There are two worlds of medicine today, the conventional disease-centered model and the patient-centered model that treats each person as a unique entity with diverse systems of genetic, biologic, social and environmental inputs. As a board certified, teaching physician, I know the conventional system well, but as a “functional” medicine practitioner I feel like I am living in a medical parallel universe.
For over one hundred years modern medicine has taught doctors to identify and treat disease. We learn the skills that lead us to a single diagnosis amongst all the different possibilities. The patient is then labeled as having this or that disease and for every disease there is an approved code, called the International Classification of Diseases or ICD. Version 9 has been replaced by version 10 and gone from 13,000 to 68,000 possible codes. If a physician wants to get paid via insurance they must submit the proper codes.
ICD coding is useful for the government and the insurance companies to facilitate billing, assess data, and measure outcomes, but is one of the biggest detriments to healthcare today. The entire system revolves around codifying and classifying of patients according to the disease or illness they have. This reductionist mentality trains and rewards physicians to see patients through the lens of a disease label instead of a complex and unique person.
The ancient healing arts emphasize restoring harmony and balance to the patient’s underlying body systems. Ironically, modern research combined with technology is enlightening us, and reminding us, of this principle. From genetics to the microbiome we are making huge strides in understanding how specific disturbances in core systems lead to disease.
Focus on healing underlying systems is the core of functional medicine. Instead of simply putting our patient into a disease classification we strive to uncover the origin of symptoms or disease so that we might eliminate the issue altogether.
Advanced testing allows us to gather information unheard just a few years ago, such as genetic mutations, nutrient or hormone deficiencies, metabolic or immune disturbances, gut dysfunction and food allergies, toxin accumulations, chronic infections and more. This information is invaluable in sorting out root cause, yet so much of it is considered unnecessary or experimental and outside covered insurance benefits.
More Than Just Testing
Including and engaging the patient in the healing process is another aspect of medicine that is lacking. In the rushed world of conventional practice we hardly have time to hear the patient’s story – there’s no ICD code for that. Everyone has a story, and listening to that story is one of the most important and rewarding processes in human interaction, especially so in medicine. It sets the stage for healing.
I teach my students that 80% of diagnoses can be gleaned from the patient’s history. The physical exam and lab tests are meant to confirm the diagnosis. While it doesn’t always work this way I think it underscores the need to listen more, and to understand what patients are up to, and up against, outside the office.
To truly heal patients we need to think holistically and we need the time to consider the mind as well as the body. Addressing attitudes, spirituality, social networks, and stressors should be part of the workup. For our part as physicians, the intention to heal and sincerity are powerful tools as well. Almost one hundred years ago Harvard physician Francis Peabody wrote, “One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient.” Perhaps now more then ever this is needed in healthcare, for the sake of the patient and the physician.
Areas such as nutrition and exercise get little more attention than a feel good marketing message in our current “sickcare” model. Having health coaches, nutritionists and personal exercise trainers involved in every primary care clinic would likely do more good than physicians learning the latest drug protocols and approved formularies for treating the increasing epidemic of obesity, heart disease and diabetes.
For thousands of years herbal and nutritional supplements have been an integral part of healing. Despite what the television commercials and lobbying pressure from big pharmaceutical companies would suggest, there is an abundance of evidence based research and experience showing the safety and efficacy of many natural treatments. We have a much larger “toolbox” of treatment options than the local pharmacy can provide.
Along the same lines, a lengthy list of complementary therapies such as chiropractic, acupuncture, and massage have proven benefits. Stress management techniques including meditation and biofeedback lower blood pressure and blood sugar. Yoga and dance expand the traditional ideas of exercise. The point is that physicians don’t have all the answers and integrating other health practitioners is part of the cure.
The Future of Healthcare
A welcome paradigm shift in healthcare is imminent. While the conventional system marches on with the disease-centric pharmaceutical model a quiet revolution is happening. Just a few years ago the prestigious Cleveland Clinic established its Center for Functional Medicine. And meanwhile, an army of physicians from around the country have discovered the joy and success of treating patients under the functional medicine umbrella.
With ever expanding coding, data collection, documentation bureaucracy, prior authorization, meaningful use, and so on there are days I feel more like an accountant than a physician. For the sake of the art of medicine and true healing, the patient-centered world of integrative, holistic, functional medicine is coming, and hopefully it won’t long be the alternative.
Scott Rollins, MD, is Board Certified with the American Board of Family Practice and the American Board of Anti-Aging and Regenerative Medicine. He specializes in bioidentical hormone replacement for men and women, thyroid and adrenal disorders, fibromyalgia and other complex medical conditions. He is founder and medical director of the Integrative Medicine Center of Western Colorado (www.imcwc.com) and Bellezza Laser Aesthetics (www.bellezzalaser.com). Call (970) 245-6911 for an appointment or more information.