For Docs: How do you “do” Functional Medicine?

OK, Functional Medicine colleagues (especially those who are fairly new to the game)…. this one’s for you.

I know it’s been a while since I’ve written anything new, but I promise that I haven’t abandoned this blog.  Life has just been very busy over the past few months and Ferris Bueller is right: it does move pretty fast.

I received a phone call from a colleague, former classmate, and good friend who has just joined up with a small clinic and is now beginning to offer Functional Medicine services.  She, like several other colleagues before her, asked me what I do for Functional Medicine patients.

Ah, yes – the familiar conundrums.  How do I market Functional Medicine?  How to attract Functional Medicine patients?  How to convince them to get the testing and help they need?  How to successfully encourage them to comply with drastic dietary changes and comprehensive supplementation regimens?  How to get them to keep regular visits?

What most doctors new to Functional Medicine don’t realize right away is, there are even more important questions than the ones I listed.  These deeper questions will answer those above.  Those include, how do I screen patients?  How do I select those who are a good fit?  How do I educate properly and when do I educate?  How do I communicate properly?  Where does my headspace need to be as a doctor?  How do my services fit into the grand scheme of the healthcare landscape and what is my value?

The second set of questions is more difficult to answer, but when you reach those answers, they also resolve the issues from the first question set.

Let’s tackle the most important issue first: headspace.  Headspace is the type of issue that will sneak up on you if you’re not aware of it, and it will continually sabotage your efforts until you develop it.  You must operate from a position of confidence, even if you’re new at the game.  You might be new to Functional Medicine, but you’re not stupid.  You know more than you think.  You sat through umpteen million years of school, took eleventy-billion exams, graduated with a degree and a license, and now you hold the title of “Doctor”.  During those dozens of classes, you learned a ton of information; use what you know.  You can (and will) expand and develop this reservoir of information with time.

Personally, my headspace came from the fact that there are fewer than 1,000 doctors practicing Functional Medicine.  And of those, a small percentage are actually practicing Functional Medicine properly.  Others may claim to (and some genuinely believe s0), but when you examine their methods more closely, you’ll easily see that they’re not.  Keep in mind that everybody in this field seems to talk a big game.  This will either come in the form of the business aspect (“I just closed a hypothyroid case for ten grand–up front!”) to the academic/clinical (functional enzyme blocks, heavy metal exposure, free radical load, exotic antibodies, genetic polymorphisms, etc), but when people puff up their peacock feathers, that’s all it is: a game.

The best way to develop a comfortable headspace is to LEARN your information.  There is no “faking it till you make it” in this field.  You either know how to get sick people well or you don’t.  Patients are highly variable individuals, often completely unpredictable.  Things hardly ever go as planned – an unanticipated reaction to a supplement, an underlying disease process that you didn’t run lab tests for, or a false negative on a lab test can all throw a monkey wrench into the patient’s progress.  The more you know, the more you can help them (and yourself) out of the jam.

Once you know your info, do your footwork – research which textbooks you want to keep by your side, which labs (and which individual test panels) you’re going to use, and which supplement companies you’re going to purchase from.  Make your choices and open your accounts carefully; it’s your reputation and not all labs and supplement companies are created equal.

Then, do more footwork.  Visit your friendly neighboring competition.  Start with their websites, then see if you can visit their clinic.  Many hold after-hours events, classes, workshops, etc in their clinic.  If you can, make friends on the inside.  You’ll quickly get an idea of how your competition practices.  For me, this was a massive confidence-booster; I offer The Most complete patient care in my entire city, outpacing the other bigwigs in my area in terms of quality and comprehensiveness of care.  I know that if a patient complains that I’m too expensive, they can go to any one of my competitors and spend (usually) less (but sometimes even MORE) and get a lower quality of care.  This puts me in a favorable position of, “sign up or don’t sign up, it’s your health.”  I know this sounds crass.  In practice, I’m not nearly this crass.  But I AM finished coddling people who hem and haw about making the investment.  I’m also done trying to convince them.  In most cases, it’s a lost cause: they’re either ready or they’re not.  If they’re not, there isn’t usually too much you can do to sway their opinion.

So, headspace is crucial.  Once that hurdle is strengthened and solidified and you are now comfortable in your shoes, everything else (the answers to all those other questions) can now spring forth, and with much less internal wrangling.

The next most important concept to master is pre-education.  You begin to lay the foundation for a good relationship with a compliant patient and a successful case outcome even before they schedule the first appointment.  This involves telling the world what you do and more importantly, how you’re different.  You also want to paint a picture of not only optimism (there’s a whole new avenue of uncharted territory and thus, hope!) but also reality.  Pre-education involves telling it like it is, not sugarcoating anything or making promises in the sky.  Patients must know what they’re getting into when they agree to start your program, such as drastic dietary modifications, swallowing lots of capsules, or making major lifestyle overhauls.  They must also know that changes don’t happen overnight and that they may need to make long-term or even permanent changes.

It is during this time that you select your cases.  Yes, this means picking and choosing who you want to work with.  You’re essentially screening them.  This does two things: 1) it lets patients know that you don’t just take everybody who walks in.  When you hand-pick your patients, those patients are special, and part of something semi-exclusive.  These patients “get” to work with you.  2) This also allows you to give yourself permission to NOT take a patient who would end up being more effort than they’re worth.  Some just aren’t worth the headache.  They won’t do anything you tell them to, and when they don’t get better, they blame you and start complaining about costs, especially in the face of a lack of results.  No, thank you; that patient can go complain to their in-network conventional family doctor.

The pre-education sets the stage and piques the patient’s interest.  The first several visits lay a further foundation, during which trust is built and commitments are made.  First impressions are huge here.  It’s a good idea to start off getting a feel for how much the patient already knows about Functional Medicine.  This way, you can avoid boring them with information they already know, and you can also correct any misconceptions they may have.  You can also expand upon their basic knowledge and grab the opportunity to sell Functional Medicine a little.

In subsequent visits, you’ll need to periodically (or continuously) reiterate the importance, relevance, and purpose of what you’re doing.  If the patient is on 15 supplements for 3-4 different problems, you’ll need to work that into the conversation (“…which is what the flax oil does; your brain literally runs on the stuff and when the brain runs well, it can run the rest of the body well.”)

Speaking of explanations – keep it simple.  Throw around the big doctorly words every so often, but then explain what they mean.  “You have tachycardia, Jane, which simply means a fast heartbeat.”  Or, “you have adrenal fatigue, which means your adrenal glands have gotten worn out from all these years of stress.”  Use analogies.  I like to use comparisons involving cars, lawns, and other things everybody has some experience with.  Use simple language along with the big words.  Use basic explanations instead of long, drawn-out PhD-level lectures.  You can talk about the frequency of firing or neurological wind-up in the nervous system; I’d stay away from NMDA receptor excitotoxicity.  (Talk about it, sure, but in simpler terms.)

Once you have your headspace intact, your screening methods down pat, and your communication skills polished, it becomes a lot easier to market Functional Medicine, explain what you think may be going on, and convince patients to confirm or rule out the possible problems with lab testing.  Always relate your recommendations back to the underlying dysfunctions you’re trying to uncover, and always relate those dysfunctions back to the symptoms they’re experiencing.  Remember that you’re not offering them a breakthrough treatment method using state-of-the-art lab testing and dynamite medical-grade supplementation; you’re offering them a possible solution to their problem–a solution that is permanent, livable, scientific, natural, and research-supported.  They need to know that this approach addresses the true source of the imbalance and the true cause of their problem.  They also need to know that it is the only approach that fits the bill and gives them what they want….which is the beauty of Functional Medicine that, once the word gets out, allows Functional Medicine to market ITSELF.

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