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Refreshing Naturopathic Examination Skills with Katie Barron

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Refreshing Naturopathic Examination Skills with Katie Barron

Are you confident in the art of naturopathic physical examination techniques? 

Today we are talking to Naturopath, Katie Barron who has a passion for enhancing her peers' clinicals skills in the art of physical examination. Katie is touring Australia running workshops to help practitioners build confidence in naturopathic examination techniques to answer a need she identified amongst her professional peers. 

In this episode Katie shares how building examinations into the consultation process is a crucial element to establishing patient rapport and how to confidently refer patients on for further investigation to medical professionals when there's an identified need. Katie also discusses some of the differences in naturopathic vs. orthodox observations and how they further inform us on the patient's overall level of health and vitality.

Covered in this episode

[00:42] Introducing Katie Barron
[02:10] Examination techniques: CAM vs. Orthodox Practitioners
[04:39] Scope of practice and referrals [07:53] Seeking consent during examination & boundaries
[11:05] The benefit of performing physical examinations
[13:52] Speaking the right language in referrals
[16:10] Why confidence and competence are important
[21:37] Best methods for learning examination techniques
[25:44] Bringing physical examination back into naturopathic practice
[31:09] How Katie weaves examination into the consultation
[36:15] Katie's workshops and resources

Andrew: This is FX Medicine, I'm Andrew Whitfield-Cook. Joining us on the line today is Katie Barron. She's a practising naturopath, college tutor of physical examination, mother, wife, and lover of all things travel. 

Katie is passionate about fellow natural health practitioners feeling confident in their clinical practice leading to better client outcomes, thriving businesses, and a rising of the whole industry and profession. With a passion for physical examination, Katie believes that this not only gives us valuable insights into patient presentation, but also builds rapport with the client and opens doors to cross referrals with other modalities. 

Katie is currently putting together a tour of workshops around Australia and New Zealand cities in 2019, to refresh natural health practitioner knowledge of the importance of physical examination.

When Katie isn't tutoring at a naturopathic college, planning her upcoming 2019 workshops, or seeing clients in her clinic, you can find her planning her next overseas adventure with her family, catching up with friends, or walking along the beach with her enormous dog. 

Welcome to FX Medicine, Katie, how are you going?

Katie: Yeah, good. Good thanks.

Andrew: So I'm picturing Cujo there. What sort of dog?

Katie: He is part Great Dane and part Bullmastiff.

Andrew: Right. So a big sook?

Katie: Yeah, so he's big. Oh, a big boofhead, massive boofhead.

Andrew: Okay. So physical examination for the natural health practitioner might be very different from the medical practitioner physical examination. So how does this differ from conventional medicine?

Katie: I suppose it's actually quite good to start with where it is similar. We actually do a lot of the same physical examinations. You know, when we're putting together our vitals and we're looking at abdominal things, we're looking at neurological and respiratory, and, you know, like listening for heart sounds, all sorts of things. 

But we also have, obviously, our more traditional naturopathic signs. Where we're looking at tongue and pulse, nails, hair, skin, as in a conventional way, but also in a holistic way. I guess one of the biggest differences and this is 100% in our favour, is that we have time. If we're thinking about how long our consultation processes are, they usually go for between, you know, half an hour to an hour. And sometimes, other praccies are sort of consulting for up to an hour and a half. 

So we have this time, we actually have time to sort of create these processes with physical examination, gather the information that we need. And also, in that time, create that rapport. Which is a little bit different to conventional medicine, where it's a little bit of more of a wham, bam, thank you ma'am. They just simply don't have the time, a lot of them.

Andrew: And it's also guided by presenting symptoms. So it's like, I've got a sore shoulder, therefore, we'll do a physical examination of the shoulder, perhaps the back might do, you know, might do a neurological examination if there's something suspected. But it's really directed into that quadrant, if you like, of the body. Whereas the physical examination may be a more comprehensive thing, right?

Katie: Oh, 100%. So what I like to encourage practitioners to do is to have their basics that they run through all of the time. You know, like the vitals should be done at every initial consultation. And then also, you know, to pick and choose as well which body systems you would dive into a bit more comprehensively as you would with questioning, with your questioning and case taking. 

But also then to make sure that you are looking holistically as well. I mean, you know, as I briefly just mentioned, when we're looking at nails, that's something that can take 10 seconds and can give you so much information.

Andrew: Yeah, yeah. Let's talk about appropriateness right off the bat. Because I think we need to set our boundaries. There have certainly been those practices that have transgressed those boundaries. So, when is it appropriate to do a physical examination and when isn't it?

Katie: Okay, so really, really big conversation and very, very important, obviously. 

So first, the number one thing to do is to work within our scope of practice. We are trained to pick up red flags. We are trained to be able to gather information that guides our treatment plans. We are not trained to be diagnosing anything, ever, really, but diagnosing anything from a physical examination. And also, you know, unless you're really diving into a specific area, say for example, you're really interested in working side-by-side with cardiologists and things like that. We're simply…not even using the same equipment as them. 

Andrew: No. 

Katie: So, you know, we need to make sure that we're working within our scope of practice. For sure, we can listen to heart sounds, are we going to be able to pick up major abnormalities and things like that? No, we're not. We're looking to bridge the gap and pick up red flags and do things like that, basically.

Andrew: And refer when appropriate.

Katie: Oh, 100%. This is one of the biggest things, is that, you know, is that a lot of practitioners are really, really scared of the referral thing. They view it as, "I'm going to lose my patient. I'm moving my patient on," whereas a referral is a shared care agreement. It's not, "Oh no, now you go on and say this person and I might see you in a couple of years." It's an opportunity to give your patient the best possible care, really.

Andrew: That was a very interesting term, shared care agreement. And too often there's this, "I have noticed this in my patient, I'm referring them to you for continued or expert care." But very often, we omit the last sentence, "I would appreciate referral back once finished." Is this something you cover in your course?

Katie: Yeah, definitely. The getting confident with doing those referral letters so that it very much has that statement. So that, you know, it will also depend on where the patient…if the patient has come from you to that person, to that other specialist or GP or whoever it might be, the other modality, but you will obviously be like, you know, this is a shared care arrangement and all of those things. 

But, you know, if they've come to you after seeing this person, and you want to send them back with maybe some ideas for further investigation, then it's very important to really just acknowledge that they were that person's patient first. And acknowledging that is saying, "I'm really looking forward to helping you with your patient and making this a shared care arrangement for the best possible outcome."

Andrew: Now, you know, we covered appropriateness just before, what about the use of just continually checking in with your patient that everything's okay, that they're feeling safe and all that sort of thing? Do you do that… I guess one would have, I'm going to think here, that there would be differing aspects to cover here when you've got a female to male or a male to female issue?

Katie: Oh, for sure. So the really big thing here is, for a start, having the confidence to keep it really professional. So remembering that during the consultation is that you are the professional, you are the person guiding the consultation. If you're keeping it on that level and they see that they're going to feel that too. So it's really important to get consent and to explain to your patient what you're going to do before you do it. 

So, you know, for example, when you're sort of asking someone to get up on a massage table or up on the table and you're going to start pulling their pants down and their tops up and things like that, you know, you're going to run into problems. Whereas if you explain to your patient what you're about to do, why you're about to do it, and with moving clothing around I always ask them to do that.

Andrew: Yeah, and of course, we are well versed in the media of those practitioners that have transgressed lines...

Katie: Yeah.

Andrew: There are also those patients that transgress lines. How do you teach practitioners to protect themselves?

Katie: Oh, well, yeah, for sure. So, yeah, so that is like 100% a boundaries thing. And I think it's very…and once again, it's how you present yourself, you know? You've got to feel safe in the consultation as well. And that's the thing, it's we think and we talk a lot about the patient being comfortable, and the patient being comfortable to say "yes" to consent to doing the physical examination as well. 

But that's just as important for us. We need to feel safe. If someone has that little…never has that little feeling in my gut like, "Oh, I don't think I really want to go there with this person" then you don't. You listen to that, you really listen to it.

Andrew: Absolutely.

Katie: It's, yeah, really important.

Andrew: It's really interesting how we talk about intuition, we talk about ‘gut feeling.’ I tend to think about minutiae, those minute cues that are given off by a patient, which you pick up on which raise your hackles. And which alert you to go, "Not safe here," and we need to listen to those cues.

Katie: And I think, like…I totally agree. I couldn't agree more. And I think in our quest sometimes for finding answers, that is backed by science…and I'm not… I mean, I have, you know, I've studied and now teach in science, but so it's so important. But I think to be able to make sure that you're tapping into that is super important, really important.

Andrew: So let's go into it. 

Katie: Yes. 

Andrew: Why do we want to do the physical examination? What does it give us?

Katie: Okay, it gives us information, huge amounts of information that can guide our treatment plan, help, which is obviously what we're there to do, to help our patients get better. And also too, that becomes part of our clinical judgment. 

So I remember back in the day, it was a bit of a old school learning about the ‘rule of three.’ So you have, you know, the three or more signs that point towards a particular diagnosis or more, so a clinical judgment. And these physical signs and symptoms are, yeah, will really help us with that. 

And also, just coming back to that, building that rapport. You know, when you've done a really...when you've done your physical examinations well, you will have people turn around and say to you, "I've never felt so heard."

Andrew: Interesting. So interesting. I actually agree with you about building trust.

Katie: Yeah. 

Andrew: That this professional trust and competency can be conveyed by how competent you show yourself in conducting a physical examination. 

Like, for instance, I was…I remember learning about the Schober's test, ankylosing spondylitis. You measure two points either side basically, at the base of the spine, on the hips, and then you put some tape up the spine, and you get them to bend over and you measure the difference, how that tape stretches. And if it can't stretch, then it's a decent indication that they've got some sort of arthroses of the spine, some sort of issue going on. And it was a really interesting test for me to do to plainly show that there was an issue and that you could refer for, then, expert help and indeed raise a red flag that something even sinister might be going on.

Katie: Yeah, exactly. That's the thing. And it's not about…and that's such a good point. Because it's not about then you using that test to make a diagnosis to treat. It's about you going, "Well, you know, this is something that I was thinking about," and now you've plainly shown it to your person. Because a lot of the stuff that we can talk about is theoretical and sometimes subjective. But if they can see that, like that is your measurement…

Andrew: Yeah. 

Katie: It's like with the straight leg raise, when we're looking for, you know, herniated disc as opposed to just tight hamstrings. They can see you doing that test, and they go, "Okay, that's cool, that makes complete sense to me now," and you'll have them on board.

Andrew: Okay, so when you're thinking about referring to an orthodox practitioner, a medical practitioner, they're not going to understand a lot of the naturopathic assessments, nor are they probably going to believe in them. 

So when do you use your naturopathic assessments? Do you tend to just keep those to yourself and maybe inter-refer to other natural health practitioners, and then the more Orthodox assessments you use and talk about in your referrals?

Katie: Yeah, 100%. That's exactly what I do and what I encourage others to do. 

So, you know, as we know, when we're writing a referral letter anyway to a specialist or to a GP or something, you know, keeping it short, sweet, and snappy I say, is the best way. 

Andrew: Yeah. 

Katie: So, you know, if we're sending pages of naturopathic signs and symptoms, they're just going to glaze over and it will end up in the junk bin or the waste bin. So it's really, really important. And that comes back to that thing as well. I mean, they will understand a straight leg raise, they will understand… I mean, for example, some of the more…when we're looking at nails, there are other naturopathic signs that we wouldn't put in a referral letter. But then, for example, if we're seeing signs of clubbing…

Andrew: Yeah. 

Katie: Which is something that they look at as well, then that's something that they will understand. So it's about being able to…yeah, it's to keep some of our things to ourselves and speak in their language when we're speaking to them.

Andrew: And I think, as you say, your workshops will teach practitioners competence in, you know, those, for instance, nail signs that are orthodox in nature. Those skin manifestations of systemic disease. They're not necessarily naturopathic, even though we use them commonly.

Katie: Oh, well, example, 100%... you know, even I mean, obviously, when we're looking at, you know, like the colour of the nails, now we know a blueing like a cyanosis situation. Now, doctors and conventional medicine will also look at lack of oxygenation, and, you know, pulmonary issues and things like that. We know that, you know, brown nails can be fungal. You know, if it's not the basics, like is it stained from nicotine? Coming back to that thing of let's just eliminate the obvious and the simple before we go down the rabbit hole.

Andrew: Sometimes it may be that the physical assessment that you do might give a clue, not just to their physical state, but indeed, their lifestyle choices and things like that?

Katie: Oh, for sure, definitely. And I think that's why it's really important to have a system. Like a basic system. And then obviously, you tailor that to the specific client and who's in front of you and what they need in particular. 

But if you've got a system that starts with the basics and that doesn't really take long at all. And then you move into the more complicated, then you're making sure that you're not missing those really simple things. I mean, case in point is seeing someone dishevelled when they come in now, you know. 

Andrew: Yeah. 

Katie: And that could be they have just dropped four kids off at four different schools, and everything was all, you know, quite...they had a crazy morning or are they always like that? Which is a sign of depression. It's really important to just ask these questions before we go down the rabbit hole of complication.

Andrew: Absolutely. I was thinking in my mind about, you know, if somebody comes in and they're hunched, are they hunched because they're depressed? Are they hunched because they're threatened? A low self-esteem? Something sad's just happened? Or indeed, is it something like a dowager's hump, some physical issue with their spine that, you know, you need an alarm bell to refer to?

Katie: That's a really good one because it's having the confidence to ask those questions, and think outside the square a little bit. 

I had a patient present to me this… I always come back to this because it drives what I'm doing now, to be fair. And she presented what has been treated for the last…for about a year by a GP as chronic vaginal thrush. Obviously, it was treated unsuccessfully, and she was pretty desperate. So she came to me. Now, once again, this is a case where it was 100% outside of my scope of practice to do physical examination in that area.

Andrew: Absolutely.

Katie: So…yes, so that just doesn't get done. But having the confidence to ask the right questions, having the confidence then to go, "Okay, I need to look… now, there are these other model…there's other naturopaths that are doing wonderful things in specialist areas. So, in this case, it was Moira, Moira Bradfield, doing with the intimate ecology and looking into it further with her. 

Andrew: Yes. 

Katie: But having the confidence to ask the right questions, having the confidence and the skills to write really good referral letters back to the GP to go, "Look, there's a red flag here. This is not right." To push for further investigation, and we had to push for this, and it actually ended up being quite a rare form of labia cancer. Now, the prognosis was not good. 

Andrew: Right.

Katie: But this woman got some answers, and she felt heard, and she felt treated, and she got…in the end, she had someone batting for her.

Andrew: Yeah. 

Katie: Because I had the confidence to just keep going.

Andrew: I think that is key in what we're going to talk about is your courses, and indeed becoming competent and refreshing. Because we think, "I've done that. I've done that. I did that.” Yeah, how long ago?

Katie: And the thing is, do you keep doing it?

Andrew: Yeah. 

Katie: Because there are a couple of things that I hear over and over again at the moment, and that is, "Oh, we only did a semester of it, it was really rushed, I don't feel confident. And now because I don't feel confident I don't do it." So equipment is gathering dust, so to speak. The equipment that praccies do have. And also the other thing is, "I don't want to look stupid in front of my patient.” 

Andrew: Yeah. 

Katie: “So I just don't do it."

Andrew: So here's a couple little tips to see if you really need Katie's course. And that is can you picture a claw hand, and can you picture a swan neck deformity in the hand? And if you can't, you really need to be doing some revision.

Katie: Yeah, the red flag stuff. The red flag stuff is massive. I mean, we talk about everything starting in the gut. And yet, nobody is doing abdominal examinations. Nobody is checking for enlarged livers and for, you know, gallbladder inflammation and things like that. So, yeah, is that lump and bump and little mass that you're feeling something benign, or is it something that we really need further investigation?

Andrew: Yeah. Now that's an interesting one to go on when you're talking about liver enlargement, hepatomegaly and things like that with the Murphy's sign. 

One thing I've picked up is we were always taught, oh yeah, you know, you just sort of examine the right-hand rib cage. But what I learned subsequently was that that's only positive if the left side is negative. 

Katie: Yeah. 

Andrew: And if the left side's positive too, then it's probably more indicative of diaphragmatic inflammation or something like that. Rather than just the liver involvement.

Katie: And when you're feeling, yeah, so when you're feeling around for things, what exactly are you feeling for? You know? You're doing these things, is it appropriate? What am I feeling for? What…yeah, all of the things.

Andrew: So with regards to your courses, and indeed what you teach at college, do you use, you know, mannequins and things like that, that are sometimes used?

Katie: We, oh, in the college, it's hands-on person-to-person. So you're actually feeling bodies, which I think is really important. We will sort of show things on mannequins and models and things like that, but you know, the actual getting in there and feeling human bodies is very, very important. And the same in my workshops. So it's about teaming up. I was reading a really interesting little article actually, it was very specific to my area, about how people, health practitioners in general, not just natural health practitioners, learn physical examination, they’re best in small groups with their peers.

Andrew: Ahh, right. 

Katie: With this… Yeah. And that's the best way to do it. Is that you do a little bit of learning and then theory and then you get in there and actually do it. You pair up and you swap around and you do all of the things and you ask the questions, and, you know, you just be really open. And that's the best way.

Andrew: So you pair up or you go into small groups, how's this shown to be useful?

Katie: Well, because you're literally practising on other bodies. The research has shown that small groups and peers, of our peers because then we're speaking the same language and we're happy to sort of go, "Oh, no, maybe just a bit to the right or a bit to the left," and, you know, all of those things to practice. 

And then we talk through what we're feeling and what we're observing, what we're listening to, what we're also auscultating, what we're percussing. And we talk through what we'd do if we're finding some abnormalities, or even just suspecting abnormalities.

Andrew: And what about the key hints and tips when you're doing physical examinations. It's not just the organ or the structure that you're palpating, right?

Katie: Oh, not at all. So it's not…obviously, we're feeling for abnormalities, we're feeling for masses and lumps and bumps, we're feeling for enlargements or, you know, sort of shrinking of organs and things like that. 

But also, you know, one of the really big things that I see over and over again, is that people are not observing their patient's face. So, you know, if we're literally just asking someone if they're in pain or if they feel tender, they can turn around and go, "Yeah, yeah, no, that's fine." But if we're looking at their face and they're grimacing, they're telling us something very, very different, aren't they? So it's about looking at that.

Andrew: Absolutely. And I guess this goes back to checking in with your patient. Constantly checking in with your patient. "Is that okay? How does that feel?" 

You know, I'm reminded by a YouTube video and YouTube videos by a very well-known medical practitioner dealing with skin. And what I found sometimes annoying was an assumptive question. Rather than "How are you feeling?" and getting the patient to give their description of what they're feeling, this practitioner said, "You're okay, right? There's no pain, right?" So, therefore…

Katie: That's right.

Andrew: …it's an assumptive question as in, "You better tell me there's no pain, because I'm cutting you right now."

Katie: And that can actually very easily… You're totally right. That can very easily go in the opposite way too, where we've made an assumption of what's going on with the patient and we will go and pick and choose and cut and edit, physical examinations or questioning to support our assumption.

Andrew: Ahh, now that's key, isn't it? That's key.

Katie: Yeah. So, for example, where we're palpating in an abdominal area and we've already decided in our head that there's an issue in a specific area. So we're sort of palpating in that area and we're going, "Oh, that feels sore, doesn't it? Does that feel tender there?"

Andrew: Yep. 

Katie: You know, and we're getting a "yes" or a "no" and we're guiding. We're guiding.

Andrew: Let's move on to how good physical examination skills can build your practice. What are the key things to learn from here?

Katie: Oh, it's massive, it's massive. Once again, coming back to that thing of taking the time because we have the time to do these things. Now, that doesn't mean to say it needs to take up a massive chunk of your consultation. If you've got a system of your basics that you always do and then a system, you know, of how to pick and choose the right ones for the person in front of you, it shouldn't take very long at all. 

But, you know, building your practices…what we know is that by building that rapport and gathering that information through physical examination means that the patient is going to trust you, if the patient is going to like you, and the patient is going to know you. So there's that know, like, and trust. 

So in terms of what this means for your business, is that your patient is effectively going to follow your treatment protocol, your patient is going to come back, you're going to have better, like, patient retention. And your patient…if your patient just thinks of you as the expert and the one that is helping them, they're going to tell everyone about you.

So, you know, building this rapport and this relationship with your patients through physical examination is really not to be overlooked. And that comes back to the power of touch, doesn't it? So even, you know, starting with shaking someone's hand and placing a hand on their shoulder and all of those things is part of building that rapport.

Andrew: Yeah, absolutely. And so what I'm picking up here is that even if it may not be related to the physical examination per se, that you might be improving patient compliance with your treatments in a systematic way?

Katie: Oh, 100%. So, you know, even if you've done a whole lot of physical examinations in that and you've decided that that isn't actually relevant to guiding your treatment protocol, the fact is, is that you've given that person time. You've given that person you. You've made physical contact with that person and you've built that relationship. You are going to, in their mind, you are going to be the person that they will listen to.

Andrew: So Katie, what are you going to be covering in your workshops? Do you start with, like, you know, really going back to the basic revision, even to things like, you mentioned it before, shaking a hand? So the space of people. For instance, urban people tend to shake hands closer than country people, than rural people, who tend to shake hands more further apart. And that's because of the space that we have allotted, if you like, to a public, private, and intimate. Do you start off with those sort of basic premises about how we approach patients and then work from there?

Katie: Oh, yeah.

Andrew: How much assumption do you make that practitioners know?

Katie: Well, for sure, and that is exactly that… you're right. That's exactly where we start. So as far as I'm concerned, the consultation has started the minute that you lay eyes on the person.

Andrew: Well said.

Katie: So the minute that you walk towards them in the waiting room, the minute they walk towards you in your clinic, whenever that is. 

So straight away, you're observing them. Are they dressed appropriately for the weather? You know, are they limping? Are they able to make eye contact? Are their hands clammy? Are their hands really cold or really hot when you shake them? 

So these things. I think these are cues that are overlooked. And often, people think that the consultation doesn't start until everyone's seated and we've started asking particular questions and it's just not true.

Andrew: Absolutely. You know, you've reminded me of two things. The first thing was a recent visit that my son made to a female doctor, and this female doctor very confidently came out with a bright smile on her face, locked eyes on my son once she'd called out his name. And from then on, you could see this connection with the patient and the doctor. And there was a confidence, there was a relaxing, it was really interesting to watch my son. There was a, "Great, I'm welcome here and this practitioner is confident." 

The other one is a warning, if you like, that a nurse gave to me in my training and it was Sister Getties, I will always remember this lady. I was disheartened at the time thinking everything was too hard and complicated. And Sister Getties said, "Look, you can learn all of this when the time comes. Right now, I want you to observe your patient. Have they got a gleam in their eye? What is their demeanour?" She said, "Right now, I want you to care for your patient." And it was the biggest lesson I've ever learned.

Katie: Oh, isn't that beautiful? That is so beautiful, and it's so true. And especially what you said about your son. We make judgments, humans make judgments. We make judgments immediately within seconds of seeing someone and meeting someone about whether we're going to trust that person. And your son, because of the way that doctor came out and presented herself to him, made the judgment straightaway that, "Okay, this is someone that I can trust and that I can work with."

Andrew: Brilliantly said. Now, Katie, you've mentioned before that you have a system, you've spoken about this system. What's the system?

Katie: Okay. So the system is that I want all practitioners to feel very, very confident, to be able to bring physical examination to each and every consultation. That's the initial, and also the follow-up. 

So basically, I want to teach them to do the vital signs, which is obviously your blood pressure, your temperature, pulse, respiration rate, beautifully, succinctly, confidently. And then to go on and be confident doing abdominal, which is obviously, you know, includes the liver and the spleen, doing some neurological testing and when to do it, respiratory, looking at the mental state, ears, thyroid, lymphatic, as well as the naturopathic signs.

Now, obviously, that is not something that you would do for every person. But to be able to pick and choose when to do them, how to do them, and why, why that really important. And to be able to fit this into the consultation. So yeah, and to be able to track these things. 

Andrew: That’s a real key. 

Katie: Patients just love this. They love…like, they like looking at charts and pathology results and to be able to see, you know, which way their blood tests are going and all of that sort of stuff because it's right there in front of them. 

They also like to be able to see, "Oh, look what's happening with your blood pressure, you know, it was sitting here before and now we're progressively getting down to here with each consult."

Andrew: You know, you said a real key thing there and that is the tracking, the trending of symptoms…

Katie: Yeah. 

Andrew: Signs, and presentations, even physical stature and things like that. So I'm going to ask you, do you tend to take copious notes, or do you tend to use things like photos? And I've got to ask, does that transgress privacy or do you ask the patient for their consent?

Katie: Well I always have a conversation about consent and privacy with everything, because, you know, you're taking…obviously, you're taking really sensitive notes as well, and then there might be photos as well. I have a whole lot of cheat sheets and workbooks and stuff like that, that I use to track things so that it's really succinct. You can pull it out and you that you can actually show them and go, "Look, this is what your nails were looking like. This is what was going on with your blood pressure," and it's very clearly laid out for them.

Andrew: And you mentioned also picking and choosing. So are there certain examination techniques and assessments that you do all the time. And certain ones that you just use if there's a focus, if there's a need to do them. Like, for instance, you mentioned neurological testing or assessment.

Katie: Ah, of course.

Andrew: So do you tend to do like the naturopathic ones and some basic physical signs, physical assessments or, you know, which one do you use when?

Katie: Well, I think vital signs should be done at every initial, at least. So, you know, the blood pressure, obvious…because when we're thinking about blood pressure, you know, not only are we thinking the actual, like, from a cardiac and pulmonary sort of side of things. But naturopathically, the blood pressure tells us a lot about the vitality of the person and adrenal function and things like that. So that's always a good thing to do. 

Temperature is always good as well, because obviously, it's a segue into a conversation about thyroid, is there acute infection? Things like that. The pulse tells us a lot about vitality. These are things as well if they're done well, they don't take long. 

So they're the things that should be done in every initial. And then obviously, you can track them with your follow-ups, and then obviously, all of the other ones, the body system physical examinations and such, you pick and choose according to how your patient is presenting.

Andrew: You know, you said a really interesting thing then about things like blood pressure.

Katie: Yeah. 

Andrew: Because there's obviously the white coat syndrome. 

Katie: Oh yeah. 

Andrew: And yeah, and the masterful blood pressure taker will be one that has this conversation about what's happening on the weekend, how they're feeling, da da da, what's the weather like… Oh, by the way, that's your blood pressure. And so, it's almost inconsequential. So there's this real relaxing of the patients' senses.

Katie: Yeah, for sure. So that's a really important conversation. And the same with temperature and the same with pulse. You're not going to have your patient rush in from somewhere, you know, 100 miles an hour and then set them down and throw a cuff on them, and start doing all of the things. 

You know, you're going to have the conversation further down the track, you're going to start talking, you're going to start taking the case, you're going to start observing. And then maybe what I do is about 15, 20 minutes into things. I say, "Okay, I'm going to take some physical examinations now and this is what we're going to do." Yeah.

Andrew: So let's talk about the workshops. When are they?

Katie: They start on the 25th and 26th of May. So they're a weekend. They are two days, and I'm going to be in eight different cities. It was six and now it has grown, as these things do.

Andrew: Yeah, I think this is indicative of just how crucial and needed and indeed wanted these courses are, because of what they're covering, how important it is for your patient care.

Katie: Well, you know, it's funny you say that. Because I started looking into this because I had people sort of saying the same thing over and over again, where they weren't confident and they weren't doing them because they weren't confident, and they didn't feel like they knew what they were doing. 

And when I started looking in to see who was doing this stuff and no one was. Like, it, you know, there doesn't seem to be anyone that is doing this, so yes, so it's been really great. 

So it's Brisbane, Auckland, Melbourne, Adelaide, Perth, Sydney, Newcastle, and Cairns. And I know I say that funny.

Andrew: And this is from May 2019, right?

Katie: May 2019.

Andrew: Okay, great. So where can people find out more about these workshops?

Katie: Okay, so you can go to my website which is  www.katiebarron.com.au, and there is a page there to sign up for your city, your place or city, I'm sure you won't have a problem finding one with the eight that I'm touring. 

I'm actually offering a special for FX Medicine listeners as well. So…

Andrew: Cool.

Katie: …the two-day workshop is $680 for two days of learning.  

Andrew: Excellent. And what about further info? Where can we get more good clinical info about assessment signs and practical examination skills?

Katie: Okay, so I am…yeah, once again, you know, it's kind of interesting because there isn’t… there is a lot of information about naturopathic signs and there's some great books and things like that, but there isn't a lot that bridges between the conventional and the naturopathic. 

I've got a group on Facebook and I go in there and do weekly trainings for people, so that they can kind of get started with bits and pieces and start, you know, just getting the ball rolling with their physical examination and that group is called Let's Get Physical.

Andrew: Ahh, brilliant, and I would urge all of our listeners to click on the website and get on to that course that Katie is offering because I think it's so crucial that we revisit these basic assessment skills for, not just our confidence, but also how it portrays to our patients and, indeed, improves our clinical practice. So thank you so much for taking us through this today, Katie.

Katie: No worries at all. It's been a lot of fun.

Andrew: Thanks, Katie. This is FX Medicine, I'm Andrew Whitfield-Cook.


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