What to bring to a first appointment

Something recurring happens in a first consultation: half the time goes into assembling information that could have arrived ready. A test done six months ago sitting in a drawer at home, a medication whose name is not quite remembered, and a supplement taken daily that nobody counted as a medicine.

This article is a practical list, and there is a reason behind every item on it.

The first thing Dr Rana says to anybody coming for the first time: "Don't worry. You are not sitting an exam, and nobody is asking you to put together a whole file before you come. But there are a few things that, if you have them, will help me understand your case faster and more accurately."

And that is the principle the whole list runs on: I need real information, not perfect answers.

What actually happens in a first consultation

A serious nutritional assessment is not the question "what do you eat?". It is the assembly of a picture: medical history, medications, lab results if they exist, the shape of the day, the history of previous attempts, and preferences and budget.

The American Diabetes Association, in its annual Standards of Care, describes a comprehensive medical evaluation as the foundation of any plan, and places medication review inside it as an integral part. And the European Society for Clinical Nutrition and Metabolism (ESPEN) has a guideline devoted to the definitions and terminology of clinical nutrition, in which assessment is a distinct step preceding intervention.

So what you bring is not paperwork — it is the raw material the plan is built from.

First: medications and supplements, all of them

Write down or photograph everything taken regularly. Prescribed medicines, medicines taken without a prescription, vitamins, supplements, herbal preparations.

This is the most important item on the whole list, for two reasons.

The first is that some medications affect food and weight directly: they change appetite, or affect the absorption of particular nutrients, or have timings tied to meals. NICE, in its guidance on medicines optimisation, recommends reconciling the medication list at any transition of care — which simply means that the new person seeing you needs to know exactly what you are taking.

The second reason is more subtle and surprises a great many people: some supplements affect the test results themselves.

A supplement can change a test result — a real example

Biotin, sold in pharmacies as a hair and nail supplement at high doses, can interfere with certain kinds of blood test that use a particular assay technique — including thyroid tests.

The United States Food and Drug Administration issued a safety communication about this interference, because an affected result can be read as a thyroid problem that does not exist — or can conceal one that does.

And this supplement in particular is not thought of as a medicine by anybody. It is "a vitamin for hair", bought without a prescription, and forgotten when the list is made.

The point is not that anybody should be alarmed about her supplements. The point is that they should be mentioned, so that whoever reads the result knows.

Her request here is specific: "If you are taking any medication or supplements, I need to know their names and the doses you are taking."

And why a supplement is not "a small thing"

There is a common belief that the worst a supplement can do is nothing. That is not accurate.

Vitamins A, D, E and K are fat-soluble, which means the body stores them rather than clearing the excess in urine as it does with the water-soluble ones. That difference matters: a sustained excess of this kind accumulates over time.

There are interactions between supplements themselves. Calcium uses the same absorption pathways as iron and competes with it, so a calcium supplement taken with an iron supplement reduces the benefit of both. Zinc and copper compete in the same way.

And there are interactions between supplements and medicines. The best-known example is vitamin K and anticoagulants, because that medication acts on precisely the same pathway.

Despite all of which, supplements in Egypt are sold without prescription, taken on the advice of a relative or an advertisement, and continued for long periods. None of that is necessarily a problem — but all of it needs to be known.

Second: the paper

Every test, scan or report from at least the past year, even if somebody said it was fine.

The reason is that one result describes a moment and two results describe a direction. A number at the low edge that has fallen from a higher one last year is one thing; the same number steady for three years is something else entirely — and they look identical on a single page.

A photograph on your phone is fine. The original is not needed.

And if there is a chronic diagnosis — diabetes, blood pressure, thyroid, bowel, polycystic ovary syndrome, coeliac disease — bring the most recent report on it.

And if the tests were done at different laboratories, say so as well. Reference ranges differ between laboratories according to the instrument and the method, so comparing a number from one with a number from another needs care.

Third: a real day of eating

Dr Rana says this is sometimes worth more than a great deal of paper: "That you can remember what your eating is actually like. Not the ideal day where you try to eat well — I want to know your ordinary day."

The questions she asks:

Do you have breakfast or not? And when is your first meal?

What do you eat at work?

When do you get hungry?

How much are you drinking?

How often do you order food in?

And what happens at the end of the day?

"And if you can write down simply, two or three days before the session, what you ate and drank and when, that helps a great deal. And you don't need to change your eating so it looks good in front of me — I need to see the normal in order to be able to help you."

Write down two or three days of food before the appointment, roughly hour by hour.

And the essential condition: an ordinary day, not an ideal one. An ideal day produces a plan for a person who does not exist.

Write down the things that do not usually get counted as food, too: tea with sugar, juices, fizzy drinks, the mouthful taken while cooking, and food at work.

Fourth: the history of what you have already tried

What was tried, what worked, what stopped, and why it stopped.

This is the information that saves months. A plan resembling something that did not work before will stop in the same way, and knowing why it stopped changes the design from the first day.

And if an attempt stopped because of a symptom — dizziness, headache, constipation, constant hunger, a drop in energy — that in particular should be said. The symptom is clinical information, not a complaint.

Fifth: your questions, written down

Questions get forgotten in a consultation. Put them on paper or in your phone.

And if the sentence that brought you here was "sort your diet out" with no detail, there is an article on what it means: what that sentence actually means.

Sixth: the circumstances that shape your day

These look like personal details and are in fact what decides whether a plan works.

Working hours, and whether there are shifts. Somebody on night shifts does not get the plan that assumes sleeping at night and breakfast in the morning.

Who cooks at home, and when food is prepared. If cooking happens once a week, the plan has to deal with that.

Budget, honestly. A plan that assumes money that is not there will stop within a fortnight, and the problem will be read as a failure of commitment.

Is there somebody else in the house with a chronic condition or a particular diet? One meal for the whole family means the plan has to work inside the pot that already exists.

And is there travel or an occasion coming? Ramadan, a feast, a wedding, exams, a work trip. Those weeks arrive regardless, and a plan that knows they are coming is better than one taken by surprise.

That is the whole list. If you have those things, you can book an appointment now and bring them with you.

What you do not need to bring

So that the list does not become a burden:

You do not need to have new tests done before the visit. What is needed will be decided after the consultation, and a test done without a reason costs money and produces numbers nobody will use.

You do not need to come fasting unless somebody has specifically told you to.

You do not need to tidy up your eating in the week before the appointment. This is the most common thing people do, and it is counterproductive: the day described will not be the real day, and the plan will be built on wrong information. An ordinary week is exactly what is wanted.

And you do not need to memorise anything. If you cannot remember the name of a medicine, photograph the box.

In her own words: "You don't need to go and order a big panel of tests yourself just because you have a nutrition appointment. And you don't need to bring every diet you have ever tried, or photographs of every meal you have eaten in the past month.

And if you have very old results, we can look at them if they relate to your medical history — but we are not going to build a current decision on old numbers without first seeing whether they are still useful for the case."

And one last thing, the most important on this list: "Don't bring with you the feeling that you have to prove to me that you were 'good', or explain why your weight went up."

The myth: "they will work it all out from the examination"

This assumes that a clinical examination substitutes for a history. It does not, and nobody has ever claimed it does.

An examination gives important information, but a great deal does not appear in it: a medication taken for a year, a test done last month, a previous attempt that stopped because of a particular symptom, a job that makes a midday meal impossible. That information exists nowhere except with you.

The myth spreads because it transfers all responsibility to the other party, which is comfortable. The result is a plan built on half the information.

In the Egyptian context

Here, paper is genuinely paper. There is no unified electronic record travelling with the patient, so what is in the bag is all there is. That is worth saying plainly: keep the paperwork, photograph it, and put it in a folder on your phone.

And pharmacies here dispense a great deal without a prescription, including vitamins, supplements and sometimes medicines. These get taken for long periods and do not get counted. Write them down.

Family is part of the picture. Who cooks, the budget, one meal for everybody, and mealtimes tied to other people's schedules — all of it changes the plan, and saying so in the consultation saves a great many adjustments later.

And if the appointment falls in Ramadan or near it, say so. The shape of the day changes completely, and a plan written for a different shape of day will not work.

And if you arrive with nothing at all?

"We have the session exactly as normal. We start by talking, and I ask you about your medical history, your eating, your sleep, your activity, your daily routine, what you have tried before, and what you are hoping to reach.

And if it turns out during the assessment that there is a test or a piece of medical information we need, then we decide exactly what is required and deal with it properly — rather than you doing random tests before the session.

So if you have important paperwork, bring it. And if you don't, don't put off the appointment because of it."

One last practical thing: if you can, bring somebody with you, or record the conversation if the other party agrees. A consultation carries a lot of information said quickly, and memory afterwards is not at its best — particularly when the subject is one you are anxious about.

Worth remembering

A first consultation builds a plan on the information available inside it. Information that is not there does not count, and the plan bends by however much is missing.

All the medications and supplements, all the paper, two real days of eating, the history of attempts, and your questions. Five things, and you already have all of them.

If you are ready, you can book an appointment. And if you have results you are unsure about, that is exactly what a lab review is for.

And if you are still deciding: there is an article on the sentence that probably brought you here — what "sort your diet out" actually means — and another on the difference between a ready-made table and actually being followed: a downloadable plan and an individual one.

And the sentence worth keeping: the most important thing to bring to a first session is an honest picture of your life. Because the point of a first session is not for me to produce the fastest possible diet sheet — it is for me to understand you first, and then we work out which plan will actually work for you.