I published a piece two weeks ago arguing that root cause medicine, as practiced in a significant portion of the wellness space, is injuring people. I used the phrase "vigorously self-certified," named medications people are refusing for supplements with the clinical track record of a strongly worded intention, and felt fairly pleased with myself afterward.

Then I saw my first patient.

The universe, it turns out, is a comedian. And it has my scheduling link.

What I ordered on day one of my new clinic was everything I rolled my eyes at when others order them. The nutritional labs, the hormone panels, the adrenal function tests.

I cannot give you details because HIPAA exists and also because my patient deserves her privacy and I would like her to know I am not laughing at her. I am laughing at myself. It's an important distinction, she was an excellent patient! I am the one who had to close my laptop and reconsider my priors.

What I can tell you is the list:

Nutritional labs. Full panel. Ordered them without flinching.

Inflammatory markers. Yes.

Autoimmune workup. Also yes.

Adrenal function. For a specific clinical reason I was not expecting to encounter on day one but there it was, staring at me from the chart, completely justified, extremely funny in retrospect.

CoQ10. I looked up the evidence. I have thoughts. Some of them are positive. I need a minute.

I typed "root cause" in my clinical notes and did not delete it. I sat with that. I moved on. I am fine.

I then shouted all of this downstairs to my husband, who was laughing before I finished the first sentence. He has read the post from two weeks ago. He is going to be insufferable about this for at least another two weeks.

Here is what I actually got wrong last week:

Not the argument. The argument stands. Root cause ideology, the version where you decline your bisphosphonate because you are working on your terrain with magnesium and optimism, is still injuring people. I will defend that sentence until my board certification expires.

But I was imprecise about something and my first patient handed me the correction approximately four hours into my new clinic, which is either humbling or efficient and I am choosing efficient.

The tests exist because sometimes you actually need them.

That is it. That is the correction.

The nutritional labs, the inflammatory markers, the adrenal workup, these are not inherently wellness grift. They are tools. Developed by people who asked good clinical questions and then designed ways to answer them. I have always known this. I ordered them on day one without a moment of hesitation because the clinical picture called for them clearly and specifically.

The problem was never the tests. The problem is ordering every test that exists on every patient regardless of clinical indication, handing them a supplement protocol, and calling it root cause medicine while they throw their statin prescription in the trash on the way out.

Those are different things. I should have said so more precisely last week. Consider this the precision. You are welcome.

Where I currently stand on functional medicine, a live document

I am, somewhat against my will, looking into functional medicine training. The introductory level. I am not committing to certification. I am simply a physician who saw one patient, instantly started yelling into the void about adrenal function, and found herself googling CoQ10 evidence at 9pm on a Tuesday like a person who has made certain choices.

I still have significant reservations about large untargeted workups ordered on everyone regardless of clinical picture. I am still not prescribing hormones for everything. I am still going to tell you to take your statin and I am still going to mean it.

But I used root cause in a clinical note without irony and I ordered things I have not ordered in years and I closed my laptop laughing about it, which is not the reaction I expected from week one but is honestly the best possible reaction and probably a good sign.

Medicine keeps being more complicated than my opinions about it.

I find this annoying. I also find it the root cause of why I still like this job. Both things, it turns out, can be true at once, which is also what I said last week about statins, so at least I am consistent.

If you're curious about what I actually do with fatigue, the quiz at http://thefatigueclinic.org/ is where I usually start. I will order the tests that are actually indicated. I will not order all of them.