While growing in popularity, functional medicine remains an unfamiliar area of medicine for most. This seems especially true down here in Kentucky compared to my experience in Indiana. Dr. Hymen, the father of functional medicine claims, "functional medicine is the future of conventional medicine," yet, in many ways, functional medicine is traditional medicine.
Functional medicine seeks to identify and address the root cause of disease and views the body as one integrated system, rather than a collection of independent organs divided up among various medical specialists. Conventional medicine practitioners see disease in a more narrow tunnel, very specific to their own speciality. Functional-minded clinicians treat the whole system, the entire person, not just the symptoms.
The underlying phenomenon that is occurring across medical specialities is that inflammation, or the oxidative stress that impacts all systems, or maybe better described as the consequence of toxic exposure and energy problems with the mitochondria in the cells is setting the stage for dysfunction and dis-ease. These are the focus of fundamental medicine. It is these nuances within health and wellness, that we ultimately dig into, becoming the bridge connecting all systems so that the root issue can be resolved.
Functional Medicine Gets into the Roots of Dis-ease
The difference between conventional medicine and functional medicine is possibly more in the details. Consider that when visiting a conventional medicine doctor, when one has an autoimmune disease, a common approach for the modern physician is to provide medications that would suppress the immune response, right? This is how we treat arthritis and asthma. What we don't do in standard practice is identify what the cause of the inflammation is in the first place.
At its core, functional medicine is about digging into the #roots of dis-ease. We care less about the label, or diagnosis a client comes to us for, and more about what caused the body to fall into dis-ease in the first place. What are the triggers, allergens, toxins, stresses, lack of movement or poor diet causing dis-ease? Functional-minded clinicians see each symptom as a signal from the body. Where symptoms of stroke alarm the conventional medicine clinician, symptoms such as constipation and insomnia alarm the functional medicine practitioner.
Conventional medicine providers await the presence of disease for treatment, and functional medicine clinicians work towards optimal health. When treating thyroid disease for example, conventional medicine clinicians typically give either a pharmaceutical or remove part of the thyroid, but as a functional medicine clinician, I see this no different than pulling the battery out of your smoke alarm and pretending there is no fire now that the alarm has been silenced. Whatever ailed the thyroid will soon cascade to yet another issue; most often we see this as diabetes.
Conventional medicine works well for those experiencing acute #trauma, but it hasn't improved chronic disease and in many scenarios, clients are much sicker and certainly, more miserable. Pharmaceuticals have become the mainstay of "sickcare" and "death by doctor" is now the third leading cause of mortality. Functional medicine providers certainly can address chronic disease through current pharmaceutical regimens, but our ultimate goal is to identify the underlying trigger of dis-ease and to work towards correcting the core issues.
Consider how you might care for your houseplant with droopy and browning leaves. You wouldn't apply medicine to the leaves. Rather, you recognize an underlying issue is how we fix these issues in the plant, so you consider infestation in the soil or insufficient water as the cause. Maybe you suspect there is greater need for sunlight or maybe even specific mineral deficiencies. Today's physicians aren't thinking beyond the leaves presenting with symptoms, which is the result of the mass profits created from the medications utilized to treat these symptoms. Fixing the real issue at the root doesn't offer a great deal of profit, because this is largely about addressing lifestyle behaviors. It may mean evaluating sleep dysfunction, toxic relationships, food intolerances, or lack of sufficient movement. Where are the billions to be profited in these industries?
Functional medicine practitioners create personalized programs following many hours of investment specific to each individual client. We don't diagnose and prescribe based on routine and protocol, shuffling clients through a revolving door. Our goal is not processing the highest number of patients in effort to gain greater reimbursement; in fact, we recognize that today's "health insurance" isn't set up with the intention of achieving optimal health. Rather, it is specific to "sick insurance." It covers quick fixes or life-saving procedures, but certainly not whole person healing. If you want healthcare, you have to invest in this on your own.
Sustainable Practice Model
Functional medicine practitioners are essentially all cash-based. Why? You are our client, not our patient. A cash-based model is also the only way we can remain true to our practice and simultaneously sustainable. The current "healthcare system" is based on identifying high-return diagnoses and the accompanying procedure codes with the quickest turn overs.
An average physician consultation is a mere six minutes and this includes your offering your concerns and thoughts on whatever ailment brings you to the doctor, their conclusion creating their diagnosis, and a treatment plan which consists of the appropriate pharmaceutical and education necessary for you to comply with their plan. Six minutes. Physicians can see anywhere from twenty or thirty clients per day, even forty or more in specialty clinics. They don't get paid the same if they sit and listen to a more detailed history or if they gain a personal timeline. They also don't get paid more if they manage one diagnosis verses twelve in any particularly client visit, so you are likely to get short, brief talking points and sent out the door, only to return again with additional concerns and questions while never identifying or correcting the underlying issue in the first place.
While many take the position that clinical visits are exceedingly expensive, consider that every person you interact with while in the office is paid from that visit fee. The provider doesn't earn the $200 office visit fee. Rather, this is split between the clinician, the nurse making triage calls, the medical assistant who evaluated your vitals, the front desk personnel who checked you in, the back office personal managing your claims, the office manager keeping everyone sane, and the housekeeper. This fee also covers overhead which is generally about half of each visit fee, so personnel wages is split among the team from only half of these office visits. In effort to earn sufficient amount to even reach minimum wage for each member of the team, multiple visits have to be completed per hour with as many as possible ordering expensive procedures. These short visits simply don't allow time for really listening and teaching. It doesn't allow time for digging into personal life habits, which really are the core issues impacting our health, which absolutely no one denies.
If providers hope to stop the cascading effects of chronic disease, they do need to really dig into all aspects of one's health and dis-ease. However, even as a functional medicine provider, it can be one thing to offer several pages of individualized wellness goals and complex treatment goals for achieving homeostasis, but it is another thing entirely to offer this in a way that is actually attainable for our clients. These pieces are vital if the goal is optimal health, but all this investment is not reimbursable.
Are You Seeking Sickcare or Healthcare?
If healthcare was really about our health, we would have gym memberships and whole food discounts. Screenings would be fully covered, but our current system doesn't care to identify early indication of disease, such as pre-diabetes. It awaits overwhelming disease, slaps a diagnosis on it, and whether you realize this or not, clinicians then quantify what they believe to be your life expectancy, and then treatment is based on that estimation. For example, those who are not diabetic are expected to have a Hemoglobin-A1c below 5.8. However, once diagnosed with diabetes, we tolerate 6.5 to 7, and if elderly or life expectancy is lower, then 7 to 8 is acceptable. Optimal health is not about what is actually healthy in conventional medicine, but rather, what is most comfortable and convenient and most importantly, covered by third party payers. This is why conventional providers don't test for pre-diabetes and help curtail that progression towards diabetes, because this would not be reimbursed. Same reason they don't test for mineral or hormone deficiency because one must be so depleted that they demonstrate overt disease before it might be covered by their insurance provider.
Sustainable functional medicine practices have largely moved to a cash-based system, which many co-oped healthcare programs do reimburse. This allows them to really invest time into their client and offer a thorough wellness program, many times complete with a comprehensive educational program. Concierge care is often associated with these practices, but not always. Not all functional medicine providers also offer primary care. Many see themselves as specialists, which is certainly appropriate. However, personally, I thoroughly enjoy primary care, most especially, because this allows me to focus on wellness before the need to address a chronic illness is even necessary. I also love building relationships with the little ones.
Our clients are offered free yoga classes throughout the month, access to our wellness course, and each are invited to our monthly book club. Hikes are scheduled throughout the year for both adults and children, and we offer a number of workshops for improving health.
This Approach Works
Six out of ten Americans have some sort of chronic disease, and four of ten have two or more conditions. Our life expectancy is dropping and our vitality - how well we are living into those latter years - is declining. Functional medicine is a holistic, client-centered, collaborative approach to healthcare. We dig into your ancestral health strategies and evaluate your environmental health, shifting the focus away from illness to preventing them in the first place, combined with a sincere focus on optimal wellness for both body and mind. We are dealing directly with the underlying cause of health issues and treating each client as a whole person, with unique needs. We incorporate health coaches, nutritionists, and other allied professionals to support our work, the journey towards wellness.
References
Bland, J. S. (2022). Functional medicine: past, present, and future. Integrative Medicine, 21(2), 22-26.
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