What You Can Expect When You Work With Me

By: Dr. Nicole Roberts, Naturopathic Doctor

Whether you have had experience with a Naturopathic Doctor before, or this is your first time considering seeing one, I think it is important to lay out the way I work to heal patients. This way you know exactly what to expect and have a better understanding pre-appointment as to whether you and I are a good doctor-patient fit.

In addition, as I work in a field where patients pay out of pocket (or through private insurance) to cover my naturopathic medical services, it is important to me that there is full transparency regarding cost and value for your money (and time!). The "wellness" movement in the past half decade has brought about a lot of opportunities to spend considerable amounts of money on your health. Many of my patients have invested in their health before and may now be coming to the table feeling wary of spending more money and of empty promises of help. As a naturopathic doctor, it is of the utmost importance to me that this never happens to any one of my patients.

Coming to someone for help with our health can be a vulnerable experience and we never want to feel taken advantage of or as though we were not heard.

This is what our work together will look like:

15 Minute Consultation: A Get-To-Know Each Other [Optional]

This 15 minute meet-and-greet is for new patients who want to come in and get to know the clinic space and me. I answer any questions you may have before deciding to work with me. We don't get into the specifics of your health concerns or prescribe any treatment, but we can talk about what naturopathic care may entail, coverage options, etc. This may also be conducted over the phone.

Cost: $0

The Intake Form

If you book in for an Initial Visit, you will be sent a naturopathic intake form via email. This intake takes about 20 - 30 minutes to fill out and submit prior to our appointment. The questions and information you give on the intake form provide me with a very good idea of where to begin in our initial appointment and enhances the quality of your initial treatment plan.

Your Initial Visit: 75 minutes

In this first official visit, you and I will go through a full health history intake. In addition to standard medical questions about your symptoms, treatments and medications, I will ask you to describe what is going on for you in your life, the relationships you have, your mood and feelings, what stresses you, what ignites you, what challenges you have making long lasting changes to your health and so on and so forth. I am looking for an understanding of who you are and I want you to tell me in your own words. This takes up the bulk of our time together. Many patients don't realize how much they have to say and how much they needed to talk until they get the time to do so.

I will then do a physical exam that is oriented towards your symptoms. Blood pressure, pulse, breathing rate, temperature, heart exam, abdominal exam, thyroid palpation and more are all standard exams I may do in the first visit. The goal is to be thorough and understand your body's baseline state. For example, if you have a nodule on the left side of your thyroid gland that no one has ever found before, or a mole that I recommend we watch, we'll find it. This way, you know that I am dedicated to looking out for your health in the present and future. We may even catch things before they become symptomatic and we can understand what your normal physical state is.

Next, I will give you an assessment of what I think is going on with you, and what we may need to investigate further. This includes the suspected root cause of your symptoms, how all your symptoms inter-relate and how your lifestyle may be affecting that. For example, it is very common for someone to talk about mental health concerns, hormone symptoms (i.e. acne, hair loss, weight gain, painful menses, etc) and digestive issues (bloating, constipation, etc). All of these symptoms affect and feed each other, and to heal one is to heal all. This is where I will describe the Short Term and Long Term Plan for your health; what it looks like in terms of supplements or follow up visits or acupuncture or lifestyle changes, and what my estimated timeline is for you to see changes and begin to feel better. This keeps our expectations realistic and oriented towards healing from the ground up (or as I usually say, from the gut --> out).

At this point I will tell you if I think any testing is indicated for your case. I'll be explicit in why I think the testing is needed, how it will inform my diagnosis and our treatment plan, and how much it costs. Testing can be an extremely useful tool to get you results quickly and efficiently. I will always give you the choice of proceeding with or without testing unless I think there is an emergent or urgent need for the test. Likely, I will ask you to sign a Release of Records to contact your family doctor regarding your last blood work or imaging and go from there.

Finally, I will explain the nature of your treatment plan and how we are going to proceed. Treatments include dietary changes, lifestyle changes, supplementation, exercise, emotional and mindful work, acupuncture sessions, botanical therapies, physical body work (cupping, trigger point therapy, spinal manipulations etc) and hydrotherapy techniques. I may also make a referral to another professional (my network of trusted psychiatrists, personal trainers, community groups, etc) if I feel co-management will benefit you the most. If I recommend supplements, I will tell you how much they cost, how you can price compare to find the cheapest version, exactly what the supplement is and why it is being prescribed at this time, and how long you will be on it for.

I fundamentally do NOT believe that supplements are the answer to our health problems. They are a tool we can use to heal that have a place in the context of naturopathic care, but they are not the whole picture. I make it a priority to limit the number of supplements my patients are prescribed and to take them off of a supplement when it is no longer necessary. This way we minimize cost and maximize results without overwhelming the body and digestive tract.

Cost: $195.00 (No HST)

15 Minute Phone Follow Up

I find that Initial Visits can be a lot of information for patients. I also find that many of us are stretched thin with our time and energy, and so intentions to begin to focus on our health may fall by the wayside. In order to address this, I have recently added the practice of free 15 minute follow up consultations after an Initial Visit.

This is something we schedule at the very end of your Initial Visit, and it involves me giving you a call about a week after your appointment to see how things are going, if you have any follow up questions, if you have found everything (supplements, specific foods, etc) alright. Generally, I want to know how you are doing and if you feel a) supported in your health and b) empowered and engaged. If something isn't working you, I'd like to know so I can help you find something that will.

Cost: $0

First Follow Up: 30 to 45 minutes

I like to schedule a follow up visit within 1 - 3 weeks of our Initial Appointment. This may not be necessary for everyone, but I have found this follow up is beneficial for the following reasons:

review of any lab results that have come in and an explanation of what each result means so you understand exactly what the labs are saying about your health and the subsequent initiation of targeted treatment for lab results
accountability and support are paramount to making healthy changes that frankly, are not always easy to implement; I don't want you to invest in an Initial Visit, have life get in the way of making slow, sustainable changes and then fall back into the same routine and not see your health progress
diet work is the foundation of my treatment plans; I do not like giving pre-made or standardized lists of food to eat and foods not to eat because I find it very inauthentic in the context of a patient's life and it rarely suits them uniquely; as such, I prefer to have you fill out a diet diary, spend time telling me what foods means to you, how you use it, what foods you like, and then we create a sustainable, personalized dietary changes just for you (that fit the speed at which you want to make them); this is usually our focus in the first follow up
it takes time for us to build our doctor-patient relationship and seeing each other a few times at the beginning of our work together can begin to solidify a life-long resource for you as you work on your health
review how any supplements or lifestyle changes have been going thus far and if any are not sustainable for you, then we make a change or find an alternative

Cost: $90 to $120 (no HST)

From here, your unique treatment plan will dictate how often I recommend a follow up appointment.

As a rule, I focus on helping my patients recover efficiently, and teach them how to no longer need me.

When you feel your health is well managed on your own, I will likely advise that we see each other a couple times a year to check-in, and that you are encouraged to book in if anything comes up or changes for you.

So there it is - demystifying the naturopathic consult with me!