How is Functional Medicine Different from Conventional Care?

How is Functional Medicine Different from Conventional Care? 
By Cortney Katz, CFMP, PA-C
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   When I first met my husband, I was working in an in-patient setting where there was a revolving door of obstructive lung disease (COPD), heart failure, and life-threatening destruction of body tissue from diabetes. As you can imagine, repeatedly treating end-stages of preventable and - at earlier stages, often reversible- disease isn’t the most gratifying way to use my medical knowledge. Wasn’t I meant to heal people?

  I had an interest in the growing field of Functional Medicine at the time, but had not yet made the big, necessary moves to start a Functional Medicine fellowship. Meanwhile, my husband was a healthy and fit man who nonetheless wished to continue to  improve his overall well-being. He would ask his doctor for advice. The doctor would simply reply, “Keep doing what you’re doing”, or, “You are healthy.” 
 
  Perhaps you know someone who has gone through something similar. They may consult with their doctor about a lingering issue, and there is nothing on the blood work that shows up as a “disease,” so they are told they are therefore “healthy.”  For others, they may wish to improve their health baseline through supplements or other methods. In both cases, to a traditional physician, “health” is always and simply defined as “absence of an overt disease.”  

  My husband knew of my passion for health and wellness, and he began picking my professional brain over minute details he could change in his diet, or supplementation or exercise to improve his overall quality of life and health outcomes. At one point he stopped to ask, while noticing improvements beyond his “healthy” baseline status, “Why hasn’t my doctor offered to help me when I’ve asked for these changes?”

  Sometimes the simplest question can reveal a profound truth, and this was one of those times. I explained that conventional medical education does not train professionals to understand “wellness,” “nutritive value,” and “preventative approaches.”  This is a sad truth, and is also possibly a reason (in addition to burnout) that many medical professionals themselves appear unwell. 
  
  In contrast to the traditional model approach, Functional Medicine is a growing field of health care that focuses on restoring order to physiology (the science of how the body works) by treating the body as one interconnected system, rather than focusing on disease states of the body. This commonly leads to finding the root cause of chronic medical problems. 

  While conventional care has made great advances in acute interventions, such as strokes or trauma, the current internal medical model for “chronic” conditions can be referred to as a disease-centered approach.  Simply put, we focus on treating diseases and managing symptoms, and not on preventing or properly determining the cause of them.  Perhaps that is why 80% of our healthcare costs go toward chronic illness with very little - if any- return on investment.

  Now that we’ve looked at how Functional Medicine differs from the conventional model, I’d like to offer five problems with conventional medicine that are solved or alleviated by Functional Medicine, so that you can better understand how the Functional Medicine approach can help you to achieve your health goals (if you happen to think like my hyper-fit partner). 

1. "Disease" has a definition, but there is no definition of Wellness.  There is no generally accepted medical definition of "well" in medical school, but on the other hand, "disease" is well defined.  In conventional medicine, there is a black/white model of "disease"/"no disease," whereas in real life many chronic medical conditions are systemic and may not be traceable to any one disease, so that these "grey" conditions fall through diagnostic cracks, and are very difficult to quantify.  This becomes that patient's baseline of "well," but they are not in fact well.
2. "If it’s not officially "broke" (that is, a disease), then don’t fix it." This maxim replaces the tenet of "First, do no harm” for many practices.  Even with experienced practitioners, there is a reluctance to diagnose even with a high level of evidence, if the lab tests do not agree entirely.   This is because lab results are easy, clear & uniform, and function as powerful sources preventing liability.
3. “Time is Money,” according to the insurance industry.  Evidence-based care has been replaced by “Reimbursement-based” care.  It takes a substantial amount of time to truly listen to a patient and to comprehend the trends in their health history, in order to detect root causes.  On the other hand, taking blood pressure takes a minute and prescribing blood pressure medication takes another few minutes. The doctor gets reimbursed more frequently, does it "by the book,"and can thus can bill more with a lower likelihood of lawsuits.  This is good for the doctor's bottom line, but not great for patients' health. Therefore, from the conventional standpoint, a practitioner who wishes to spend more time making the proper diagnosis based upon the medical history and the whole body is “wasting time.”  For the Functional model, this diagnostic time is critical and leads to treatments that are longer-lasting and heal the entire body, not just a symptom.  
4. Medicine is "Siloed."  The world of medical professionals is a world of superspecialties.  This is good if you need a brain surgeon immediately. However, for non-acute conditions, this "silo" perspective is insufficient. The proper diagnosis and care is only truly knowable with Functional Medicine's root-cause and pan-systemic approach, which requires a more general understanding of the whole body and all its systems, rather than knowing everything about a single sub-system.  
5. If the doctor can't find a disease, the answer is "Psychiatry." A psychiatric diagnosis is the catch-all end-game when the doctor doesn’t have an answer from lab tests. That is, if someone has symptoms but no clearly diagnosable "disease," after multiple attempted tests, the most common outcome is psychotropic pharmacopeia, which is not optimal for health, but easier than trying to find the root cause of the problem

  This may not sound like the best possible outcome, but it’s not your doctor’s fault.  First, as noted, primary care physicians are so overworked in our current medical model that their short visit times do not allow them to focus on prevention. (Sadly, this is heavily influenced by insurance payers and what they value.)  Second, there is a very strong emphasis on diagnosing and treating disease states, but very little placed on preventing them. For example, most medical doctors do not have more than a few hours of nutritional education. 

  How does this affect diagnosis and treatment? If we focus just on our anxiety we may fail to notice that it actually only flares up when we eat gluten and our gut is inflamed.  We may fail to recognize that the rash we get every fall is actually our body’s way of showing us the immense amount of psychological pressure we are under during the holiday season.  That's what we mean when we say we get to the roots of the problem and heal the body by treating the root causes of the illness. 
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  In our office we have a saying.  If you have a nail in your foot, you can take a pain reliever, but the pain will return very soon.  If you want to heal, you have to take the nail out of your foot. With Functional Medicine, we resolve the foot pain once and for all by taking out all the nails.