What most functional medicine doctors and clinics get wrong

And how to get it right

"Listen to your patient, he is telling you the diagnosis."

- William Osler

What most functional medicine doctors and clinics get wrong is a lack of attention to the fundamentals. My last post in this series (entitled, “What You Need to Know About Functional Medicine”) was, “The Biggest Mistake Patients Make When It Comes to Functional Medicine.”

What is fundamental to medicine? First, that, as we are the sum of our habits, our actions make all the difference. Second, that you are therefore sick as result of some combination of things that you keep doing over and over again, whether or not you realize it.

All of this comes down to taking a good and thorough history of the patient's illness.

Yet to take a good history, you need - more than anything - time.

The famous allergist, Theron Randolph, MD, PhD, was once presented with a difficult case. He couldn't figure out why his patient had gotten sick. So he sat for hours and hours on end, typing away at his typewriter, listening to the patient until, finally, she recalled an episode of petrochemical exposure that triggered here symptoms.

He had found her root cause. He went on to pioneer what became known as Clinical Ecology, which is now more widely known as Environmental Medicine.

Regardless, it took him a lot of time to get to the bottom of what ailed her.

The easy thing to do when presented with a sick patient is to order a bunch of basic tests to make sure they are not dying literally at this very moment, give them a few prescriptions to numb the pain, reassure them that everything will be fine, and tell them to come back in 3 months for a check up.

This reverses exactly 0% of modern diseases.

I am not willing to sit back and watch disease take over someone’s life. I want to galvanize them to take action to live life to the fullest, and to keep death as far from them as is possible.

What I found when I had more time with my patients, was that I needed less and less medicine, and less and less lab testing.

What I found out, from my patients, was that most functional medicine practices were offering quick initial consults, quick follow up consults, and in between a lot of very expensive lab testing and supplements.

What doctors and clinics realize is that it is hard to justify the expense of a physician's time. Patients want to minimize that cost, because it can add up so quickly, particularly on top of things like supplements, IVs, hyperbaric oxygen treatments, and the like.

Most functional medicine clinics right now are running at a brisk pace, where physicians and staff have very, very little time to just sit and THINK.

I THINK about my cases. The more my patient is struggling, the more I am thinking about them. I don't charge my patients for the time I spend ruminating on their cases, because I think that would be silly. I don't know how I could possibly keep track of that honestly.

What would the invoice look like?

Wondering if _____ will fix your ______ over my morning coffee - 5 minutes, $40.00

Sudden inspiration to send you a new protocol or add another supplement to your current regimen - 1 minute, $8.00

That would be immensely silly.

But I can only take the time to think about my cases because I charge a premium for my time. And I have to admit, it gets my patients much, much better outcomes.

The truth is, getting good results requires actual creativity. You can't just hand everyone the same plan and tell them to execute it. They just don't get the same results as if you personalize and tailor it to them.

What I realized, after working with my strength coach Jim Laird, is that people need a lot of coaching to get really great results. They need coaching on how they move, how they breath, how they eat, how they think, how they sleep, and everything in between.

What most functional medicine doctors and clinics get wrong is this vital component of good results - time.

Many, many patients have come to me with labs that someone else had drawn, and I give them a far, far more complete answer as to what is wrong with them than they had previously.

I know exactly what it's like to not have time. I hated the old model I worked with. I charged less, so I couldn't take as much time. And it left my patients wanting more from me than I could afford to give of myself.

The funny thing about spending more and more time with patients, is that you see how little you need all the other bells, whistles, and expensive accessories of modern functional medicine.

Don't get me wrong - ozone, hyperbarics, IV therapy, and so on - all have a place, but I don't use them in my day to day practice. And I get startlingly good results, just by getting people to engage in the fundamentals. In fact, I frequently have people coming to me who are using all of those expensive therapies on a weekly or monthly basis, and we get them so much better that they don't need those things at all.

All because I know how to leverage my time to get people out of their problems. I cannot guarantee such results, but they are consistently dependent NOT on fancy, expensive therapies, but upon counseling the patient in the fundamentals.

What's the bottom line? You don't need fancy this or that to get well, you need a smart doctor who can get you into the diet and lifestyle that are right for you. You need a coach like Jim Laird to help you figure out how you're moving, breathing, and living in a way that is undermining your health, rather than building it up.

That's why the backbone of what I do is a combination of medicine (that's me) and coaching (that's Jim). Since we started working together, our results have gotten much, much better.

If you're paying a lot of money for practitioner time, but not seeing any results (particularly over months of treatment) then I've got some uncomfortable news for you. You probably don't have the right practitioner for you. They are probably great for someone else, but you have probably exhausted what they know to use to help you.

Don't be too hard on practitioners whose knowledge you exhaust. None of us knows everything, and we therefore cannot possibly be all things to all people. I think good practitioners will know when enough is a enough, and a referral to someone else, who will take a different approach, is in order. There are times when I contact other physicians who are experts in fields that I am not an expert in, to get their input on a case. For example, I might call a homeopath, an herbalist, a cardiologist, or a psychiatrist for advice on a case. Sometimes, I refer my patients to my colleagues, whether or not they continue working with me in any capacity. If I think someone needs to see one of my colleagues first, before working with me, then I am ready to refer them.

I don't want to work with people who need someone or something else first, before engaging with my services. Good doctors do not try to do everything themselves. This is a recipe for burnout and bad outcomes.

Don't get stuck in the mindset of thinking that the answer to your problems is in a bottle, bag, or box. It's in the mind of the right practitioner. You just have to find them. It will certainly incorporate things you get in bottles, bags, and boxes, but it starts with the right plan, and the right plan requires careful consideration.

Next, we're going to talk about why functional medicine is so expensive.

Until next time, be well,

Dr. Stillman