Dear Colleague,

Your patient returns and says, “I’m feeling better.”

Then asks:

“Which parts of this plan do I still need?”

If you started five things together, how confidently could you answer?

Improvement matters. But it does not automatically tell you which decisions helped, which added unnecessary burden, or what you should repeat with the next patient.

A plan can produce improvement while leaving your explanation of that improvement uncertain.

See how FMU teaches clinical reasoning and sequencing

Consider this illustrative teaching example—not an actual patient report.

Same patient. Two ways to build the plan.

A patient presents with fatigue, disrupted sleep, and intermittent bloating. After an appropriate assessment, several elective changes are being considered: a sleep routine, dietary changes, and multiple supplements.

Necessary medical evaluation and treatment continue in either approach.

In the first approach, everything begins together.

Suppose that, at follow-up, sleep is better, fatigue is unchanged, and bloating is unchanged

Which changes contributed to better sleep? Which additions remain justified? Does the persistent fatigue challenge your original explanation? What information should guide your next step?

The response raises questions, but the number of simultaneous changes makes them harder to resolve.

In the second approach, you build the plan around explicit questions.

The history identifies irregular sleep timing as one plausible contributor. The patient agrees to a consistent sleep schedule and records sleep patterns and daytime fatigue.

You continue evaluating the gastrointestinal symptoms. Supplements without a sufficiently established indication are deferred.

Before beginning, you explain:

“We are examining whether this change helps your sleep. We are also tracking fatigue separately, because better sleep may not resolve it.

Your gastrointestinal symptoms remain a concern to evaluate.”

Now suppose the follow-up shows better sleep, unchanged fatigue, and unchanged bloating.

What happens next?

You do not intensify sleep treatment simply because fatigue persists.

Instead, the next decision is to investigate the unresolved fatigue further, using the history, examination, medications, and other findings to determine what assessment is warranted.

The gastrointestinal concern is evaluated on its own evidence.

Persistent bloating does not, by itself, justify an antimicrobial protocol.

The sleep plan is reviewed for benefit and sustainability rather than expanded automatically.

One symptom improved. That does not mean one explanation accounts for the whole patient.

Nor does the improvement prove that the sleep schedule caused it. But the starting plan has made the follow-up easier to interpret.

You can explain what was attempted, what changed, what remains uncertain, and why the next decision is different.

Here is the larger insight

You are choosing more than an intervention. You are shaping the information available for your next clinical decision.

▶ Listen to my two-minute audio: Before You Add Another Intervention

Sometimes several treatments must begin together. Patient safety and necessary care come first.

For elective decisions, however, each addition deserves a clear purpose. Before starting it, ask:

• What evidence justifies this choice?
• What will I monitor?
• What response would make me continue, stop, or reconsider?
• What can proceed alongside it—and what should wait?

These questions turn a list of possibilities into a plan you can explain and revise.

At Functional Medicine University, we teach foundational functional medicine and develop this reasoning through advanced sequencing case exercises.

Students identify a priority, justify their choice, and reconsider their decisions as additional information becomes available. The educational benefit is practice connecting findings to decisions—not simply hearing another list of possible interventions.

If you are new to functional medicine, this helps you develop reasoning habits alongside your foundational knowledge.

If you are experienced, it gives you a structured opportunity to examine why a familiar approach fits one patient—and may need reconsideration for another.

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

As enrollment approaches on October 19, I invite you to explore how FMU teaches foundational knowledge and clinical sequencing.

Explore FMU’s program and clinical sequencing education

Warmly,

Dr. Ron Grisanti
Founder, Functional Medicine University

P.S. Before adding another intervention, ask: “Will this make my next decision clearer—or make the patient’s response harder to interpret?”