The following is a guest post by Dr. Bojan Kostevski.

Are you recommending your clients to stop eating grains, to stay away from dairy or drink tons of water? Better yet, are you recommending they do anything without FULLY UNDERSTANDING all angles of your recommendation?  STOP - right away! By giving medical advice you might be hurting clients, wasting money, and risking your credibility!

An inter-professional network is important,  as is knowing your limitations and when to refer out to a physician. Most importantly, I'll show you how to communicate to keep the consultation effective and efficient. By knowing the system of communication that doctors prefer you can encourage communication and will get more referrals out of it.

Networking

The inter-professional network between those working in preventive medicine, and general health (personal trainers), and those working with disease treatment, is what's lacking in modern health care. So how can you, as a personal trainer, build up that network?

You need to be innovative and find your own system to build a professional network since no fixed systems exists. Be creative: write a list of professional categories you want to include and contact people who might be interested.

Working with people, we're dealing with complex biological systems. And just as important as it is to be competent in your area of expertise, it's important to understand your limitations and know who to contact when you reach them. There's no shame in asking.

What is a shame is giving half-assed advice because you're afraid of looking incompetent, even if you have the best interest in enriching your client's lives.  If I've learned one thing from my clinical experience it's how much patients appreciate the answer "I don't know, but I know someone who can help you figure it out. Let me get back to you".

Find people from a range of professions to include in your network. Make sure they're OK with you consulting them when you need to, and vice versa. Keep a list of contacts in your phone. By analyzing your own area of expertise and deciding where your limits are, you will know who to contact and when. It'll show your clients that you really care, improve your knowledge in fields outside of your expertise, and save you time and money.

When should you consider contacting a doctor?

You should contact a doctor for advice or discussion if referring out is necessary. For instance, contact a doc when a client has a medical condition that might limit their work capacity, or jeopardize the safety of the workout.

Don't give advice on cutting out foods when you suspect intolerance - it's not your area of expertise and you might be restricting your client's life based on guesses and personal beliefs.  The tips I see being thrown at clients from personal trainers could even be directly harmful!

Other reasons to consult a doctor includes abnormal weight changes (there could be a medical reason you're client just won't lose fat or is gaining weight in an abnormal rate), when you suspect an undiagnosed eating disorder, when the client experiences abnormal pain, recurring viral infections or when, for any reason, you get that dull feeling deep down in your stomach that something is wrong. Trust your instincts!

You spend more time training your client than I, as a doctor, consult them. That's something we need to take advantage of if we want our patients and clients to stay strong, healthy and good looking.  Give "your" doc a call or refer the client to a medical professional - it's always better to be safe than sorry.

Building communication skills

If you find yourself in the position where you want to consult a doctor, there's a few guidelines to use that'll save you time and money.  Whenever you consult another professional, use the SBAR algorithm:

Situation Background Assessment Recommendation (SBAR) is a standardized way of communicating among healthcare practitioners. Originally developed by the US Navy as a communication technique that could be used on nuclear submarines, the system is today the golden standard in many healthcare organizations.

The SBAR system helps you identify the important points of a situation, organize relevant information and present it to others in a quick but coherent way. In a situation where you, as a personal trainer, need to communicate with a doctor for a fast consultation, I find this system invaluable. It gives the consultation a structure that both are familiar with.

Example of a trainer consulting a doctor using the SBAR system

Introduction: Hey dude, hope everything is well. I've a trainee here that I need to discuss with you. Do you have a minute?

Situation: (Describe the current problem and why you are calling.) My trainee Angela has chest discomfort when I put her on any kind of cardio or high intensity lifting.

Background: (Give a brief background of the client.) Angela, who's 52 years old, came asking to lose weight. She has type 2 diabetes and went through cardiac surgery a few years ago. She also has asthma, but is otherwise healthy and active. She has been overweight most of her life. I've put her on a calorie deficit diet and prescribed 2 heavy full body strength training programs and 2 interval cardio sessions on non-strength training days. She works out a total of 4 days/week and the first couple of weeks we've used low intensities to prepare her body. Her discomfort started when I wanted to ramp up the intensity.

Assessment: (Give your assessment of the situation.) Exercising at low intensities is ok but when we try to do some high intensity stuff such as interval training or full body movements, she has a dull discomfort in her chest. The pain subsides after a few minutes of rest. I think what she feels is the "normal" chest pain one might experience with high intensity exercise, but I'm not sure. I thought I'd better contact you and get your thoughts.

Recommendation: (What do you recommend to do next?) I think she should come over to your clinic so you can exclude anything related to her old heart issues or make sure there isn't something else hindering her from exercising safety.

Conclusions

There is a missing link between trainers and healthcare workers. I've observed the result of this misfortune: trainers and doctors sometimes giving advice outside of their expertise. This is a lose-lose situation for all parts. From the trainer's perspective, the problem is that the client might do an activity that could be harmful to them and you risk credibility by giving advice outside of your expertise.

The points below are practical takeaways and steps you need to take RIGHT NOW to prepare you for situations like this. You've no time to lose. It's about time we stop the second guessing and bash-talking other professionals, and start seeking solutions and help each other out.

1. Analyze your own competence, define your limits. You have no professional scope (regulation doesn't exist) but you have a responsibility.

2. Think about what other professional categories might complement your area of expertise. Build an inter-professional network.

3. When uncertain about your client's health status, contact a doctor. Remember why, how and when to contact a doctor. NEVER stretch you own area of expertise or second guess - even if they are qualified.

4.When presenting a patient, use the Situation Background Assessment Recommendation (SBAR) system. It will save you time and money.