The Functional Medicine Consultation
The Functional Medicine Consultation
There is no standard functional medicine consultation. That is a beautiful thing. Each practitioner has their own style, approach and methods. Each brings a broad background of experiences and knowledge. Each office provides their own range of offerings, from diet and lifestyle modification all the way through to IV therapies.
- You may be greeted by a front desk receptionist, a nurse or by the clinician themselves. They may come out to greet you in the waiting area or the entrance to their office.
- The consultation can range anywhere from simply conversation about your concerns and teaching & recommendations or may involve a full exam, blood work, biometric measurements, and more.
- The office may be somewhat conventional, with exam rooms, or may be a simple consultation room within an office building; maybe it is within a larger wellness center; it could be a home office or the visit could even take place in your own home.
- Some are full service Family Practice and Primary Care, others are consultation only.
- There is often artwork on the walls, comfortable seating, possibly some soothing music in the background and aromatherapy diffusing or candles lit. It is often an inviting experience.
- The wait to be seen may be minimal, if any, and you may be the only one in the waiting room.
- You are often treated as a guest and made to feel at home. Coffee, tea or infused water may be offered.
- The initial visit may last from 90-120 minutes and follow up visits from 30-60 minutes.
- You may be connected with a nutritionist, life coach, personal trainer, complementary provider (massage therapist, acupuncturist, chiropractor, yoga instructor, therapist) that will assist in your care and healing process.
- Your clinician gets to know you, personally. Your history from birth, your family circumstances, spiritual beliefs, dietary habits in extreme detail. The intake forms may be 20-30 pages long – a novel by medical standards. You may even be invited to bring in your family members for support or for their input.
- You will depart with a comprehensive plan that addresses diet, exercise, supplements, stress management.
- You are the owner of this appointment and your future path. You play an integral role in the decision-making process. What are you willing to change? How willing are you to change your diet? Can we get you into a gym membership? You are in control. There is no judgement. There is no documentation of “noncompliance with instructions”.
- This visit is about your Wellness.
Optimal Health & Wellness
This in stark contrast to a typical Conventional Office Visit. These are very standardized. One is almost a carbon copy of the next.
- You are greeted by a receptionist behind a window, placed in a waiting room, that is often filled with people, where you may wait for as long as 60+ minutes. You are surrounded by others that may be coughing, vomiting or even bleeding. You may sense anger and frustration and may experience some of it yourself.
- If this is your first visit to this office then you will complete an intake form in the waiting room. “Please arrive at least 10 minutes early”. This form may be 2-3 pages long. Present Concerns. Medical History. Medications. Supplements. Family History. Social History. This visit is typically going to be about 30 minutes with the clinician.
- Follow up or acute appointments may get you a 10 minute visit with the clinician, where you spent more time in the waiting room, evaluation with a nurse and blood drawn by a phlebotomist than you did with the person deciding your fate.
- You are brought back to a treatment room that is quite sterile in appearance, white walls with scant art. Stainless steel bins and a brown/gray examination tables may be the only color accents.
- Your vital signs are checked and charted. Maybe you have some blood drawn before you see the clinician.
- The clinician walks in with chart in hard, “so let’s see why you are here today”. Brief conversation about your complaint, focused physical exam. Brief review of recent lab or X-ray results. 10-15 minutes later you are walking out with a prescription for something or with no change whatsoever.
- “Eat better and exercise more… you’d benefit from losing a little weight”.
- You may be referred to see a specialist (cardiology, gastroenterology, rheumatology) who will see you at some point, run more tests and likely prescribe more medications.
- Stop at front desk and schedule your follow up appointment in ______(fill in the blank).
- This visit has nothing to do with Wellness.
I often get inquiries about whether my practice accepts insurance. No we do not.
- Many Functional Medicine practices do not, though you will find some that do. These are more often associated with a conventional practice and have a structure in place to complete the billing through insurance and people employed to complete forms that are needed to be sent to the insurance companies justifying reimbursement.
- Insurance companies are not interested in paying for these services. They do not pay for time spent with you, getting to know you and what has led you to the condition where you are now – they pay for diagnosis codes. It is not about the Quality but the Quantity. Insurance pays for “sick care”, not for “health care”.
- The level of reimbursement would not allow for these comprehensive visits (time spent for amount received)
- The recommendations may not fall in line with the treatment recommendations you’d receive from a conventional office. The guidelines and recommendations made by the professional societies (eg American College of Cardiology, American Academy of Pediatrics, etc) are expected to be carried out and these are routinely followed in conventional practice. This also typically involves prescribing medications for treatment of “abnormal” labs or symptoms.
- Financial survival in medicine (in an insurance based model) requires brief visits and many patients per day. Offices have overhead that must be paid in addition to making a salary.
- For an initial consultation, it takes me an average of 60-90 minutes to review and formulate a plan based on the initial intake forms that I send out. There is a lot of information to assimilate. I need to understand your journey that has led you to me before I see you – before you ever walk into my office. In a conventional office your intake form is reviewed with you in the room.
- Follow up visit forms are shorter and I am already quite familiar with you. The preparation time is less but I need to formulate a plan of action based on how you are doing with the plan we set in place. It is not simply adjusting a prescription or adding a new one. A follow up visit may be only subtly less comprehensive than your first visit. I have had some follow up visits that have lasted as long as the initial visit.
- Sometimes, the reasons for you symptoms do not fit neatly into a Diagnostic Code (ICD-10). The physiologic dysfunctions don’t fit neatly into a pre-defined code. You are more than a culmination of symptoms and abnormal lab values.
- After a visit I may spend upwards of 90 minutes completing the medical record and the functional medicine prescription in written form (diet, exercise, stress management, supplements, referrals, recommended testing, etc) that I then email to the patient.
- We do put labs through private insurance. Just because our office does not accept insurance does not mean that the insurance company will not pay for your lab work – as long as it is “reasonable and appropriate”.
- If a test is considered “experimental” or “unnecessary”, according to their reviewer, then it will not be paid for.
- If you do not have a pre-existing diagnosis, that justifies running a specific test, then it may be denied. I often see this with Hemoglobin A1c, an incredibly useful test but you must be diabetic for it to be considered necessary.
My personal practice setting is within the living room of a country cabin. We offer comfortable seating, refreshments, and have essential oils diffusing. While most of my appointments take place there, I have also provided consultations at local coffee shops as well as the individual’s home. Our emphasis is on discussion about diet and lifestyle modifications to address root causes, targeted testing, supplementation and referral to other holistic practitioners to address aspects that I cannot. I do not provide traditional primary care services. We don’t administer medications or vaccines in the office, we don’t evaluate acute complaints (colds, flu, injury) and we don’t manage chronic prescriptions for symptom control.
I do enjoy being able to work from a home-like environment and reviewing intake paperwork at my local coffee shop drinking my favorite brew. It is important to live what we teach. The average conventional practitioner spends 50+ hours at the office per week, seeing 3 or more patients per hour, and may spend their weekends catching up on charting so that the office can get paid by the insurance company.
There is quite a contrast between Functional Medicine and Conventional Medicine, in the office and out of the office. Both serve a role in your health needs. Only one has an emphasis on truly getting you well, on a path to healing, unconstrained by the insurance industry and pharmaceutical industry.
You can find a functional medicine practitioner near you. Go to: http://www.ifm.org and find a practitioner. If you are interested in a functional medicine provider with a focus on Paleo/Primal or Ancestral Health approach then go to https://re-findhealth.com/ and locate a practitioner. Don’t settle for less when it comes to your health.