What is the Best Training to Prepare for a Career in Functional Medicine?
Functional Medicine in Nursing Case Paper

I’ve personally worked with several thousand practitioners in the last twenty years showing them how to become a functional medicine doctor and have a deep understanding and appreciation for the various functional medicine degree programs. When I coach someone new to functional medicine I’m always looking for what is best for them, knowing that even if I send them to a different program from one I teach, if they get a benefit it works to all of our advantages in the long run.Functional Medicine in Nursing Case Paper

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There are two general categories you could be in. Those that already have a degree and those that don’t. If you have a MD, DC, ND, or Lac degree already then how to become functional medicine practitioner issues boil down to what starting point you have in mind. Do you want to learn the science and background underpinning of functional medicine first? If that is the case then the Institute of Functional Medicine has world-class courses for every significant area of practice. Start there with IFM’s introductory course and go on. If you want to learn about the coaching aspect of the work, how to teach people about the best diet and exercise programs, then one of the stellar coaching programs out there is the best option. If you want to learn an area of specialization such as a focus on cancer patients, Lyme disease or genetic issues, then there are specific trainings in each of those areas. The quite amazing thing is at this point in my career I am very familiar with and oftentimes friends with the various doctors that teach all these programs. We all, myself and the other doctors teaching this work, have your best interests at heart and rather than seeing any sense of competition I am very clear that we are all mission oriented. Therefore we all work together cooperatively to help folks like you build a practice.Functional Medicine in Nursing Case Paper

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Practical Clinical Application
My specific niche is practical application of clinical protocols and lab interpretation along with practice management and patient education techniques. In other words, I teach what I do with patients. I’m one of the few teachers who still runs a practice and so I continue to develop my focus on practitioner mentor ship type educational programs. Many of my colleagues are more into research and they are far superior for situations where a doctor wants to specialize in an area such as treatment of cancer patients or Lyme disease or complex degenerative diseases like Parkinson’s or dementia. My programs are for the generalist who wants to get started and learn the basics. If you want practical application and clinical knowledge then my courses, such as the Kalish Method Mentor ship are the perfect program to start you on your new career path.

I also have watched my students go on in their careers and everyone ends up taking multiple courses so as much as possible I would like to act as a resource, not just to funnel people into my online functional medicine training programs but also as a mentor that can help you with the many key moments in your career when choices come up. I’m old enough now to go to conferences and see on the speaker list several doctors that were still in school when they did my training! This is a wonderful experience for me, as I feel my role as a teacher is elevated when I see my students become thoughtful leaders and researchers developing the next level of treatment options for patients.

Become a Functional Medicine Practitioner
If you are really just starting out and don’t have a degree yet, you have many opportunities in front of you. The interesting thing about functional medicine is the discipline can be practiced very successfully by people with a wide range of professional backgrounds. I do find some professional licensing makes a huge difference and that those that are unlicensed health coaches or unlicensed nutritionists have a much tougher go of things than those that pursue an advanced degree. This is because even just ordering functional medicine tests can become problematic without a degree. That being said there are some exceptional health coaches out there that contribute to functional medicine in many ways.Functional Medicine in Nursing Case Paper

I opted to become a chiropractor in order to practice functional medicine simply because in the late 1980’s California didn’t license naturopaths and the acupuncture schools didn’t seem like the best option way back then and I thought about medical school but it didn’t seem like the best fit for me. I took one trip to Cambridge, MA and met with an alumnus from my undergraduate school that was a professor at Harvard Medical School. We had lunch and toured around and let’s say I didn’t resonate with the vibe there! I’m a simple let’s do this now, let’s not be limited type personality and felt much more at home in the slightly wild, wild west atmosphere of functional medicine back in those days. Let’s call it a nonconformist attitude perhaps. Much has changed since the 1980’s, from hair styles to pop music, and functional medicine has moved on considerably as has the rest of our culture, now you can operate under a ND license in California and the many schools of Chinese Medicine are top notch and well developed and I see large numbers of folks from those schools pursuing work in functional medicine. The chiropractic profession is still strongly represented within functional medicine and of course the largest growth I’ve seen is within the medical field where we now see MD’s and NP’s building functional medicine clinics in ever-larger numbers.

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What is the Best Training to Prepare for a Career in Functional Medicine?
Depending on your previous schooling and general aptitude I think many of the professional licensing school options are viable, from medical school to naturopathic medical school over to a chiropractic degree or degree in Chinese medicine and acupuncture. Some practitioners really want the option to adjust medications, prescribe medications and have a more full service clinic that balances conventional medical care with functional medicine in which case an MD, NP, or DO degree makes the most sense. Others have a more anti-conventional medicine approach in mind and want to combine functional medicine with Chinese medicine, chiropractic or naturopathy.

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I honestly at this point don’t think it matters what you choose in terms of professional programs controlling your potential success in functional medicine. In other words there is no best or ideal training, it’s more what suits you and your overall career goals. For me as a chiropractor I’ve been so happy, I would not want to nor was I ever interested in prescribing drugs. The sight of blood makes me a little dizzy, so medical school would have been a challenge and I really like the structural component of healing that chiropractors are so good at. I have other close friends who are the absolute best doctors of functional medicine that combine functional medicine skills with their conventional medical training. My favorite example of this happened a few years ago when I was at a cabin in the woods and one friend came down with an allergic reaction to a food and my MD doctor buddy ran to his room, grabbed his doctor bag (yes an old fashioned black leather bag he carries with him) and offered the allergy sufferer a homeopathic remedy or a prescription to stop the allergic attack! Knowing both worlds of conventional medicine and functional medicine is a powerful combination. If you can handle getting into and getting through medical school then go for it.

I also see doctors of Chinese medicine really excel at the work because their original training is systems oriented. They see a complex web of meridians and energy systems and organ systems in the body as part of their basic training in Chinese medicine and this carries over quite well to a functional medicine practice. Also acupuncturists tend to have good energy and enjoy the coaching and hand holding aspects of the work. Chinese medicine blends exceedingly well with functional medicine, in a way it is quite seamless. Be on the lookout for specific state law related issues as there are some states that do not allow acupuncturists to order lab tests, although that is rare.Functional Medicine in Nursing Case Paper

And the naturopaths, oh the naturopaths! They have all the natural medicine training on herbs and nutrients and clinical applications of natural hormones and so on, so once again their background brings a richness to a functional medicine practice. The reality is I don’t know if we’d even have functional medicine if it weren’t for the development of naturopathic medicine in the first place. Naturopathic schools and the acceptance of the degree seem to be on the rise in my lifetime with greater and greater acknowledgement of their role in our healthcare system. Again be on the lookout for state to state related issues in terms of licensing for ND’s, as it varies quite a bit and if you for sure want to practice in a state that doesn’t allow ND’s to be licensed, as happened to me in the 1980’s in California, then you may want to rethink things.

Many Disciplines Within Functional Medicine
I went to chiropractic college, but upon graduation my two main teachers in the area of functional medicine and clinical nutrition were naturopaths and further, I was trained by an MD, a well known one named Dr. John R. Lee, in the use of natural progesterone. So even outside of whatever specific licensing program or degree program you choose there are many opportunities to learn from other professionals and become cross trained so you cover all the bases you need to build the type of practice you want.

I also see such a variation in types of functional medicine clinics. There are clinics like mine where we just do a simple version of functional medicine. There are complex clinics that treat Lyme, toxic mold, Parkinson’s and cancer patients. There are MD’s combining a psychiatric practice with functional medicine and those combining diabetes treatment with functional assessments. We see acupuncturists doing half functional medicine and half Chinese medicine depending on the patient’s needs and the same with ND’s and chiropractors. Really it’s a very open area with much room for interpretation and the ability for you to put your own unique stamp on the clinic you want to create.

If you have questions on this topic feel free to schedule a call with our staff or myself, happy to help sort through this issue and come up with best options for you. Be sure to checkout our most popular course The Kalish Method Mentor ship.

25-year-old nurse Coreena Cruceanu’s life turned on its axis when she contracted a Lyme-like illness. The extensive lifestyle and dietary changes she made to facilitate her recovery sparked a fascination with natural health and she is now studying to become a nutritionist.

It was while I was working as a full-time Registered Nurse at a specialist pediatric hospital in Sydney that I was diagnosed with a Lyme-like disease. Initially I just felt very tired and run down, which I attributed to my new job and lots of night shifts. Unfortunately, the fatigue didn’t lift, and I started experiencing joint pain, nausea, breathlessness, nerve pains, extensive muscle twitching and fevers. One of the most frightening moments of this illness I experienced was while at work, nursing a baby, where I lost all strength and control of my arms and had to call on a colleague to come and pick the baby up and place it in its crib. The illness continued to progress and reached the point where I was unable to work for a number of months.Functional Medicine in Nursing Case Paper

It took me four long months to receive a diagnosis. I saw countless different doctors and specialists, in the process being incorrectly diagnosed with Ross River Fever, Post Viral Fatigue Syndrome and Irritable Bowel Syndrome.

Among-st all the confusion of my debilitating and mysterious condition, my mum happened to come across an old photo from a trip to the UK where I noticed a strange looking bite and rash which I had just assumed was a spider bite at the time. It was only then that I made the connection to Lyme Disease. After connecting with a GP in Sydney with an interest in tick-borne infections, I was able get the appropriate testing done and gain a diagnosis for what was, until this point a mystery.

Lyme-like disease has the potential to cause long-term chronic illness if not managed correctly, and has resulted in me having to change many aspects of my life. The nursing lifestyle isn’t known as being the healthiest, with many nurses eating on the run, working nights and burning the candle at both ends, working lengthy twelve hour shifts in order to cash in on the additional loading’s. Many nurses will tell you that despite our best efforts, trying to live well whilst working as a nurse, can be much like mixing oil and water.Functional Medicine in Nursing Case Paper

The biggest change I made was stepping down from my full-time role in the Neonatal Intensive Care Unit and moving to casual work. I now only take on eight hour shifts and no night shifts, and I have also had to overhaul my diet after consulting with a nutritionist. In addition, I work with an integrative GP who has prescribed a grueling supplement, antibiotic, anti malarial and intravenous treatment program.

This illness experience left me extremely frustrated and to some degree, caused me to begin to question the medical system I had always known and trusted. I clearly had an observable illness, but it felt like no one could help me, finding many of the specialists and doctors I consulted with unhelpful and with no answers.

I began to see the bigger picture of health, the missing puzzle pieces in our current medical system. I began to want more for people like myself, struggling with chronic illnesses. I still maintain that our medical system treats acute symptoms and conditions in a very pragmatic and effective way, but on the flip side there is a huge piece missing when it comes to chronic illness management… these people are the ones that we see presenting over and over again with the same symptoms, or progression of their illnesses, that consequently and unfortunately become an enormous drain on our healthcare system. We often refer to this as the ‘revolving door of healthcare. I began to aspire to help people gain more control of their health before acute presentations, and hospitalization is required, through understanding and treating the underlying pathology and signs the body often exhibits to suggest imbalance; as well as promoting long term positive behavioral changes. I sought to work towards registration as a nutritionist, working on health promotion in the community; rather than a dietician working in hospitals (acute settings). I landed on the Nutritional and Dietetic Medicine degree at Endeavor College of Natural Health because I was drawn to its evidence-based, holistic and functional approach to well being; something which really resonated with me following my experience with Lyme.

I’d like to continue working as a nurse, and when I become qualified I hope to work in a creative role where I can combine both my nursing and nutrition worlds, in order to address the current gaps in our delivery of healthcare. I’m not exactly sure what that job looks like yet, but I know with time the vision will develop.

There is a huge deal I would like to see change in the hospital system. I look forward to a time where the meals diabetic patients receive do not include white bread and low-cal jelly, and eating disorder patients are managed by nutritional goals (or optimization) in addition to weight gain. There needs to be a place for both “macro nutrients” and “micro nutrients” in order to move towards the philosophy of using food as medicine.Functional Medicine in Nursing Case Paper

As for me, the cost of the experience has been high – I live week to week at home with my parents as I am unable to afford rent, and there are weeks when I can spend half my time in bed due to fatigue and pain. My future is somewhat uncertain – some people with Lyme-like disease can require many years of treatment, however I have been on treatment now for twelve months and am seeing incredible improvements. I am hopeful to be on the other side of this long tunnel, and am compelled to get out there and start making some colossal transformations on how we see health.

The term “Functional Medicine” can seem rather ambiguous. Although this field is becoming more mainstream due to voices like Dr. Oz, Dr. Frank Lipman, and Dr. Mark Hyman lauding it as the future of health care, Functional Medicine is still generally unknown to the public. The term and field of Functional Medicine refers to something completely different than what we have now come to know as conventional medicine or the standard model of care. To fully understand what functional medicine is, it is important to contrast it with conventional medicine.

Traditionally a medical doctor uses drugs or hormones as therapeutic tools to deal with dysfunction or disease. For various conditions including low thyroid, diabetes, high blood pressure, elevated cholesterol and so on, the standard model of care is generally all the same. Your general practitioner could decide to treat you, or could elect to refer you to a specialist. A GP and specialist have access to the same basic tool: medication. The training in the standard model of care is to diagnose a disease and match that disease with a corresponding drug. The standard model of care works well for acute diseases, trauma, infection, and emergencies. Sadly, it fails miserably in the care of the chronic diseases that affect over 125 million Americans.

Chronic conditions – such as allergic, digestive, hormonal, metabolic and neurological problems – which most Americans suffer from on a daily basis, are finding solutions in the field of Functional Medicine.

So what exactly is Functional Medicine and how can it assist the millions of Americans dealing with chronic disease?

Here are 5 basic principles that define Functional Medicine:

1) Functional Medicine views us all as being different; genetically and biochemically unique. This personalized health care treats the individual, not the disease. It supports the normal healing mechanisms of the body, naturally, rather than attacking disease directly.Functional Medicine in Nursing Case Paper

2) Functional Medicine is deeply science based. The latest research shows us that what happens within us is connected in a complicated network or web of relationships. Understanding those relationships allows us to see deep into the functioning of the body.

3) Your body is intelligent and has the capacity for self-regulation, which expresses itself through a dynamic balance of all your body systems.

4) Your body has the ability to heal and prevent nearly all the diseases of aging.

5) Health is not just the absence of disease, but a state of immense vitality.

Here lies the clear distinction and definition of Functional Medicine. Instead of asking, “What drug matches up with this disease?” Functional Medicine asks the vital questions that very few conventional doctors ask: “Why do you have this problem in the first place?” and “Why has function been lost?” and “What can we do to restore function?”

Functional Medicine addresses the underlying causes of disease, using a systems-oriented approach and engaging both patient and practitioner in a therapeutic partnership. It is an evolution in the practice of medicine that better addresses the healthcare needs of the 21st century.

By shifting the traditional disease-centered focus of medical practice to a more patient-centered approach, Functional Medicine addresses the whole person, not just an isolated set of symptoms.

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Functional Medicine practitioners spend time with their patients, listening to their histories and looking at the interactions among genetic, environmental, and lifestyle factors that can influence long-term health and complex, chronic disease. In this way, Functional Medicine supports the unique expression of health and vitality for each individual.

Most people can relate to the frustrating situation of making an appointment to see their doctor, only for the appointment to start an hour or more later. Then, after a very rushed visit, being sent home with a prescription and no new insight into what exactly is happening with their health.

This is a cycle that focuses on symptoms, ignores underlying causes, and it’s not one person’s fault. Our conventional medical system arose from the treatment of acute illnesses. It’s a good thing, too! Our modern medicine successfully treats many acute and infectious diseases.

The problem is now when most people get sick, it’s no longer an acute illness that sends them to the doctor. Chronic conditions are on the rise and proper diagnosis and treatment of these diseases requires more than a 15-minute appointment.

Comprehensive medical histories, lab work, and a broad understanding of the body and its metabolic processes are needed. I like to think of it as detective work. Clues are collected and a diagnosis is revealed. Because finding the root cause of symptoms is the foundation of integrative and functional medicine treatments involve completely addressing underlying issues; infectious, toxic, genetic, nutritional, metabolic, and others.Functional Medicine in Nursing Case Paper

When you address the root cause, there’s a much better chance of reversing or eliminating the condition altogether. The ability of functional medicine to look beyond the symptoms and offer real, lifelong solutions is why I am so passionate about my life’s work. I believe everyone should have access to the benefits of holistic personalized medicine, which is why I want to write about how to choose a good integrative and functional medicine doctor. Here are my tips for finding the doctor best for you and I hope it helps you on your journey to better health!

Types of Functional Medicine Practitioners
There are different types of practitioners that specialize in integrative and functional medicine, and it’s important that you know the difference so you can choose which is most beneficial for you. With the increase in online resources and advice, I believe it is actually very important to check the credentials of the person from whom you are taking advice. Sadly, It is not uncommon for unscrupulous individuals to call themselves “doctor” without any basis or credentials, playing on the vulnerability of the general public.

Medical Doctor (M.D.) – A doctor who first went through traditional medical school and then added training and education in integrative and functional medicine. They will have the most flexibility in ordering tests and prescribing medications.
Doctor of Osteopathic Medicine (D.O.) – This is a doctor who, like an M.D. has a wide range of services they are able to offer. This means they can prescribe medication, and are even able to become surgeons. They generally focus on the body as a whole.
Nurse Practitioner (N.P.) – Many people don’t realize that nurse practitioners in many ways have similar abilities as doctors. They are able to own and operate their own practices and can also prescribe medications.
Doctor of Chiropractic (D.C.) – While chiropractors are generally thought of a those who primarily treat orthopedic dysfunction, they are also able to practice functional medicine. They cannot prescribe medications and usually have a medical doctor they work with or recommend if you need a traditional treatment.
Doctor of Naturopathic Medicine (N.D.) – These doctors use a system of treatment of disease that avoids drugs and surgery and emphasizes the use of natural agents, prescribing and licensing privileges vary by state.
All of these practitioners carry different benefits. Ultimately, it’s up to you to find the best fit for your life.Functional Medicine in Nursing Case Paper

Key Characteristics of a Good Functional Medicine Doctor
Here are the key characteristics of a good functional medicine doctor:

They recommend a plant based organic often grain free diet.
They don’t make grandiose promises.
They specialize in complex chronic conditions such as autoimmune disease.
They see themselves as your partner in health.
They outline expectations so you know what to expect all along the way.
They help you prioritize decisions such as testing and changes that need to be made.
They make you feel comfortable and judged.
They spend the time with you.
That is a great question. In fact, that is one of the first and most common questions people ask. This is understandable; after all, chances are you are paying good money for your premiums, not to mention deductibles and co-pays. Your employer has no doubt touted the benefits of each plan, which seemed generous at the time.

So where does Functional Medicine fit in? The short answer is found in your insurance policy. I recommend that you first carefully review your policy, checking for any reference to “preventive” services, or possibly “nutritional counseling”. When in doubt, it is best to call your insurance company directly and ask them if any of these types of service are covered under your plan.Functional Medicine in Nursing Case Paper

To understand the long answer, we must first make an introductory venture into the world of so-called “health” insurance. The first thing that you should know about health insurance is that the term is a misnomer; your health insurance company (be it Blue Cross Blue Shield, Aetna, Cigna, Humana, or worse, United Healthcare) has not made your health their top priority. How can this be? Well, let’s do a little research. Quick Google searches show that the elder of the insurance companies, Aetna has been around since 1853. Blue Cross plan was introduced in 1939. Humana was founded in 1961. And, United Healthcare is the new kid on the block, formed in 1977.

Since insurance companies are private corporations, this may go without saying, but it is worth highlighting here: in order to survive, health insurance companies must turn a profit. This is true of any company, family/household, or individual. You must make more than you spend. By definition, this means that they must take in (revenue) more than they pay out (expenses). This means that their customers (that is you) must pay more in premiums (as well as deductibles and co-pays) than they pay back out on your behalf (in the form of benefits, or covered services).

Functional Medicine itself requires the doctor to spend an enormous amount of energy behind the scenes between your appointments. This time spent on your behalf includes careful review of extensive new patient intake forms, deeply interpreting lab results and putting them together, attempting to find the underlying common cause or causes of the problem. This may also take research and review of the newest published studies as they come hot off the presses. No other healthcare discipline goes this far or invests this amount of time on each patient.

Unfortunately, I have only so many hours in a day, and I would rather devote that time to your case, (researching and reviewing your case, preparing information and treatment plans, and answering your questions), than wrangling with insurance bureaucrats, none of whom have any medical training themselves and thus lack the understanding that Functional Medicine doctors have. Like most Functional Medicine doctors, I would love to provide the convenience and assistance of filing insurance for my patients, but with the time and energy constraints, I find that I cannot do both well. The bad news is, Functional Medicine providers do not file your claim for you but we provide you with a receipt, which you may submit to your insurance. The good news, though, is the most important: Functional Medicine providers are not bound by the arbitrary rules of insurance, and our time can be spent where it counts: Devoted to YOU.Functional Medicine in Nursing Case Paper

So, about that receipt I just mentioned…­ Yes, I will provide a descriptive receipt, aka “Encounter Form” at the end of your office visit and/or treatment. Depending on your insurance company, they may accept that receipt and perhaps reimburse you for part of the out-of-pocket investment you made. I can never guarantee this, as insurance companies are like water, always changing and tough to get a firm grasp of. Sometimes they will require additional information and/or codes, and this is where things get sticky…­

The codes the insurance company likes to have essentially reduce you to a Dewey Decimal-like system of numbers. Every established disease (official diagnosis) has a 4- or 5-digit number, in the form of “123.45”. Each recognized type of treatment has a 5-digit code, too, in the form of 12345. Although the two numbering systems are different, each recognized disease corresponds with its appropriate (aka conventional) avenues of treatment, and vice versa. So what is the problem? The difficulty arises in that these coding systems are old and outdated. They fail to consider dysfunction (i.e. breakdowns in healthy functions or processes, the earliest signs of disease) and they usually neglect to include contemporary health issues. In other words, there is a language barrier between Functional Medicine and health insurance, especially considering that health insurance is actually structured around — and oriented toward — conventional medicine, which intervenes only when the dysfunction has advanced for years to decades, resulting in a blatantly recognizable, established disease condition.

The common scenario is this: you start to feel that something is not quite right. You visit your conventional/regular doctor, who runs the blood tests and, after scanning them quickly, says “everything is normal”. You know that it is not, but now they are hinting that it is all in your head. Meanwhile, your health does slide further and further away from healthy ranges, toward the outlying borders of “normal” and eventually it does cross into “abnormal” territory. This may be years later, and by then it may or may not be too late to effectively use natural methods. However, the insurance company now has a number it can assign you, a little numeric box it can neatly put you into. They are happy because they have been satisfied. But what about you?Functional Medicine in Nursing Case Paper

That is where Functional Medicine comes in, and hopefully you will be able to see a Functionally-oriented doctor before you reach the disease point. With any luck, your insurance company will cover at least part of the tab. If they do, look at it as a secondary bonus, and if they do not, simply consider it part of the cost of living. After all, when owning a vehicle, we understand that if we do not invest in maintenance, the car breaks down and stops working. We must pay for regular oil changes, state-mandated vehicle inspections, license plate tags/stickers, brake pads (which are actually designed to wear out!), tires, and many more. Why give your body any less? Make your health your top priority, even if it is not your insurance company’s. Why? Because you only have one body, and it only treats you as well as you have treated it. We are a product of the decisions we have made every day. Up until now, people have relied on their insurance coverage for any kind of medical care. But if we want a different result, we may have to consider a different approach, ­whether an out-of-touch insurance company thinks it’s medically necessary or not.

My clinic often receives calls from patients wondering are functional medicine doctors covered by insurance. There is no comprehensive functional medicine health care insurance plan available. Some insurance plans will cover some services and labs, but usually not the supplements required for complete programs. Also, insurance reimbursement is usually quite limited, often it’s not enough to cover the doctor’s expenses for running a clinic. There are, however, a small number of functional medicine doctors that take insurance and many of them are my close friends and colleagues and I’d like to share what I’ve learned from them about practicing functional medicine in an insurance based model.

First to lay out the pros and cons of functional medicine within the insurance model, this is an area the Kalish Institute course “My Practice Plan” explores in depth as we help functional medicine doctors build business models and financial models for their clinics.

The insurance model has several excellent built theoretical constructs behind it, although in the current health care climate these ideals have been over shadowed. One excellent aspect to insurance is the general theory that paying insurance premiums spreads risk among large groups of people so that when the time comes and you have a $250,000 medical bill, you have your insurance company, funded by other like minded patients, step up and cover the cost. And for all those years you have no significant medical expenses you pay into the insurance pool to support others. In this way it’s a community minded and progressive concept. Taking care of others and, when needed, taking care of your own needs.Functional Medicine in Nursing Case Paper

However, as the insurance industry has gradually taken over the practice of American medicine, increasingly controlling the delivery of care since the end of World War II, the human tendency for greed has snuck into our medical insurance model just a little bit. The negative aspects of insurance include removing the patient from directly experiencing the real costs of treatment and stimulating a sense of entitlement that one deserves the best of treatments available, regardless of cost. So we want everything for everyone without taking into account if the treatment makes financial sense and without taking into account if there is an equally effective less expensive solution.

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Also, insurers picking up the tab can distance the patient from the financial reality of their lifestyle choices. For example you can eat a high animal fat diet for a few decades expecting that your insurance company will pay for the medications and surgeries required to treat your now significant heart disease. Also, the emphasis on third party payers picking up the tab has allowed for an escalation of drug prices and an increase in the cost of various medical procedures. We’ve lost the normal check and balance system that exists in other industries. For example there is a limit on how much people will pay for a pair of shoes and shoe companies are required to stay within certain price ranges or people won’t buy their shoes. Imagine if there was “shoe insurance” and every new pair of shoes you got you just had a fixed co-pay on, it’d be likely that shoe companies would jack up their prices and you wouldn’t really think twice about it. You pay the co-pay, the shoe insurance kicks in for the remaining balance and everyone is happy. You would complain about the skyrocketing cost of shoe insurance at cocktail parties, but then what to do, it’s just the nature of shoe insurance premiums to go up faster than the rest of the economy.Functional Medicine in Nursing Case Paper

Insurance (health insurance!) companies in the U.S. are not sufficiently motivated to keep the burden of health care expenses down. At the same time patients feel somewhat entitled to every available service that they want without being price sensitive. Further adding to the mess, doctors have become completely overwhelmed by all the extra work required by insurance company billing and reimbursement schemes and the majority of physicians now working in insurance based practices are burned out because no matter how many hours they work it’s hard to put together a decent income that will cover your student loans and other day to day expenses.

Enter Functional Medicine. So, is Functional Medicine covered by insurance? Sometimes yes and sometimes no. The answer depends on what specific services you are taking about and what specific doctor you are working with. While the majority of functional medicine doctors have all cash practices, meaning the patient pays up front in cash for all services and products, there are a few Functional Medicine doctors that have figured out how to make an insurance model work without having a schedule that leads to over work and exhaustion.Functional Medicine in Nursing Case Paper

Getting away from the more common cash model, there are some progressive and socially minded doctors that are determined to make an insurance based Functional Medicine clinic work for their community. In speaking with many colleagues I’ve found there are some important reasons why some doctors want to work within the insurance model. One is simply to increase the spread of functional medicine by increasing the number of people using it with an emphasis on the end goal being the wide spread acceptance of Functional medicine. Another reason is to open up Functional Medicine as an option to more people by making it more affordable.

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The challenges faced are many. Functional Medicine doctors often have one or two hour new patient intake sessions and thirty or forty minute follow up consultations. Insurance companies often only want to reimburse for visits of a few minutes and won’t cover visits lasting a few hours. Additionally, many Functional Medicine concepts are not yet accepted by the conventional medical system and this means many treatments such as high dose nutrient replacement are not seen as valid treatments and are not typically reimbursed. Because the payment on an hour long visit can be the same as a visit lasting a few minutes and because of the significant costs incurred by clinics in taking and processing insurance, a typical stand alone Functional Medicine insurance based practice goes into debt losing money hand over fist and will fail in a short period of time.

Because Functional Medicine is individualized and there are no “this for that” type treatments such as “high cholesterol means X medication” and because all Functional Medicine also involves time consuming health coaching and lifestyle coaching and teaching – the business model collapses quickly if insurance is the only source of income for the clinic. To make up for the deficits created by practicing Functional Medicine, doctors that are committed to providing Functional Medicine services to those that would not otherwise be able to afford them have come up with hybrid models.

By hybrid I mean they accept insurance when they can for the procedures that are covered by insurance, often losing money on this part of the practice. Then they add in non-covered services, meaning they add in Functional Medicine services explicitly not covered by insurance which are then paid for in cash by the patient. This might be supplements or a special class on diet. These non-covered services that patients pay for in cash are profitable enough to cover loses incurred elsewhere. This means the cash based non-covered services help finance the parts of the clinic accepting insurance that lose money so as to create a feasible business model.Functional Medicine in Nursing Case Paper

Another hybrid model is a combination of an insurance based practice with a membership model. In this example all patients in the practice pay a membership fee and I’ve seen these range from $300 per year to $5,000 annually. This cash payment for membership provides a variety of membership services and then all remaining services are billed through insurance. In this situation the membership fees create profit that makes up for the losses on the insurance side of the practice. It is exceedingly rare to see a doctor make a go of it with a 100% insurance based practice that solely delivers Functional Medicine treatments.

While the majority of Functional Medicine practices may be cash based, there is often the option for insurance to help reimburse for a few of the high-ticket items, even within a cash practice, usually lab fees. This can help defray hundreds or even thousands of dollars and lower the barrier of entry for people on a strict budget to still be able to enjoy the benefits of Functional Medicine access.

What Is Functional Medicine?
Restores Health by Identifying the Root Cause
Functional Medicine asks how and why illness occurs and restores health by addressing the root causes of disease for each individual. It is a systems biology–based approach that focuses on identifying and addressing the root cause of disease. Each symptom or differential diagnosis may be one of many contributing factors to an individual’s illness.

The Functional Medicine model is an individualized, patient-centered, science-based approach that empowers patients and practitioners to work together to address the underlying causes of disease and promote optimal wellness. It requires a detailed understanding of each patient’s genetic, biochemical, and lifestyle factors and leverages that data to direct personalized treatment plans that lead to improved patient outcomes.

By addressing root cause, rather than symptoms, practitioners become oriented to identifying the complexity of disease. They may find one condition has many different causes and, likewise, one cause may result in many different conditions. As a result, Functional Medicine treatment targets the specific manifestations of disease in each individual. Functional Medicine in Nursing Case Paper

Functional Medicine treats the body as an interconnected system in order to uncover and addresses the root cause of illness, as opposed to addressing only downstream symptoms.

It is a paradigm in which we view the patient and their body as a network of parts, each communicating with one another. Using this process requires longer visits to understand your life story and cutting-edge testing in order to fully evaluate your condition(s).

Integrative Medicine is the inclusion of all proven modalities of healing that promote health and wellness in a particular individual.

Treatment plans address lifestyle habits, environmental and genetic factors, nutritional deficiencies, and includes collaboration with a health coach.

I believe all practitioners are working with the best intentions to help their clients and patients resolve health challenges, prevent future ones, and ultimately improve overall quality of life. That being said, some are missing the mark, or making mistakes that are negatively impacting the results their clients and patients are getting. Understanding these five mistakes that functional medicine practitioners commonly make can serve as a guide to help you find an effective practitioner to work with.

Like any profession, the level of competency among st practitioners varies greatly. An old joke illustrates this conundrum best. What do you call the guy who graduates at the bottom of his class from Medical School?” Answer: “Doctor”.

Unfortunately, we can’t ask practitioners for their report card, so it’s up to us to attempt to figure out who has the competency you’re looking for, and more so, who has the experience to best serve you.

In a recent report released by the Institute for Functional Medicine they found that on average, people have six diagnosis and over thirty symptoms. This isn’t something that can be addressed by one treatment (as we see with most allopathic interventions), or a slew of seemingly impressive testing. It is something that requires a comprehensive evaluation and multifaceted therapy regimen to address the root cause.

This is where a functional medicine practitioner can be helpful, as long as you choose the right one.

The following is a framework that will empower you to make informed decisions when choosing the right practitioner for your needs.Functional Medicine in Nursing Case Paper

5 Mistakes Functional Medicine Practitioners Are Making
1. Too Much Testing
When you go to the doctor for your annual check up, they will likely requisition some basic testing including a complete blood count, and possibly some others like TSH, blood sugar markers, serum ferritin, and vitamin B12, based on your specific history. These tests are mostly looking for end-stage imbalances.

For example, hemoglobin A1c (HbA1c), a marker of long-term (about 3 months) blood sugar levels, shows high readings after years of consuming high glycemic index and high glycemic load meals. Then one day, HbA1c comes back high, and you are declared as “pre-diabetic”.

There is a whole other world of testing called functional lab testing. With functional lab testing, practitioners are more interested in finding imbalances, rather than making a diagnoses. These tests can find imbalances years before symptoms appear. They often have the ability to detect issues where conventional lab testing falls short. For example, a blood fatty acids test can determine if someone is prone to inflammation, or even has silent inflammation. For a conventional lab test to detect this, inflammation would have to be pretty severe.Functional Medicine in Nursing Case Paper

Yes, there is tremendous utility in these functional lab tests. However more testing and more results, doesn’t mean you are going to get better care and better results for your health.

An effective practitioner will first address the fundamentals. This is key, though often not as sexy as the fancy testing. Too often, people come to me with piles of test results, but have not addressed some key principles like practicing proper sleep hygiene, cleaning up their diet, integrating regular exercise or addressing stress levels.

Second, though test results can tell us a lot, they need to then be used to direct the protocol. Too many practitioners will give their clients the results, without taking effective action. This sounds surprising, but I’ll ask clients if they made any changes after doing this test or that one. The answer is often “no, my practitioner didn’t know what to do”, or “no, there wasn’t any follow-up after we received the results”, or “they just gave me some supplements”. This is an unfortunate waste of time and money for all parties, and opportunity lost from good objective information.

Finally, when a proper history and evaluation is completed by the practitioner, they can often confidently determine imbalances without any testing. For example, if someone has a history of smoking, uses conventional cleaning products, doesn’t use clean skincare products, and eats non-organic food, why run a toxicity screen? They are surely going to have high levels of multiple chemicals, and a detoxification protocol would surely be beneficial.

“A functional lab test should only be run, if it’s going to change the clinical decisions.”

Optimal Course Of Action: Before beginning a program with any practitioner, ask if they do any functional lab testing. If they do, ask them what determines if a test should be done, and how do they use the information gathered.Functional Medicine in Nursing Case Paper

2. Lack of Follow-up
Habit modification is not easy. It’s simple, but not easy. The greatest changes come to those who have a solid foundation of the why behind the new habits they are adopting, coupled with repetition and refinement.

The job of a practitioner is to guide their clients on the path to change. To help get them back on track when they fall off, and troubleshoot issues with staying on track. This can’t be done with one session. The practitioner has to be accessible to the client for as many sessions as necessary to reach their health goals.

Consider the stages of change. They are pre-contemplation, contemplation, preparation, action maintenance, and transformation. Do you know how many people can successfully move through these stages from start to finish? It’s a mere 5%. Most people are going to cycle through these stages multiple times, and guidance is a key success factor through it all.

Optimal Course Of Action: Find out what kind of support you get as you’re going through the protocol. Is there a coach or practitoner that will follow up with or whom you can ask questions of? Is your practitioner available for serious concerns? Can you contact by phone or email? Must every follow-up be an in person appointment? How long does it take to get an appointment or to hear back if you send an email? The answers to these questions should align with what you feel you need for success.

3. Doing the Right Things, But In The Wrong Order
I tell my students that you can do the rights things, but if you do them in the wrong order, you might not get the results you’re after.

Sometimes it is important to follow a specific sequence of treatments in order to both ensure the efficacy of your protocol, and to prevent any unwanted side-effects.

For example, if someone is about to undergo a detoxification protocol, and is experiencing constipation, they are setting themselves up for seriously uncomfortable side effects that may dissuade them from continuing. The bowel is one of the five channels of elimination. If it is not “open”, i.e. the person isn’t having regular bowel movements, then toxins that the body is trying to eliminate will go back into circulation. It’s analogous to vacuuming your home, without a vacuum bag in the machin– the dust just settles right back into your home. Many people call this a “healing crisis”, but I just call it poor detox preparation.Functional Medicine in Nursing Case Paper

Optimal Course Of Action: Find out if protocols are tailored to each individual. If a practitioner is doing a one-size-fits all type of protocol, then seek out someone else who understand personalization.

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4. Relying Too Heavily on Supplements
Supplements are powerful. In fact, I teach a whole course about their utility and how powerful they are as tools for healing.

That being said, I see people using them, and practitioners prescribing them, too often without addressing the root cause. In the field we often refer to this as carpet bombing — you know when you’re left taking a dozen supplements and aren’t quite sure why or what they’re for.Functional Medicine in Nursing Case Paper

Consider someone who has spread their time too thin across all facets of their life. They are working long hours including weekends. They travel for work. They wake up early with an alarm to exercise. They drink coffee for energy. They forget to eat during the day because they’re so busy. They have one or more children at home they have to tend to. There are powerful nutrients and herbs that can support this stressed individual, however if they want to prevent a degradation of resilience leading to disease, they’re going to need to make major lifestyle changes. No supplement is going to replace the basic diet and lifestyle modifications that are essential if this person wishes to live and healthy, happy and long life.

Optimal Course Of Action: Find out from the practitioner how supplements are used and what their philosophy is on the topic. You want to find someone who understands that they are for the most part, temporary therapeutic tools. Optimally, they also don’t conveniently have stocked at full retail price every supplement being recommended. That might raise some alarm bells.

5. Failure To Address Diet
I recall a client who came to see me about her chronic yeast infections. She had been dealing with these for about twelve years. When I questioned her about what she had tried so far, she pulled out a pile of prescription pad scripts from her naturopath. As I read through them, I noticed that not once had there been any discussion about diet. It was supplement after supplement to try and kill off the yeast. My first step with her protocol was putting her on a strict anti-yeast diet, and after just one month she started to notice positive changes that she hadn’t been able to accomplish for twelve years.Functional Medicine in Nursing Case Paper

Food can be a powerful healing tool, or, the cause of a disease. We eat daily for energy and sustenance, but food can also affect us in ways unrelated to their nutrient content. Our immune system can react to the food we eat inducing allergies or sensitivities. There are certain naturally occurring chemicals in food that people can be sensitive to like lectins, oxalates, phytates, goitrogens, and others. Processed foods often contain additives that can trigger a reaction, like sulphites and asthma, or food dyes and hyperactivity. Those with digestive imbalances such as small intestinal bacteria overgrowth (SIBO) might have issues with certain carbohydrates. Therefore diet must always be addressed for healing to occur.

Optimal Course Of Action: Inquire what the practitioner’s primary healing tools are. If diet modification is not one of the top three, then this is a red flag.

Functional medicine is a patient-centered approach to individualized medical care that focuses on the whole person. By examining your entire life and complete medical history, we find underlying causes that may be contributing to health problems or chronic disease, such as nutritional issues, stress levels, hormonal imbalance, environmental influences and genetics. Functional medicine looks for the root cause of disease by examining how all the systems of the body work together.

Why choose functional medicine?
When your body’s biological systems become out of balance, chronic disease may follow. Functional medicine seeks to restore and rejuvenate the body’s optimal functions that have been metabolically disrupted by aging, lifestyle, diet, obesity, diabetes, high blood pressure, inflammation, autoimmune diseases or cancer. Some hallmarks of functional medicine include:Functional Medicine in Nursing Case Paper

Evidence-based medicine. Functional medicine uses the latest medical science and research to guide diagnosis and treatment decisions.
Individualized health assessment. Functional medicine doctors use specialized tests to gain a better understanding of your body’s metabolic functions. These tests may include a comprehensive stool analysis, urine metabolite testing, saliva and hormone assessment, and serum analysis.
A comprehensive health study. You are the greatest resource for your personal health. That’s why your doctor will listen to your complete health history, including discussing symptoms pertaining to digestive health, autoimmunity and chronic inflammation, hormonal imbalances, food allergies or sensitivities, genetic influences, and physical and social environmental factors.
A focus on quality of life. Functional medicine focuses on the whole person – mind, body and spirit – to guide the body to an optimal state of well-being.
Applies to any condition. Functional medicine physicians work closely with all medical specialties and any medical condition. Functional medicine also applies to patients of any age with chronic conditions or those seeking generalized wellness and healthy aging.Functional Medicine in Nursing Case Paper