Dear Colleague,

A patient arrives with a long history and several concerns. Then comes the question: “Where do we begin?”

Consider a patient with elevated blood pressure who also reports loud snoring and waking unrefreshed.

Both concerns matter. But those few facts do not yet tell us what the first step should be.

Before choosing a first step, I would want to know whether the blood pressure or any accompanying symptoms require prompt attention, what care is already underway, and what further assessment could change my priorities.

Recognizing what is missing is part of making a sound first decision.

Hear my 90-second reflection on where a sound first decision begins.

▶ Listen to my 90-second message

That is a question you can take into your next complex patient encounter: What requires attention now, and what information could change my priority?

Whether you are beginning your clinical career or have practiced for years, you want to understand the person in front of you and make a thoughtful decision about what to do next. Knowledge matters. So does knowing how to use it when several needs compete for attention.

Later in this series, I will give you a short case exercise. You will choose what you think should lead, see additional information that may change the decision, and compare your reasoning with mine. 

The purpose is to practice the decision, not simply hear me describe it.

A patient may need many things—but they cannot all be first.

Warmly,

Dr. Ron Grisanti
Founder, Functional Medicine University

P.S. You do not need to have a final answer from the few details I have shared so far. Knowing what else you need to assess is itself a valuable first step.