[INTERVIEW]
Ronda Nelson: Listen, I’m gonna say something that might ruffle a few feathers. Here it is — you probably do not need to order that next test. I know, I know. Functional medicine is about getting to the root cause, and testing is how we find that root cause, right? Wrong. Not every time. Today I want to make the case for starting simpler, trusting your clinical brain, and remembering that taking a good history along with some basic blood work just might tell you more than any fancy lab test ever could. Alright, let’s dive in.
Welcome to the Clinical Entrepreneur Podcast. I’m Ronda, your no-fluff, tell-it-like-it-is business bestie for wellness practitioners just like you who want to build a practice you love, make a bigger impact, and a little money while you’re at it. So if you’re ready to ditch the overwhelm, attract your dream ideal patients, and finally run your practice with complete confidence, you’re in the right place. Each week we’re tackling things from programs to patient retention to marketing strategies that actually work — sprinkled, of course, with a little sass, a lot of heart, and the step-by-step strategies that will help you get there. So grab your cup of coffee, your notebook, or whatever keeps you going, and let’s build a practice you love and a life you love together.
Welcome back to the podcast. Today we’re gonna be talking about testing and why I do not think you need it as badly as you think you do. So this topic is probably one of those ones that I get a little saucy about. I mean, I get saucy about a lot of things — you ask my husband, he will say, “Girl, settle it down.” I don’t know how. I don’t know how.
But here’s why we are so conditioned to order a test. I think it’s become kind of like Pavlov’s dogs. You know, ring-ring-ring — symptom — and off we go onto some lab portal where we’re gonna order a stool test, or order an allergy test, or order a toxin test, or order a mold test, or a genetic test. The list goes on and on and on and on. But here’s what I have seen over and over again — in fact, it’s so predictable that I now fully expect it. A patient comes to me and they have a stack of lab results. They’ll upload 20 different lab results into the Practice Better portal, and I just shake my head. I know where they’ve been. They’ve been to a functional medicine practitioner — that’s exactly where they’ve been. Sometimes it’s two, three, four thousand dollars worth of tests. And obviously that didn’t work, because they’re with me now. And I’m like, well, if you ordered all these tests, then certainly someone should have been able to figure this out. You’d think, right? Somebody should be able to figure it out. But they didn’t.
And they upload them all to me because what happens is the practitioner found, you know, one, two, three, four — 17 things that were “off” in quotes. And now the patient is on 15 supplements and we’re gonna rebuild Rome in a day. That is not how we rebuild Rome in a day. And it’s definitely not how we put Humpty Dumpty back together. Not how we do it. What we do is we start slow. We start small. We start by just saying, okay, what does this look like? If it looks like a duck and it acts like a duck, it probably is a duck. Why are we going through all of this expensive testing only to find out that there was maybe nothing wrong, or just a couple of things wrong? What if the test doesn’t show anything? Very likely there are false positives and false negatives.
What I think when we start doing all this testing work is we’re just — we’re not doing root cause medicine. What we’re playing is expensive guacamole. And it’s just like whack-a-mole — whack the mole, whack. And we’ve all had that happen. I get it. I’m in the middle of a couple of cases right now, I’m not really sure what to do, and I may end up having to order a test. But that’s exactly when I believe that testing is needed.
What we don’t do as well, I don’t think, is we don’t take the time to really investigate and take a good clinical history — ask good questions, think through, use your brain, think through what’s going on. You don’t need a whole bunch of panels and all the things. I just had a patient come in — she’d filled out all of her paperwork, and part of the instructions I have for her in Practice Better is to upload any tests. So I go in on the morning of — dumb me, I should not have done this — but I did. The morning of, I go in, I’ve already reviewed her intake forms, and I know that there are tests uploaded. So I go into the documents folder in Practice Better and I look in there, and there are probably 14 or 15 genetic tests. No blood test. No saliva. Nothing meaningful. Just genetic tests.
Genetic tests don’t tell me anything about what’s happening. They might give me some clues about why it might be happening. But right now, if I am going to treat this particular patient, if I’m gonna work with her — you tell me what kind of information am I gonna get from a genetic test that’s going to dramatically influence the protocol that I put her on. I’m gonna have none. Zero. In fact, this particular patient — I found out during our conversation that she had significant emotional trauma as a child. And all of what’s going on with her, I don’t think it’s all of it, but I think a huge amount of it is rooted in this emotional trauma. And you tell me what genetic test is gonna show that. None. Can you hear my spiciness coming through? You probably can. Yes. Because I’m spicy about this.
A genetic test doesn’t give you a diagnosis. A lab test doesn’t even give you really a diagnosis. All it gives you is data. And all that data does without context — that’s your history — is provide noise. Let me say that again. The tests don’t give you a diagnosis. They give you data. But when you have all that data from all the different tests without context, it’s just noise. Now I know you’re probably saying, “Oh yeah, well, I take a good history” or “I use FMU or FM Logics.” I use FM Logics too. I like it. But that is no substitute, in my opinion. It’s no substitute for using your brain and asking really intelligent questions — so that we don’t charge the patient $2,500 worth of tests and they come back and there are abnormalities everywhere. But if you run enough lab tests, you’re gonna find something wrong. That, I think, is not good medicine. That’s not being good at what we do. It’s playing defense. “I don’t know what’s going on really, so I’m just gonna test everything and see what shows up.” But I would argue that there is a better way.
Now, I use lab tests and I don’t have an issue with that. I use them. But I don’t resort to them as a first point of investigation — that’s not what I do. I’ll order — well, not a Dutch test, you know, I don’t like those — I’ll order a Diagnostechs test, or maybe a stool test once in a while. But only when I need to. So there are three reasons — three key reasons — why I will order.
One is if I have a hypothesis. I’m thinking, hmm, I wonder if this might be it. And this is the big “and” — ordering the test, depending on the results of the test, will change my protocol. In other words, if I’m on the fence and I’m thinking maybe this is mold, let’s say, but it might be X over here — maybe it’s yeast and maybe it’s mold, or maybe it’s some infection, maybe it’s a neurological something — I have kind of two options and I would kind of weigh them as like yeah, maybe 50/50. Then I would say, which one of these two could I test to rule out yes or no? See, that’s verifying my hypothesis. I’m just trying to get an idea of do I go left or do I go right? Do I choose door number one or door number two? In which case I would probably order a mold test, and if it comes back negative, then I know it’s over here. That then changes my protocol. So that’s when I’ll test.
The second reason that I’ll test is to get a baseline. Most of the time that’s gonna be your pretty standard labs. I order from Professional Co-op Services — I love their Opti Thyroplex 2 panel. That’s the panel I use. That’s like my wellness panel. I’ve also been getting ready to kind of switch that up a little bit. I’ve started to add the NMR test, but then I realized, oh, well that’s dumb because it’s a duplication — the lipid test is in there. So I might see if they’ll create a different panel for me. But all of that to say, I’ll get a baseline there. And for menopausal women, I always get a baseline of the bone health panel — always — because I want to see what’s happening with bone, and it also gives me hormones and a little snapshot into cortisol. So those are kind of the circumstances where I’m gonna get a baseline.
The third reason that I’ll order a test is if I’m really truly stuck — in other words, I have just done everything and I cannot figure it out, and I’m bouncing around, bouncing around. I’ll give you an example. The H. pylori case that I talked about in the clinical series — she’s getting so much better, she’s definitely a hundred percent getting better, I’m really really happy. But I just know that infection is not quite gone yet. But I’m curious: is there something else that I’m missing? Is it just the H. pylori, or is there something else there? I don’t know. And so I’m considering — I don’t feel stuck, I just don’t know where to go next. I’ve tried all the things and she’s so much better, but I can’t quite get over that last little hump. So I may order a test. But those are the only three times: to prove or confirm a hypothesis, to get a baseline, or to get me clarification on a super stuck case.
But now let’s talk about history for a minute. Because I don’t think we do a great job with our history taking. We have them answer the questions on the intake form, and then we sit down and we say, “OK, I reviewed your forms,” and we ask a couple of questions, and then we just say, “OK, well, this is what I think.” And listen, I’m guilty of the same thing. I think we end up getting about 80% of the information on an intake form — that’s what my experience has shown me. The more questions I ask, the better information I’m gonna get. Because they can only answer the questions on the form. If the question is there, black and white, I’m gonna answer the question. But sometimes patients don’t think outside the box. They don’t think about, oh, well, that might be related to blank.
So their timeline — I’m big on a timeline. Their timeline kind of tells you all the things. So of course you’re gonna ask for the never-been-well-since moment. When was that moment? What was happening in your life when the symptoms started? Was there an infection? Did you fall off a horse? Did you buy a new house? Did you get a new car? Did you start a new job? Was there a remodel at your job when you started to feel bad around that time? Did you travel? There are some things that are real obvious — travel would be obvious, right? But what about if they all of a sudden start getting respiratory problems and they don’t tie it to anything? You might ask, did the building that you work in recently have some kind of air duct cleaning, or was there new furniture in the building, maybe new carpet, something like that? I think we just don’t ask deep enough questions. We don’t keep asking and probing and probing until we’ve exhausted that rabbit hole before we go to the next one.
So there are obvious clues that the patient will give you that kind of tell you you’re on the right track. For instance, if they say, “You know, I’m bloated” — okay, qualifying question would be: above the belly button or below the belly button? Next question: is it within 30 minutes of eating, or two hours or more after eating? Those are gonna give you insights into what’s happening. Is it related to upper digestive function? Is it related to lower digestive function? What is it? Sometimes the pattern can point you in the right direction, and then you can query further into that. If they’re nauseous after meals, or they have pain under the rib cage, or they crave sugar and crash out in the middle of the afternoon — all of those things are gonna give you clues.
And also, I think sometimes we forget that just as important, we need to know what didn’t work. So if they came from another practitioner, I wanna know what did that other practitioner do that didn’t work. Maybe it’s the supplements that they were using that didn’t work. Maybe it’s that they didn’t stick with it long enough. I’ve seen some — and this was not so much for those of you that muscle test, I think most of you are pretty good, at least the ones of you that are listening to me — but I found in the past I was always so shocked when a patient would come in, they’d muscle test, give them a whole bunch of supplements, three weeks later come in and muscle test again, and they needed a whole another bunch of supplements, and they never finished the first bunch. And then three weeks later they test again and they need a whole another bunch of supplements, and they never finished the first two bunches of supplements. And I’m thinking, well, are you driving a Mercedes because of your business model here? Because I’m not seeing how this is benefiting the patient — because now we have a bunch of bottles of unused, unfinished supplements and the patient’s not better. I don’t think any of you are doing that, but I have seen that done.
And so I wanna know: what did the other practitioner do? What did they not do? What do you think is wrong? What do you feel in your body is wrong? What is your body trying to tell you? How often do you ask that question? There are so many deeper questions that we can ask. And then of course lifestyle — you guys all know how to do that: sleep, stress, all those things.
The better the history, the better the outcome. Because the history is gonna tell you where to look. The lab tests will confirm what you found out. So you start with the history, and then you don’t have to rely on the labs.
So here’s what I order if I’m gonna order labs. I told you about the bone health panel from Diagnostechs — I love that panel. For every post-menopausal woman — I don’t usually do it with peri-menopausal women, I wait until they’re post-menopausal — and then I’ll order that as a baseline. Then I’ll do it every year or every two years depending on what I see. I just put a reminder in, set to remind them in a couple of years or 18 months or whatever time to get their bone health panel again. For almost everyone, I get that comprehensive panel from Professional Co-op Services — you can order it from wherever you want, that’s just who I use. I have in the last, I don’t know, six months or so been adding in that NMR lipoprotein panel, and I love it because it’s gonna tell me what’s going on with those proteins, particle size, that kind of thing.
I always look at thyroid function — and not just TSH and T4, for Pete’s sake. There’s a lot more going on in the thyroid. I personally love looking at total T4 because that tells me what the thyroid is producing. I mean, that is like your topline revenue in your business. That’s like the total amount of money in your bank account. That is the roof of the house. What is the total amount of hormone the thyroid is producing? So I like to do that. I like to order a full thyroid panel. Obviously the CMP is gonna have liver and kidney markers. I will always add inflammatory markers — CRP, even fibrinogen. I like to look at that. Sometimes fasting insulin. You guys know the drill. You know what to order. But you want to make sure that the wellness panel is comprehensive enough. And you know, sometimes they’ll come in with a blood test from their medical doctor, and it’s pathetic — because they don’t order comprehensive testing at all. So you may have to reorder a few things or just reorder the panel.
But if you’ve got that baseline and you have a good history, you’re gonna have a really good idea about what you need to know. If the patient has like a whopping gut infection and I’m going along, going along, and it’s not getting better — OK, I’m probably gonna order a stool test. But I’m pretty hard pressed before I’m gonna do that. I’m gonna try everything I can. Because I know that these protocols work. I’ve seen them work over the years. I’ve seen them work. So why do I need to spend money, or have the patient spend money on a test, when I already know that these protocols will work? We don’t need to test everything. We don’t need to do a bunch of food sensitivity tests — if you know they’re sensitive to some things, then just pull those foods out. See how they do. If you get backed into a corner, then you can order the test.
So just remember: your brain is the most valuable asset you have as a practitioner. The best part of you is your brain. And I watch practitioners all the time — they just second-guess themselves. They don’t trust their intuition. They don’t trust that clinical brain. I know intuitively what questions to ask. Intuitively I know that I need to pursue that line of thinking a little bit. Or I don’t know, it just feels like there must have been something in the environment. Or where did you grow up? Were you in a — what part of the country did you grow up in? Were you on a street where other kids were sick? Were there other children where you went to elementary school that had illness?
I remember one young woman that I worked with — this was years and years ago. She had a cleft lip and palate, and they had repaired it. And she said there were four girls on her same street who were all born within two years of each other, and four of them had cleft lip and palate. And the doctor said, “Oh, just coincidence.” Some relative said, “Do you believe that?” She said, “No, there’s no way.” I mean, that’s a pretty easy one to put together. But maybe she wouldn’t have even thought to put that on her paperwork. I don’t remember — it’s been so long ago — but I would have asked the question: was anybody else around you with that same diagnosis? Were there more autoimmune diseases? Was there a lot of cancer? If the patient has cancer, was there a lot of cancer around them? Just think outside the box. Ask questions.
The better clinicians that I know — honestly, the ones that I see that really are successful — they order lab tests very sparingly. They don’t spend a lot of money on lab tests. And I know I’m gonna alienate some people, and that’s okay. We can just agree to not agree. I just don’t think that playing whack-a-mole with a lab test is serving the patient very well. I think it’s time that we just learn how to dig a little bit deeper and find out what is really going on underneath the surface.
So if you’re feeling overwhelmed, don’t just start randomly — start by asking more questions. Ask different questions. Ask better questions. Even if it seems like a dumb question, because you never know what that will trigger in someone’s brain. It’s like the case I told you about where the young woman came to me and she said, “I’m crying all the time, I’m moody all the time, I don’t know what’s wrong with me.” I think it was the first clinical case — I think it was the first podcast of 2026 — and she was just all upside down. She said, “I don’t know what’s wrong with me, something’s wrong, I don’t have any stamina, I’m tired, I can’t —” and it was at the very, very end of the conversation when she just happened to mention — and this was on me, like, I didn’t ask all of the questions that I should have asked — and she just happened to drop that she had been to the dentist. And all of a sudden I thought, ding ding ding ding — something’s here. And like the earth starts to vibrate. I think, oh my gosh. And then I started asking questions down that path that I wouldn’t have asked before. But boy, let me tell you — after that, now I ask it to everybody.
When was the last time you were at the dentist? Did you have your teeth cleaned? What did they find? Do you have cavities? How many have you had? I ask the basics on my intake form, but good grief — how could you ever think of all the questions to ask on an intake form? You can’t. And that’s why you just have to have a conversation. So plan enough time in your intake process to be able to ask the questions that you need to ask in order to get the information that you need.
[CLOSING]
Ronda Nelson: So check the show notes out — I will link all the things that you need in there. I’ll link to Practice Better. I’ll link to Professional Co-op Services. And if you want more clinical instruction, I’d love to have you inside Clinical Academy. It really is the bridge between clinical education and how to implement it in practice. I will see you next week on the podcast. For all the things, you can go to rondanelson.com/clinicalacademy to get in there. Alright friends, take care.
[END]