Special Programmes
High-level performance medicine.
Who it serves
The chair who has not been properly examined in years. The chief executive about to carry a difficult transaction. The founder whose sleep has been shrinking as the company grows. The athlete approaching a season, or a return from injury, with a great deal riding on it.
Also, the person who is perfectly well and would like to know exactly how well, and to keep it so.
The programme
Prep is our high-level performance medicine arm: a programme of biomedical, neurophysiological and biomarker appraisal for people whose cognitive performance matters.
The body is the brain's first and most reliable witness. Blood, sleep, autonomic recovery, executive control and mood are read together, by one doctor, against the standard your work actually demands. What we find is usually small, often reversible, and very seldom visible from the inside.
The measure
Laboratory reference ranges answer one question: is this bad enough to treat? Elite performance asks a different question: is this the best this system can do? The normal medical index is set for someone who needs to get through the week, not for someone carrying a valuation or a championship.
How quietly this goes wrong is unusually well documented. Individualised markers are not in themselves specific, but changes in your own markers over time are a fantastic tool of personalised performance medicine.
The approach
Prep is a baseline, and then a rhythm. A routine assessment, then a picture from up to six sources: blood chemistry, physiology and recovery, sleep and circadian function, cognitive and emotional-control tasks, neurophysiology where it is warranted, and a considered measure of psychological strain.
Nothing on the list is exotic; what is uncommon is having all of it read together, over time, with the authority to act on and rectify it.
You are your own control. A single abnormal reading tells us little, but a drift in sleep, heart-rate variability, blood pressure, inflammatory markers and executive-task performance speaks volumes, earlier than anything else could. The trend is within you, not in the general population.
Tests and markers
| Domain | Tests and markers | Why we look |
|---|---|---|
| Blood | Full count; ferritin and iron; B12 and folate; thyroid (TSH, free T4); hs-CRP; HbA1c, fasting glucose and insulin; ApoB and lipoprotein(a) | To find what passes for stress: iron falling while haemoglobin holds, thyroid drift, insulin rising before glucose does |
| Physiology and recovery | Resting and orthostatic blood pressure; resting heart rate; heart-rate variability; body composition; VO2max; continuous glucose monitoring where indicated | A sensitive view of how well the autonomic nervous system restores itself between demands |
| Sleep and circadian rhythm | Two to four weeks of wearable data and a sleep diary; home apnoea testing or polysomnography where indicated | Sleep apnoea in a fit, driven person looks like irritability and a slow afternoon, seldom like tiredness |
| Executive control | Trail Making B; Stroop; 2-back; verbal fluency; sustained attention; working and learning memory | Repeatable tests of flexibility, inhibition and working memory, so that your own line becomes the reference |
| Neurophysiology, by invitation | ECG; task-related EEG (frontal-midline theta, P300, frontal alpha asymmetry); electrodermal activity | Adjuncts to clinical judgement, never verdicts, used only where a question warrants them |
| Strain and function | Perceived stress; mood and anxiety screens; burnout and recovery questionnaire; emotion regulation | Read alongside the clinical interview, not in place of it |
Why medical
If the quality of your mind is what you are paid for, it is an odd economy to service it only when it fails. Moreover, the mind deserves better than to have its judgement of itself left solely to itself.
Physical issues are often mistaken for cognitive ones. A coach can observe behaviour. A counsellor can hold a difficult year. Neither can examine you, order the tests, authorise them or interpret what comes back, and neither should be asked to.
Performance doctors are as at ease with a thyroid panel and a sleep study as with hearing how a mood, a drive or a certainty is behaving, and asking whether it is temperament, circumstance or biology.
Add a working familiarity with the top of the performance range and the difference becomes practical. We find the small losses that come before disease, and tell them apart from the ordinary weather of a demanding life.