As patients become more engaged in their medical treatment, might new alternatives be more popular among them and their providers?
Today’s healthcare patients are commonly asked to not play the role of Dr. Google and to not walk into their doctor’s office or the hospital having already tried to self-diagnose symptoms. In the information age that we all live in, the ease at which someone can search for information online can lead to unnecessary misconceptions when incorrect information is accessed online and perceived to be factual.
While this advice is well intentioned and is likely favorable for the patient when a diagnosis is not considered severe or when a prognosis is positive, healthcare providers may still find themselves in situations where patients insist that they are experiencing systems that are not supported by said diagnoses and prognoses.
This is the trending paradigm of what’s become referred to as “functional medicine” and clinicians now have to determine whether or not it is going to become part of the conversation with patients or whether or not the average patient might seek this form of alternative, or complementary medicine, before first contacting their primary provider.
This ideology, described as an option for patients to consider when their symptoms or healthcare concerns do not fit the clinical criteria of established disease states as defined by traditional medicine, appears to be posing these types of questions, and the impacts may be felt by patients and medical practitioners alike.
Centered and Functional Care
The United States health system has long been promoting the concept of patient-centered care as one of the main tenants of quality healthcare. According to the Institute for Healthcare Improvement, this type of care requires that one’s cultural traditions, personal preferences and values, family situations, and lifestyle preferences be accounted for when planning a patient’s care. This philosophy also encourages providers to ensure that their patients are a part of the care team in that they are expected to be active collaborators in their care by placing some level of responsibility on self-care and helping patients to be more accountable for their health in a supportive fashion. What’s more, insurance payments are increasingly being linked to a provision of patient-centered care being delivered and preventive care being financially incentivized for both providers and patients.
The concept of “functional medicine,” a term defined by the Institute For Functional Medicine® (IFM) as a systems biology–based approach that focuses on identifying and addressing the root cause of disease.1 In this sense, it’s as if the disease takes the focus before the patient. But at the same time, functional medicine is also promoted by the IFM as considering the individual patient’s genes, environment, and lifestyle when diagnosing and care planning, and only suggesting treatments that address the “right” cause of the condition in an effort to have a lasting benefit to the patient beyond symptom suppression.
As an example, the IOM offers the diagnosis of depression, which it cites as potentially being caused by inflammation, among many different factors. That inflammation may also be contributing to a number of other diagnoses in this patient example, the precise manifestation of each cause depends on that actual patient. It is from this standpoint that the patient “centeredness” is said to be taken into account within functional medicine, for which certification is available.
A School of Thought
To be eligible for certification as a functional medicine physician, practitioners must have a license in a primary specialty, with one of the following credentials: medical doctor, doctor of osteopathy, doctor of chiropractic, naturopathic doctor, dentist, nurse practitioner (NP), physician assistant (PA), registered nurse, registered dietitian, acupuncturist, pharmacist, or an equivalent degree from countries outside of the U.S.
According to the IFM, the typical length of time to complete a degree in functional medicine is 18 months to two years. In collaboration with the Cleveland Clinic, the IFM offers the Center for Functional Medicine, a facility that provides care focused on the practice of functional medicine “as a proven clinical model within the standard of care.” The team on staff includes nutritionists, health coaches, and a behavioral health therapist, who have all been trained in the practice of functional medicine, is involved in research across the Cleveland Clinic health system, and is closely measuring its patient outcomes, according to Cleveland Clinic officials. The staff has grown to nine physicians, certified NPs, and PAs who are certified or are in the process of becoming certified, according to Cleveland Clinic officials.
At a time when U.S. adults are not living as long as advances in medicine would seem to indicate that they should, those in the field of functional medicine are taking the opportunity to suggest that providers and the general public consider their services as a chance to improve outcomes, particularly when a provider has determined that the patient is otherwise healthy yet the patient does not specifically feel “healthy” or may believe that he or she is symptomatic without the identification (or a ruling out of) a root cause.
“Functional medicine is particularly helpful for patients who have been to a succession of specialists, who each conclude ‘no problem’ and have no answer for the question, ‘Then why do I feel so terrible?’” says Dr. Ron Grisanti, DC, founder and director of the Functional Medicine University, an online training program for practitioners that launched in 2006, serves healthcare professionals in more than 80 countries, and is reportedly the oldest online certification training school of its kind. “Using functional medicine techniques and principles, we are able to uncover an individual’s unique sensitivities, infections, imbalances, deficiencies, malfunctioning’s, and stresses, which we can then address with nutritional support, lifestyle changes, elimination of toxins, and other scientifically proven natural therapies,” Grisanti said in a prepared statement. With life expectancies in the U.S. down to 78.6 years2 and reportedly the first time the country has seen a loss in this metric since the flu pandemic of 1918,3 his sentiments may have some influence. Health experts are inclined to think that the decrease is due to numerous factors, not one glaring issue, which brings with it a more generalized concern and the stigma of a generally unhealthy population.
With treatment geared toward a return to optimal functioning and relief from suffering as opposed to the healing of a body system diagnosis, the field is also being recognized as evidence-based and a potentially better alternative than employing a “health coach.”3 Patients can determine a provider’s credentials, and with healthcare costs continuing to rise, the trend of functional medicine as a healthcare consideration is expected to similarly rise.3
References
- The Functional Medicine Approach. IFM. 2019. Accessed online: www.ifm.org/functional-medicine/what-is-functional-medicine
- Why Life Expectancy in the United States Is Lower Than Cuba or Slovenia. Healthline. 2019. Accessed online: www.healthline.com/health-news/why-is-us-life-expectancy-so-low
- Weintraub, L. Americans are not living longer, healthier lives. Can functional medicine change that? Los Angeles Daily News. 2019. Accessed online: www.dailynews.com/2019/08/08/americans-are-not-living-longer-healthier-lives-can-functional-medicine-change-that
