Your First Consultation: What We Assess and Why

At a Glance

This Is Not a Standard Medical Appointment

If you have been to conventional doctors for your chronic condition — and if you are reading this, you almost certainly have — you are probably used to consultations that last 10-15 minutes, involve a brief review of symptoms, and end with either a prescription or a referral.

Your first consultation with us is different. In structure, in depth, and in purpose.

We block 60-90 minutes for your initial assessment. We ask questions that no one has asked you before. We order laboratory work that most physicians do not know exists. And we use the results to build a treatment plan that is designed specifically for you — not for your diagnosis category, but for the unique constellation of factors that is driving your illness.

This article walks you through exactly what to expect so that you arrive prepared and get the most out of your first encounter with our team.

Before the Consultation: What to Prepare

The quality of your first consultation is directly proportional to the quality of the information we have before it begins. Here is what to send us in advance:

Medical Records

• Treatment timeline: A chronological summary of your illness — when symptoms began, what triggered them (if known), how they have evolved, and what treatments you have tried with what results. This is the single most valuable document you can provide. If you have not written one, take an hour and create it. Be specific about dates, doses, and outcomes.
• Prior laboratory results: Everything from the past 12 months. Include standard bloodwork, infection-specific testing (Lyme Western Blot, ELISpot, PCR results), immune panels, hormonal testing, and any specialty labs.
• Imaging reports: MRI, CT, ultrasound — any relevant imaging with reports and, ideally, the images themselves.
• Current medication and supplement list: Every medication and supplement you take, with exact doses and frequency. This includes over-the-counter medications and anything you take intermittently.
• Genetic testing: If you have MTHFR, HLA, or other genetic data, include it.

Symptom Documentation

I encourage patients to bring a written list of their current symptoms, rated by severity (mild, moderate, severe) and how they impact daily life. This serves two purposes: it ensures nothing is forgotten during the consultation, and it provides a documented baseline that we can compare against at follow-up.

Practical tip: Organize your symptoms by system:

• Neurological (brain fog, headaches, numbness, tingling, memory issues)
• Musculoskeletal (joint pain, muscle pain, stiffness, weakness)
• Cardiovascular (palpitations, exercise intolerance, chest tightness)
• Gastrointestinal (nausea, bloating, food sensitivities, bowel changes)
• Psychological (anxiety, depression, mood swings, irritability)
• General (fatigue, sleep quality, temperature regulation, night sweats)

Questions to Bring

Write down every question you have. Your consultation is long enough to address them, but if you do not write them down, you will forget some in the moment. Common questions patients bring:

• What do you think is causing my symptoms?
• What treatments do you recommend, and why?
• What are the risks of the proposed treatments?
• How many treatment sessions will I need?
• What is the expected timeline for improvement?
• How will we know if the treatment is working?
• What happens if I do not improve?

All of these are fair questions, and we will address all of them.

The Consultation Itself

Part 1: The Clinical Interview (30-45 Minutes)

This is the longest part of the consultation, and it is the most important. I or one of my colleagues will conduct a systematic review of your health, starting not with your chief complaint but with your full medical biography.

What we ask about — and why:

Birth and developmental history. Were you born vaginally or by caesarean section? Were you breastfed? Did you have recurrent childhood infections? These factors shape the immune system in ways that are still influencing your health decades later. A child born by caesarean and formula-fed starts life with a fundamentally different microbiome than one born vaginally and breastfed — and these differences have measurable immunological consequences.

Infection history. Every significant infection you have ever had, with approximate dates. Known tick exposures or tick bites. Travel history (exposure to tropical infections, parasites). Mononucleosis (EBV). Recurrent herpes outbreaks. Viral illnesses that seemed to trigger a deterioration. Many patients have not connected events that occurred years or decades apart, but they are often related — a Lyme infection in 2010, a period of severe stress in 2015, and a collapse of health in 2018 can represent a single pathogenic trajectory.

Environmental exposures. Mold exposure (water-damaged buildings, visible mold, musty environments). Heavy metal exposure (dental amalgams, occupational exposure, contaminated water). Chemical exposures. These factors are frequently overlooked in conventional medicine but are critical in understanding chronic illness.

Dental history. Root canals, dental implants, jawbone infections (cavitations), mercury amalgam fillings. The oral cavity is a significant source of chronic immune activation that most physicians do not evaluate. We take dental history seriously because it frequently changes our treatment approach.

Gut health. Digestive symptoms, food sensitivities, antibiotic history (cumulative lifetime exposure), probiotic use, dietary patterns. The gut-immune axis is central to virtually every chronic inflammatory condition we treat.

Stress and trauma. Physical and psychological stressors, including adverse childhood experiences (ACEs), can profoundly alter immune function and stress-response pathways. We ask about these factors not to psychologize your physical symptoms, but because they have measurable biological effects that influence treatment design.

Current lifestyle. Sleep quality and duration, exercise capacity (current vs. pre-illness), diet, alcohol and caffeine consumption, screen time, stress management practices, social support. These factors directly influence treatment outcomes and help us identify modifiable variables.

Part 2: Physical Examination (15-20 Minutes)

A thorough physical examination follows the clinical interview:

• General assessment: Overall appearance, body composition, skin changes, nail and hair quality (these reveal nutrient status and thyroid function)
• Neurological examination: Cranial nerves, reflexes, sensation, coordination, cognitive function (including detailed assessment if neurological symptoms are present)
• Cardiovascular assessment: Heart sounds, blood pressure (both arms), peripheral pulses
• Abdominal examination: Liver and spleen palpation, tenderness patterns, bowel sounds
• Lymph node survey: Cervical, axillary, and inguinal nodes — lymphadenopathy can indicate active infection or immune activation
• Musculoskeletal assessment: Joint examination if musculoskeletal symptoms are present, tender point assessment, range of motion
• Skin examination: Rashes, erythema migrans (Lyme-associated rash, which can persist or recur), stretch marks (potentially associated with Bartonella infection), livedo reticularis, and other skin findings relevant to infectious and inflammatory conditions

Part 3: The Laboratory Order (10-15 Minutes)

After the clinical interview and examination, we design a laboratory panel tailored to your presentation. While the exact tests vary by patient, here is the scope of what we typically order:

Standard blood chemistry and hematology:

• Complete blood count with manual differential
• Comprehensive metabolic panel (electrolytes, glucose, liver enzymes, kidney function, albumin, total protein)
• Lipid panel with Lp(a)
• Coagulation panel (PT, aPTT, fibrinogen, D-dimer)
• Iron studies (ferritin, serum iron, TIBC, transferrin saturation)

Inflammatory markers:

• High-sensitivity CRP (hs-CRP)
• Erythrocyte sedimentation rate (ESR)
• Interleukin-6 (IL-6)
• TNF-alpha
• Complement C3 and C4
• Fibrinogen (also a coagulation marker, but elevated in chronic inflammation)

Infection-specific testing:

• Lyme disease: ELISA, Western Blot (IgM and IgG), ELISpot (LTT) for Borrelia, Babesia, Bartonella, Ehrlichia, Anaplasma, Rickettsia
• Viral reactivation panel: EBV (VCA IgG, VCA IgM, EBNA, EA-D), CMV, HHV-6, HSV-1/2
• Mycoplasma pneumoniae, Chlamydia pneumoniae
• Candida antibodies and antigen

Immune profiling:

• Lymphocyte subsets (CD4, CD8, CD4/CD8 ratio, CD19, CD56/16 NK cells)
• NK cell function (cytotoxicity assay)
• Immunoglobulins (IgG, IgA, IgM, IgE, IgG subclasses)
• Autoimmune screening (ANA, anti-thyroid antibodies, additional panels if autoimmunity is suspected)

Endocrine and metabolic:

• Thyroid panel (TSH, free T3, free T4, reverse T3, anti-TPO, anti-TG)
• Adrenal function (morning cortisol, DHEA-S)
• Sex hormones (testosterone, estradiol, progesterone — as appropriate)
• Vitamin D (25-OH)
• Homocysteine
• HbA1c

Toxicology and environmental:

• Heavy metals panel (mercury, lead, arsenic, cadmium — provoked or unprovoked depending on clinical suspicion)
• Oxidative stress markers (glutathione, SOD, lipid peroxides)

Functional markers:

• Organic acids test (urinary metabolites reflecting mitochondrial function, neurotransmitter metabolism, gut dysbiosis, yeast overgrowth)
• Methylation markers (if not already available)
• Zonulin (intestinal permeability marker)

This panel typically encompasses 80-120 individual parameters. It is substantially more comprehensive than what most physicians order, and it is designed to identify the root causes of your condition rather than simply confirming a diagnostic label.

Blood draw logistics: The blood draw itself takes 15-20 minutes and requires 15-20 tubes of blood. Some patients are surprised by the number of tubes, but the volume drawn is well within safe limits (typically 100-150 mL total — far less than a standard blood donation of 450 mL).

What Happens After the Consultation

Lab Results Review (24-48 Hours)

Standard laboratory panels return within 24-48 hours. Specialized testing (ELISpot/LTT for tick-borne infections, organic acids, certain immune function tests) may take 5-7 business days.

As results come in, I review them in the context of your clinical history and examination findings. I look for patterns — not just abnormal values, but the relationships between values that reveal the underlying pathophysiology.

Examples of patterns we look for:

• Low NK cell function combined with positive EBV EA-D IgG — suggesting active viral reactivation with impaired viral surveillance
• Elevated fibrinogen and D-dimer with positive Borrelia ELISpot — indicating active Lyme with coagulopathy that may benefit from apheresis
• Low free T3 with normal TSH and elevated reverse T3 — suggesting thyroid conversion dysfunction rather than primary hypothyroidism, commonly seen in chronic infection
• Depleted glutathione with elevated lipid peroxides — indicating oxidative stress that needs to be addressed before or alongside antimicrobial therapy
• Positive Bartonella LTT with neuropsychiatric symptoms — suggesting Bartonella as a primary driver of neurological complaints, which changes the antimicrobial strategy

Treatment Plan Design (Within 48 Hours of Results)

Once all critical results are available, we design your individualized treatment plan. This is a written document that includes:

• Diagnosis and assessment: A clear summary of our findings, including primary and contributing diagnoses
• Treatment protocol: Which therapies, in what order, at what intensity, and over what timeline
• Rationale: Why we have chosen each component of the plan — what it targets and what we expect it to achieve
• Monitoring plan: What we will track during treatment to assess response
• Estimated duration and cost: How long the treatment will take and what it will cost
• Risks and alternatives: Honest discussion of potential side effects and what options exist if the primary plan does not achieve the desired results

You review this plan with your treating physician, ask questions, and give informed consent before any treatment begins.

For Telemedicine Patients

If your initial consultation is conducted via telemedicine (which it is for most international patients during the planning phase), the structure is identical, but the logistics differ:

• We send you a laboratory order list, and you complete the blood work at a laboratory near your home
• Results are sent to us electronically
• The treatment plan discussion happens via a second telemedicine call once results are available
• Physical examination is deferred to your first in-person day at the hospital

This approach means that by the time you arrive in Germany, we already have a clear picture of your condition and a treatment plan ready to begin. Your first in-person day is spent confirming findings, completing any additional assessments, and starting treatment — rather than waiting for lab results.

Clinical Perspective — Julian Douwes M.D. The consultation is where medicine begins, not the procedure room. I have seen patients arrive at our hospital with years of suffering who had never been asked about their dental history, their mold exposure, or the antibiotic course they received fifteen years ago that preceded a decline in their gut health. These details matter. They are not curiosities — they are diagnostic clues that change treatment decisions. When I spend 90 minutes with a new patient, I am not being thorough for the sake of appearances. I am building the picture that allows me to treat the person in front of me rather than just the diagnosis written on their referral letter. The laboratory work we order is extensive because chronic illness is complex, and you cannot treat what you have not measured. Every parameter we test is there because it has changed a treatment decision for a previous patient.

Key Takeaways

• Your first consultation is a 60-90 minute comprehensive assessment — far more detailed than a standard medical appointment
• We ask about your full medical biography, not just your current symptoms, because chronic illness has roots in factors most physicians do not evaluate
• The laboratory panel covers 80-120 parameters across infection, immune function, inflammation, endocrine, metabolic, environmental, and functional domains
• Results are integrated with your clinical history and examination to build a personalized treatment plan within 48 hours
• The treatment plan is a written document including diagnosis, protocol, rationale, monitoring plan, timeline, and costs
• Telemedicine patients complete labs locally before the consultation, so treatment can begin promptly upon arrival in Germany
• Prepare for your consultation by organizing your medical records, writing a treatment timeline, documenting current symptoms by severity, and bringing written questions

References

1. Nicolson GL. Chronic bacterial and viral infections in neurodegenerative and neurobehavioral diseases. Lab Med. 2008;39(5):291-299.
2. Stricker RB, Johnson L. Lyme disease: the next decade. Infect Drug Resist. 2011;4:1-9. PMID: 21694904.
3. Beaulieu-Jones BK, Finlayson SG, Yuan W, et al. Examining the use of real-world evidence in the regulatory process. Clin Pharmacol Ther. 2020;107(4):843-852. PMID: 31562770.