Teamwork: The Doctor / Patient Relationship

The moment I enter the exam room with people, my approach is, “What can I do to help you?” and, “How can I make your life better?” People often smile or chuckle at this and say, “No doctor has ever asked me that before.” This genuine care and connection with people is what I love about being a doctor and a healer. The process begins even before I see a person for the first time. As most physicians do, I ask them to fill out the usual family and personal medical history information, but I also give them a more detailed personal history and medical symptoms questionnaire before the first appointment. This isn’t the usual sort of medical form, however. I want to know all about you. I want a true head-to-toe perspective to have a complete view of your health. It starts with your head, asking about headaches, faintness, dizziness, and insomnia, and then it moves on to questions about your eyes, ears, nose, mouth, and throat. I also ask about your skin, your heart, your lungs, your digestive tract, and your joints. That’s all the medical stuff. But in functional medicine, we look further. I ask about your weight, your energy level, your physical activity, your mind, and your emotions. But I don’t just stop there. I ask about your current health problems, your past problems, your early life, your childhood, and even about the time in your mother’s womb (if you have access to that information). It’s all pertinent because it all influences who you are and the balance that you have or don’t have. And most importantly, I see people as a combination of many forces, all of which have separate needs and balances. I do this because your body, your mind, and your spirit can’t be separated; they are all one and are each essential parts of what make you uniquely you. The questionnaire and my initial intake forms are good starting points for an office visit. In the exam, I’ll ask about what the Institute of Functional Medicine calls the ATMs: antecedents, triggers, and mediators. I ask open-ended questions—not the yes and no type— designed to probe not just the physical but also the mental and spiritual aspects of your life. I’ll say, “Tell me about what you eat. Tell me what your sleep is like. Tell me what your activity and movement is like.” That’s the physical component. Then I say, “Tell me a little bit about your stress, your community, and your relationships.” Then I say, “Tell me what you believe in. Tell me the sorts of things you want to accomplish. Tell me some of the things that you look forward to. What makes you come alive?” I want to see the whole person, not just a collection of symptoms. If you tell me on the questionnaire that you have achy joints, we’ll go into that more deeply to find out when the problem started, what sets it off, and what seems to help. A traditional doctor would ask far fewer questions and would quickly reach for the prescription pad to give you a powerful anti-inflammatory drug. As a boardcertified internist grounded in traditional medicine, I prescribe these medications when they’re needed, of course, but my first step would be to take a broader view. Drugs will help relieve the symptoms in the short term, but what about the underlying causes and the long term? Could more activity and physical therapy help that aching joint? Would herbal supplementation or botanicals work? And let’s not forget that dietary changes and weight loss often help. We talk about all the possible treatments. I ask the person what her goal is and what she’s willing to do and what she won’t do. I base my recommendations on what the patient tells me. I call these deal breakers. They’re essential to knowing your people as well as knowing the best approach to each one. In addition to taking a standard personal and family history, I also use active listening and active interviewing techniques to learn more. In functional medicine, we want to know more than usual about your family history and your younger years. For example, I want to know as much as possible about you before you were born. Did your mother have bad morning sickness? Did she get sick? Did she have any complications, like gestational diabetes? Were you born via C-section? Did you get breastfed? Did you have a lot of antibiotics when you were a kid? All these things matter! Then I’ll say, “Tell me a little bit about what your young years were like. Was there anything significant in your childhood, the sort of thing your mom told you about?” We go into later years, looking for significant events that shaped your life. Then I go back to the past six months or even a year, prior to the beginning of the current health concern. We often find that a significant or even traumatic event happened just before things started to decline. Functional medicine says that balance in your body is what gives you good health. Imbalance throws you off. When you have a major life event, the stress can affect your health by pushing one or more systems to the limit. If there’s already a susceptibility, that’s the system that will get out of balance and disrupt your health. Think of it as a juggling act with spinning plates. When your system gets out of balance, the plates come crashing down. A traditional doctor will say, “Of course you feel terrible. Your plates are broken.” A functional medicine doctor says, “What are the long-term imbalances that broke the plates? What are the environmental factors and genetic predispositions that got you out of balance? How can we work together to fix them?” Rebalancing is a process. In traditional medicine, your doctor would say, “You have an infection. Here’s an antibiotic. The infection will be gone in ten days.” That approach has its role, and I take it when it is appropriate. But for longer-term problems, the functional medicine approach is, “You’ve had some imbalances and disturbances. We have to look further and take some time to repair them because usually there’s more going on than meets the eye. We don’t want to miss anything.” We can often fix the imbalances by changing the diet. Food is foundational; food is forever. Food is a key element, but it may take a longer time to make a difference than symptom-relieving prescription
drugs. In fact, it could take up to twenty to thirty months of eating a better diet to change your internal environment. Still, I want to get to the roots, not the leaves. Once your plates are broken, though, you may not want that timeline. Most of my people say, “I need to get this fixed faster than that.” That’s where nutraceuticals—foods that act like gentle drugs—and supplements come in. They can give a more rapid response. You couldn’t eat whole sprigs of rosemary, but you can take a capsule that contains concentrated amounts of rosemary oil. My traditional medicine colleagues call this pixie dust. Well, okay, I’m willing to make deals with pixies because they can’t do much harm. I’m much less willing to prescribe the dark magic of powerful drugs. I only make those kinds of deals when there is no other option. After all, dealings with Voldemort or Maleficent are much scarier and have bigger consequences. In modern medicine, the body is seen as a machine; each part is important but may or may not interact with any other part. And when a part is broken, you fix it or replace it. In traditional Asian medicine, the body is seen more as a garden. I like to take the garden approach. The plants that grow best in your own backyard are species that are native to your area. They’re well adapted to the environment, so they’re hardy and will grow without a lot of extra watering and fertilizer. But even native species won’t do well if they’re in the wrong environment. A plant that needs a lot of sun and not too much water won’t do well in the shade. You have to know your own internal environment and choose what will work best for you in terms of diet, exercise, sleep, and everything else. As a functional medicine doctor, I work to help you achieve and maintain that understanding so you can thrive. Many of my people have been to other doctors, sometimes many other doctors, without getting any real help. By the time they see me they’re usually at a high level of frustration, hopelessness, and even mistrust toward traditional medicine. After our first interview, they’re thrilled. At last, a doctor has really listened to them—probed and questioned to get down to the real problem—and finally has taken their problems seriously. They often tell me, “I came into your clinic feeling hopeless about my condition and circumstances, but now, after meeting and listening to you, I have hope again.” Comments like that are what make me feel alive, keep me going, and make me love my role in functional medicine.

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