I recently had Dr. Andrew Lenhardt on my podcast, talking about the intersection of functional medicine and traditional medicine practiced in the United States. During the show, we talked about how some practitioners can seem to take advantage of their vulnerable patients by ordering numerous, expensive tests and making a large profit off the supplements they prescribe. Dr. Lenhardt and I have both had desperate, sick people come to us with fancy, colorful (and often meaningless) reports and bags full of expensive pills.
The following week, I got an email from Lisa, asking how people should go about choosing a practitioner. She went on to describe how she’s now on her third practitioner, having first started with a “holistic medicine practitioner”, then a naturopath, and finally a functional medicine doctor. In each case, she paid out of pocket for blood work and other tests, expensive supplements, only to still find herself not “cured” and exhausted, mentally and physically. At the end of her email, she wrote this:
“How do you find a trustworthy and reliable practitioner who you know has your best interests at heart (health wise AND financially)? It hasn’t been until after I’ve met with each of these practitioners and spent an ungodly amount of money before I realize they weren’t the best choice for me. How do you filter through all of the practitioners out there? I just want to feel healthy again. Why does the process of finding and working with a practitioner have to be just as stressful as the health problem itself?”
For those of you with complex chronic medical issues whom have already seen 5, 10, 15 or more providers, this is a summary of what I would consider:
1. Experience: If you have multiple systems involved, you will often need someone trained in a more holistic approach. This could be a provider certified in “functional medicine” through IFM, a naturopath, an expert in traditional Chinese medicine (TCM), an expert in Aryuveda or other. It is always preferable that the person has years of clinical experience working with people. It is one thing to go through training, but another to have worked with many complex patients/clients. Ask how many years they have been managing real people or how many they have worked with especially with your particular issues.
2. Humility: I don’t care who the practitioner is, sorting out issues of pain, fatigue, headaches, bowel problems, etc. is challenging. Be wary of someone who acts as if they have it all figured out. It is common for practitioners to develop tunnel vision. It is human nature to cherry pick our successes and ignore failures. The Lyme expert sees everything as a tick-borne illness with co-infections. The mold/biotoxin expert sees CIRS. Best is to have a working diagnosis and a working plan that may need to be adjusted over time. I have seen people on three antibiotics, an antifungal, an antiviral and innumerable supplements for over 10 years in poor health, but the Lyme practitioner still plows forward with that as the primary issue.
3. Practicality: I work with each person not only based on their individual health issues, but also their preferences, priorities and budget. If you see someone who wants hundred and hundreds of dollars of testing and seems to order the same 50 pages for everyone, you may need to look elsewhere. If they only work with one lab or one supplement company, that can be a red flag. That said, it often takes a lot of different tests to help sort things out. Money invested up front will often save more down the road if it gets you on the right path earlier. There may be no way to figure things out without incurring significant costs since the health insurance companies have no real interest in your long-term wellness.
4. Empathy: The person should be easy to work with and show compassion for you and what you’re going through. You each should be able to talk for a reasonable amount of time without interruption. That said, you will have limited time at visits and you are probably paying out of pocket, so I would try to make the time productive.
Words of advice to you as the patient/client…
1. Work with One Person: Try to keep the number of gurus and experts as low as possible. You may have to meet with a few once to screen them, but try to have just one practitioner who works collaboratively with you to get you better. The more people giving you advice, the more difficult it will be going forward with recommendations that conflict with each other.
2. Stick to the plan. If you have a good person helping you, it will probably only work if you stay as close as possible to what they recommend. If they recommend five things and you do three, they will be legitimately frustrated at the follow-up visit. If you don’t agree with a course of action…
3. Speak up. This should be a collaboration. If you have questions or concerns or you don’t think things are going in the right direction, you can’t stay passively on the side hoping the practitioner will read your mind. It is your life and your health. You need to do a lot of research and be involved. There is only one person who knows you best, Dr. Ruth. No, I’m kidding, its you. I sometimes joke (although no one ever finds it amusing) how curious it is that everyone in the world has the same favorite subject.
4. Be patient. It probably took many years to become ill and it usually takes many months or years to sort things out and return to a state of wellness. Focus on the positive. Consider a diary to track progress. You may not think you’ve improved much until you go back and read some early entries. Don’t double or triple some supplement hoping it will get you better faster unless you discuss it with the practitioner.
5. Be specific about your goals and priorities and keep the provider honest. I have seen tests and supplements utilized that gurus have used that did not seem relevant to the most important health issues for the individual.
6. Maintain Your Regular Providers: In a perfect world, your traditional physicians and any outside practitioners would all work together in a seamless tapestry of total wellness optimized for everyone. This may be a lofty goal, but your regular doctors, nurse practitioners, nurses, etc. are also hard-working, dedicated people doing their best for you. If they are open-minded and supportive, they also may help you order tests and treatments such that they are covered by insurance.
– Andrew Lenhardt, MD
Dr. Lenhardt is the Medical Director of Lahey Hamilton – a practice with over 6,000 patients that has consistently been awarded the highest quality scores within the Lahey system. He is an Assistant Professor of Medicine at Tufts Medical School and the author of The Best of All Worlds – A Family Doctor’s Path to Integrative Medicine.
Dr. Lenhardt’s primary goal is to target the root causes of illness and to provide patients with the tools to achieve optimal health. While a focus on prevention is critical, he is able to incorporate the principles of functional medicine, naturopathy, ancestral health, diet, and lifestyle in caring for his patients. His blog, drlenhardt.com offers concise commentary and advice on critical issues that affect us as individuals and as a community.