Sir William Osler, MD
The diagnostic process is one of collecting disparate data points, pattern recognition, and organizing the various elements into a meaningful hypothesis.
- The process begins with comprehensive listening. Your story, the evolution of your symptoms, your diet, environment, family history, and more, all are taken in to account. This is traditional Western medicine which has been forsaken by assembly-line medicine. William Osler, broadly considered to be the father of modern Western medicine said famously, “Listen to your patient. He’s telling you the diagnosis.” Comprehensive listening.
- Nutrition and diet: Your dietary patterns will be reviewed in detail. Health recovery and health maintenance must address diet. Dr. Cooke is familiar with practically all the schools of thought on diet and will do her best to steer you toward a diet prescription appropriate to your metabolic type and health goals. She holds by the old Hippocratic teaching, “Let thy food be thy medicine.”
- Environmental exposures: Your memory will be jogged by the environmental intake form. Many people are the extent to which environmental factors.
Virtual visits in the comfort of your home, office, or hotel are easily scheduled. Many people are welcoming the convenience that remote visits offer. Whether for a brief assessment of an acute issue, longer follow up visits, or even a new patient appointment, please notify the office if this is your preference.
While history is as much as 90% of the diagnosis, a comprehensive physical examination is an important complement to form a whole picture of your health profile. The doctor typically spends 90% of the initial appointment on history taking, and begins the first follow up appointment with the complete physical. As a clinical preceptor in physical diagnosis to medical students at the Columbia division of NY-Presbyterian Hospital for 22 years, Dr. Cooke has constantly honed her skills in physical examination.
Every single analyte on the standard lab reports is meaningful if you look at it within broad context. Beyond looking at reference ranges on the side of the report, representing the 95% confidence interval, one must consider optimal ranges. Dr. Cooke owes a debt of gratitude to Nicholas Abrishamian, PhD, biochemist, with whom she reviewed lab reports of dozens of patients over the course of months in 2002-2003. With a strong foundation in nutritional biochemistry, Dr. Abrishamian generously imparted many of his insights into laboratory interpretation.
Heart rate variability
Heart rate variability (HRV): Originally developed for the study of arrhythmias and syncope, members of the holistic medical community seized upon HRV more than 2 decades ago as a measure of autonomic nervous system resilience. Even an ostensibly regular heart rate and rhythm, when parsed down to milliseconds, reveals a beat to beat variability in optimal states of health and this is a good thing. As we age, all systems grow progressively fixed, rigid, and this is also reflected in the electrical conduction system of the heart. The HRV is a useful benchmark to follow as subjective improvements develop. We must look for objective correlates of subjective states in illness and health.
EKG/resting electrocardiography: This is available through the office and may be indicated depending upon your symptoms and risk factors.