In the last chapter, we saw how practicing within the ADAPT Framework—especially after working in a conventional setting—can be enormously freeing for the practitioner. The same holds true for the patient but perhaps even more so. Let’s spend some time with patients to see how the two worlds look to them.
First Impressions
Functional Medicine clinics try to create an environment that feels conducive to health and healing. As I mentioned in the last chapter, that might include soft lighting, tasteful décor, and a peaceful, quiet space with comfortable seating. It might strike a patient more as a massage therapy office or spa than a typical doctor’s office.
A patient might feel surprised by this initial impression; he’s probably used to harsh fluorescent lighting and busy waiting rooms. Often, the staff in conventional offices seems to be harried and stressed. Most of the patient’s past office visits probably took place in rooms with white walls and white ceilings; the environment typically felt sterile and a bit cold.
Plenty of Time With Doctor
After being invited into an appointment, the patient at a Functional Medicine practice leaves the restful waiting room to sit down with the clinician. The patient—let’s call him Jerome—is accustomed to feeling nervous in this moment. In past appointments, Jerome typically felt anxious as he wondered how he could describe everything that he wanted to talk about in the short time allotted. Now, there’s plenty of time for thorough conversation. He feels relieved. The clinician invites him into his office, which has a desk, a chair, and sometimes a couch. There may be a table set up to accommodate a physical exam, if necessary. Once again, Jerome is surprised; this office feels like a therapy office, not a sterile clinic.
Active vs. Passive Role
During the appointment, the clinician encourages Jerome to play an active role in his experience. The clinician begins by inviting Jerome’s opinions. What does he think is going on? Jerome may wonder why nobody’s ever asked him these questions before. He remembers one or two former doctors who encouraged him to express himself, but usually he just feels intimidated and clams up. He did once mention a treatment he had read about online to his PCP, and asked his doctor if he thought it might help, but the idea was quickly dismissed as amateur. After that, Jerome didn’t voice his ideas anymore. He didn’t want to expose his ignorance—not when his doctor seemed to know so much more than he did.
And yet, his symptoms remained. The prescriptions from his PCP hadn’t helped, so he kept researching on his own. Finally, he stumbled across information about ancestral health and Functional Medicine. He cut out processed foods and sugar, and reduced his intake of grains and dairy. This seemed to help. But when he returned to his doctor and ventured a question about Functional Medicine, the PCP was once again dismissive. “That’s not real medicine. But if you feel like you need further treatment, let’s set you up with a specialist.”
So Jerome went to the specialists. Maybe they would have the solution. If doctors were the experts, then surely specialists would be the very gatekeepers of information. But even the specialists let him down. Years after starting his pursuit of better health, after taking multiple prescriptions and keeping countless appointments, Jerome’s symptoms weren’t any better.
Eventually, Jerome finds himself in a Functional Medicine clinic, sitting on a couch, facing a very different kind of doctor. The intake form had been like nothing he’d ever completed—the questions were about far more than medical history or symptoms. They had asked about his profession and his interests, his past experiences with medical care, and what he was looking for in a healthcare practitioner. One question had asked, “What is your opinion on what has happened to your health?” The first thought that occurs to Jerome is: “I can’t believe my doctor wants to hear my opinion.”
Yet this is exactly what a Functional Medicine clinician wants to hear: we know that the key changes are going to come from the patients, so we’re eager to hear the patient’s input and ideas. Functional Medicine doesn’t work if the patient doesn’t actively participate in changing his behavior, diet, and lifestyle. We don’t want patients to feel like mere medication recipients. We want their motivated participation. In fact, one question on our clinic’s intake form asks patients to measure their motivation: “On a scale of one to ten, how committed are you to recovering your health?” We get the best results with highly motivated and committed patients who can apply our recommendations, so this is useful information.
Jerome may be wondering by now what’s going on. He had expected a brief consultation and a new sort of pill. Instead, this new doctor tells him he’s going to be expected to play a participatory role. He was used to operating under the assumption that pills alone would solve his problems. That might be true if he had an acute infectious disease, but he’s dealing with a chronic illness that requires a different kind of treatment. As they talk, Jerome realizes he now has a very different role as a patient.
Jerome’s practitioner explains the necessary shift: “Our typical modern lifestyle is at odds with our genes and biology, and that’s what’s causing your symptoms. But if you can bring your diet and lifestyle more in alignment with what we know is appropriate for us as a species, you have greater potential to address your complaints than any pill does.” By the end of the session, Jerome has learned about a system for implementing those changes and received referrals to a support team to help him do it.
Taking Responsibility for One’s Own Health
Over the course of his appointment, Jerome starts feeling empowered. The power to heal no longer rested solely in the doctor’s hands. He didn’t have to follow blindly along, taking exactly what they told him to take, without question. Now he is the primary agent in his own care. With this realization comes a new hope and a sense of validation he may not have known he was missing. Jerome had started to worry that his symptoms were a result of his own personal problems, a failure of willpower. Now he understands that chronic illness might be more a result of environmental and cultural factors. Perhaps his problems don’t stem from any personal lack but are a result of sitting at a desk for eight hours a day. Maybe it has something to do with his exposure to blue light while he watches movies on his iPad before bed. Could that be what’s keeping him awake at night?
As the Functional Medicine patient’s gaze turns from an inner sense of failure to an outward view of empowered action, he starts to think about the areas of his life that are inconsistent with his natural human template. If he can identify those, he can choose positive lifestyle changes.
He also is now better equipped to make those changes. Conventional diet plans are notoriously difficult to maintain. They may be hard to follow or unappetizing. The recommendations given to him by his new doctor, based on an ancestral diet, are somehow more satisfying. He’s not hungry all the time! What’s happening here? When Jerome asks this in a follow-up appointment, his doctor explains that the diet is geared to meet human genetic requirements, and therefore does a better job answering our cravings than other diets. Because the patient feels more satisfied with this way of eating, he can continue consistently and happily.
Jerome makes other lifestyle changes as well. Although he’s heard some of this advice before, it feels more doable with an evolutionary framework guiding him. Jerome knew he should get more exercise but after sitting at his desk for eight hours, the last thing he wanted to do was head to the gym for an hour and run on a treadmill, as a previous doctor advised. In this case, his Functional Medicine doctor helps him brainstorm ways to avoid sitting all day. “The point is not just to get exercise but also increase your non-exercise physical activity all around,” his doctor urges. Jerome develops a mixed routine where he’s standing and walking at work and sitting less. Moving more throughout the day gives him more energy to pursue high intensity activities outside of work. It’s easier to maintain consistency—especially with the check-ins from the Functional Medicine clinic—and he feels noticeably better. As a result, the new routine sticks.
Jerome finally feels like he has someone on his side. He has honestly connected with his doctor after many generous appointments filled with respectful conversations. His doctor’s advocacy and the support of a coach and allied providers make a profound difference in his determination to participate in his healing.
Allied Provider Interactions
Those allied providers are an important part of a patient’s experience in the Functional Medicine model. Let’s say a patient named Kevin comes to our clinic with rheumatoid arthritis, an autoimmune disease. The initial consult takes place with the nurse practitioner. Kevin senses he’s speaking to a professional who understands his situation and trusts she will perform a thorough and informed interview to ensure the right information is collected for determining a successful treatment.
Kevin then goes on to have his case review with the clinician. The clinician goes over the patient’s data, forms, and paperwork and prescribes a treatment plan. Especially given this patient’s autoimmune disease, the treatment plan might be extensive. It might involve an autoimmune diet protocol and could require some herbs and supplements to address Kevin’s gut issues. The clinician will likely want Kevin to focus on stress management because stress is a big factor in autoimmune disease. There might also be a focus on appropriate physical activity and movement because that’s important for arthritic conditions.
That’s quite a list. Even if Kevin is highly motivated to make these changes, he might still feel overwhelmed by the complexity of his treatment. Left to his own devices, he’s going to have a difficult time carrying them all out successfully. Enter: the health coach. The coach provides resources like handouts that describe the diet protocol in more detail. She answers any questions, and helps the patient gear up for his dietary changes, giving him practical advice about where to shop for new ingredients and how to prepare his food. She’ll also provide information on stress management resources, like tools that can help monitor sleep. She outlines options for physical activity, and perhaps refers Kevin to a local physical trainer who has experience with rheumatoid arthritis clients. Or if the health coach is experienced herself, she can suggest some at-home exercises to try. As Kevin navigates the ups and downs of his treatment plan, he can regularly touch base with his coach. She will help him break the changes down into bite-sized pieces, perhaps suggesting which step to focus on first. With this support, he is far more likely to be successful with his treatment plan—and far more likely to start experiencing real improvement.
Technological Support
Kevin’s experience at the Functional Medicine clinic is also supported through a variety of technological touchpoints. He can regularly log into a patient portal and communicate with his providers. He has immediate online access to all his lab reports and the handouts he’s received. He can send a follow-up question to his clinician after an appointment and receive a response within forty-eight hours. This regular interaction with his providers feels efficient and effective, and the regular dialog helps him continue with his diet and lifestyle changes.
If the Functional Medicine practice Kevin visits also uses telemedicine, he can easily maintain consistent contact with his care team. If he must travel for a business conference, for example, he can still make his Wednesday appointment by video during his lunch break and continue his treatment on the optimal timetable.
Payment
So how much does all of this cost the patient? In Chapter Eight I explained that, although Functional Medicine will almost certainly prove more cost-effective than conventional medicine over time, right now out-of-pocketexpenses are higher for Functional Medicine because of the lack of insurance coverage. Patients may have to increase the amount of money they initially invest in their health, understanding that, like with other good investments, they’ll receive a significant return over time. Most find the investment in Functional Medicine to be worth it because they receive a high level of care that helps them address problems more effectively and consistently than everbefore.
It’s worth noting that conventional care can be enormously expensive for patients since it relies heavily on medications, surgery, and other expensive procedures. Insurance provides some relief but doesn’t always cover these expenses—and when that happens the results can be disastrous. One in five Americans struggle to pay medical bills each year. Three in five bankruptcies are due to medical expenses, making health care the number one cause of such filings, even ahead of unpaid credit cards or mortgages (LaMontagne 2013).
Functional Medicine, with its emphasis on preventing and reversing disease rather than just suppressing symptoms with medication, can potentially save patients thousands of dollars over the course of their life. Latisha, the patient with Crohn’s disease and diabetes that we met in Chapter Four, is a perfect example. She was forced to stop working and go on long-term disability, and eventually had to declare bankruptcy, because of her conditions. With a Functional Medicine approach, she may have been able to reverse or at least control her Crohn’s disease, and prevent the onset of type 2 diabetes. She could have kept her job and avoided the steady accumulation of unpaid medical bills that eventually bankrupted her. Functional Medicine, though more expensive initially, could have saved Latisha tens of thousands of dollars in direct medical costs over a lifetime—not to mention the tens or even hundreds of thousands of dollars she forfeited from lost income, savings, and investments. So, even without insurance coverage, in some cases Functional Medicine can be significantly cheaper than a conventional approach.