloads and has covered many women's health topics over the last few years.  Our clinician-facing podcast, The Confident Clinician Podcast, focuses on clinical topics and studies that are changing our practices in integrative care.  Today's topic is for everyone. We're talking about the term "hormone imbalance" and how damaging this term can actually be. We cover concepts such as Why accurate diagnosis is the first step towards getting treatment.  Why universal language is an important bridge to connect practitioners.  Why using vague terms (like your 'private parts') does a disservice to patients.  Which "buckets" of hormone concerns you might fall into, and why we need to accurately label you.  Where we go from here.   If you're a practitioner, be sure to get on the wait list for The Confident Clinician at www.confidentclinicianclub.com to ensure you're the first to access our hormone assessment module in 2024 when our doors open.