Defining the Role of a Health Practice
A Healthy Practice
Participants include:
• Jacob Teitelbaum, MD, Kona, HI, www.endfatigue.com
• Cheryl Burdette, ND, Progressive Medical, Atlanta, GA, www.progressivemedicalcenter.com
• Sara Gottfried, MD, Founder and Chief Medical Officer, Gottfried Institute for Functional Medicine, Berkeley, CA, www.saragottfriedmd.com
• Holly Lucille, ND, Healing from Within Healthcare, Los Angeles, CA, www.drhollylucille.com
For many patients and clients, the concept of “healthy practice” is rather murky. Americans are now keenly aware of the role of healthy lifestyle, diet and exercise, as well as dietary supplements in promoting better health and well-being. Yet many still continue to visit their allopathic physicians when symptoms present, and do not think to discuss or inquire about the impact of their diets and lifestyles, much less request professional guidance in these areas. Typically, the results of these doctor visits are pharmaceutical prescriptions or OTC (over-the-counter) recommendations, and/or further testing. Although many allopathic physicians will advise to exercise and give some basic diet advice to control weight, blood sugar, cholesterol and blood pressure, for the most part, that’s about the extent of it. Several practitioners discuss what it means to have a healthy practice, what you can do to create further community impact, and how to weather any challenges.
NP: Please describe your mission, philosophy and specialty with your practice.
Dr. Teitelbaum: Our mission is to empower people with the information they need to thrive.
Dr. Burdette: At Progressive Medical, the clinic where I practice, my mission is to help each person achieve optimal wellness. Optimal wellness allows people to maximize their potential and their contributions to community while on planet earth. Many forms of treatment in medicine are designed to blunt symptoms. Treating symptoms is important, but it’s not the only piece. If we can diagnose and treat symptoms, we have started to improve whole-person health. But if we then ask the question—what is causing the symptom(s), we have a more complete response to patients’ needs. Often, symptomatic treatment is merely a Band-Aid, but as we search for the cause we can address what is at the heart of the issue and more successfully move signs, symptoms and pathology into remission.
Dr. Gottfried: I came to my mission the hard way: in my 30s, I constantly felt tired, overwhelmed, cranky, chunky and frumpy. I couldn’t lose the baby weight after having two kids. I was a stress case, in couple’s therapy, and suffered with premenstrual syndrome (PMS). I went to my doctor who offered Prozac and birth control pills—and even though I was trained to offer women like myself the same cocktail—it no longer felt right.
I decided to apply my medical training to myself, and I discovered my cortisol level was two to three times the normal range, and which my traditional doctors told me wasn’t a big deal. Within one month, I corrected my cortisol and felt enormously better. My PMS resolved and I started to lose stubborn weight. I took on my low thyroid next, and then my estrogen dominance. I ate differently, exercised less, and took three supplements. I lost 25 pounds and graduated from couple’s therapy. I was on to something!
I reclaimed my life. Using my own journey as a source of inspiration, I have created several online programs to help other women reclaim their lives—whether she struggles with the number on the scale, feels irritable, or never wants to have sex again. I’m a gynecologist, but I don’t treat problems. I don’t even treat symptoms: I specialize in root cause analysis because I know—and evidence shows—that the greatest health transformations are triggered when the root cause is addressed. That’s the basic tenet of functional medicine.
I treat people. Mostly, I treat women. I see women—and what I see every day is that each woman is a special snowflake. Sometimes I prescribe supplements that fill nutritional gaps that she might have. Sometimes I prescribe an iPhone app that helps her connect to her heart. Sometimes I prescribe botanical therapies with a very low risk profile. Sometimes I prescribe bio-identical hormones. Many times I prescribe all of the above. With every patient I see, I consider her unique context, physiology and preferences…and then invent a treatment plan to promote maximum health and happiness. It’s not one method fits all. It’s not fix-’em-up-and-send-’em-home. It’s a mission.
My mission is to help women feel sexy, vital and balanced from their cells to their souls. That means getting your weight right where you want it, getting your energy and sex drive maximized, and doing it all naturally and safely.
Dr. Lucille: When thinking about the word “healthy,” and trying to define it to my satisfaction, I came across a word I love even better—Eudaimonia—which means “human flourishing.” That’s my mission.
I believe in the science, art and mystery of healing and I have a heartfelt passion for the individual wellness of all people. In my private practice, Healing from Within Healthcare, I focus on comprehensive naturopathic medicine and individualized care.
NP: In your expert viewpoint, what are the elements that constitute a healthy practice?
Dr. Teitelbaum: I believe in two tenets. One is being authentic by being honest with yourself about with what feels best to you. This will take into account both the needs of the people you’re treating and your own well-being. The second is empowering people by giving them the information needed to make informed choices.
Dr. Burdette: Healthy practice can seem wildly complicated. Every diet book tells you something different. If we follow the media, one day something is good for you, the next it’s bad for you. There is a lot of conflict about what is healthy, but there is also a lot of consistency. The consistency is there is no debate that improving nutrition by increasing vegetables in your diet is good for you. There is also no debate that high levels of free radicals and stress are bad. If we can lower free radicals, reduce stress and improve nutrition, many symptoms will improve and the root cause of disease can be calmed. These are pillars of health that ring true.
Dr. Gottfried: I believe that a healthy practice encompasses preventative, proactive and lifestyle-based approaches, with an emphasis on the role of the individual and his/her responsibility when it comes to daily choices, habits and long-term consequences.
I believe that the alliance and collaborative relationship between doctor and patient is imperative to a healthy practice. Women need to feel empowered in order to heal. A healthy partnership can bring about repair, healing, harmony and hope.
Dr. Lucille: Transparency, integrity and personal balance, along with the willingness to fail and learn. You must be willing to continue to assess and grow. Healthy communication and boundaries are also important for a successful practice. Achieving and sustaining a personal balance with life and work helps exemplify what you espouse.
NP: How do dietary supplements fit in to a healthy practice?
Dr. Teitelbaum: Dietary supplements are an important part of the toolkit to help people get well safely, more effectively and at lower cost. In a healthy practice, the sale of supplements, just like doing procedures in a standard medical practice, supports a practitioner so he or she can spend time with the person, and keeps the number of hours one needs to work each week lower to prevent compassion burn out. I would note that 28 hours a week of direct patient care is a lot. Consider doing other work to make up the additional hours if needed.
Dr. Burdette: Dietary supplements can help to replace what we can no longer get from food. For instance, the major pesticide used in the U.S. was originally designed as a chelater. A chelater is something that can grab nutrients and pull them out. We use pesticides that literally pull the nutrition out the soil and consequently, the food that’s being grown in the soil. Add to that increased pollution in the environment, and higher levels of stress and you have the perfect recipe for broad nutritional deficiencies. However, it is not entirely a story of doom and gloom, as we can replenish what we have lost.
Supplements build for us a level of protection, or as I call it, the “light-weight bullet proof vest.” Supplements can give us protection without weighing us down. For example, we all know the profound impact of broccoli. It is a potent antioxidant, decreases the risk of cancer, and can help people detox in a challenged environment. By taking a capsule a day of the powerful compound found in broccoli, glucoraphanin, we can add the equivalent of a serving of broccoli to our body instantly. While you could get this from diet, it would be difficult to maintain daily. Studies show there is a dose response to glucoraphanin, meaning the higher the dose the better, so this is a realistic way to achieve the positive outcomes seen in hundreds of studies. In addition to prevention, we can use higher levels of nutrients to treat conditions such as hypertension, fatigue and obesity. They are powerful tools that can positively affect parts of the wellness arsenal.
Dr. Gottfried: I believe in “food first” for healing, but dietary supplements are important for filling micronutrient gaps and as tonics. Dietary supplements are a safe and effective approach to resolving many neuroendocrine problems, from insomnia to anxiety and PMS, and I believe they can be a positive addition to a healthy practice. In my first New York Times bestseller, The Hormone Cure, I offer evidence-based protocols for the top seven hormone imbalances that women face—the protocols include proven supplements. In a healthy practice, the practitioner works closely with the patients to determine which dietary supplement they will benefit the best from, and start with a single supplement, at least initially. I’m not a fan of “spray and pray” with a long list of supplements. It’s confusing and probably unnecessarily alters feedback loops. Give the supplement the necessary time to take effect, and return the patient to homeostasis. Dietary supplements should be taken in conjunction with lifestyle changes.
NP: How can healthy practitioners thrive in the modern health care environment?
Dr. Teitelbaum: Work for the client instead of the insurance company. You’ll be much happier. To do this, you need to offer people help that is not readily available from standard practitioners who take insurance reimbursement. This is pretty easy, as standard medicine is very poor at addressing fatigue, pain, fibromyalgia and health optimization, as well as using anything besides surgery and pharmaceuticals.
Dr. Burdette: The health practitioner must operate in a challenging environment. Negotiating a different philosophy in a landscape of changing insurance and health care rules can be tricky. However, even though the power of nutrition in medicine has not been fully recognized by the health care industry, patients at increasing rates are demanding it. There is greater acceptance of the importance of diet and lifestyle change and, some are beginning to realize this is the only way we will change our health care costs. More important than health care costs, this is the only way we will truly change health! While there are complications, for the most part, patients want to be helped and are looking for answers that treat them as a whole person. Sure, there are obstacles in terms of access to natural therapies, but when you can reach a patient there is generally a favorable outcome. The research and patient outcomes continue to support the use of natural therapies. Given the success of this approach it will continue to grow, and when people get well, like ripples in a pond, their health affects their families’ health, their communities’ health, and ultimately a shift in the paradigm of medicine. Even something as simple as nutrients from broccoli and other vegetables can restore quality of life, and when enough people feel good about themselves, all change is possible.
Dr. Gottfried: I believe that the modern health care environment is heading towards more personalized lifestyle medicine and DNA-based functional medicine protocols that address genetic variations and the exposome, or the aggregate non-genetic exposures from conception onward.
Dr. Lucille: Slowly but surely, patients want more from conventional Western reductionistic care. And I think healthy practices can continue to thrive through educating and doing very good work. When you do good work, you empower people who start feeling better. When they feel much better, the word-of-mouth will spread like wildfire.
NP: What are the significant challenges imposed upon today’s healthy practice—and what do you feel can be or needs to be accomplished to overcome those challenges?
Dr. Teitelbaum: You are competing with practitioners on a treadmill, who are forced into seeing more and more people in less time. Again, take the time to get a sense of what inspires and excites you in the healing arts and focus on that. And then let the public know what you have available.
Dr. Gottfried: As medical practices have become increasingly technical and specialized, the time available to devote to more complex issues including women’s health, lifestyle choices and root cause analysis has become increasingly scarce. In fact, the average appointment with a doctor in this country lasts seven minutes! I strongly believe that longer appointments can allow for a dialogue between practitioner and patient and create a collaborative partnership, with the patient playing an active role in his or her own health.
Additionally, conventional medical practices focus heavily on identifying and treating symptoms—doctors have been trained to fix what is broken in the body. Practitioners should be encouraged and trained to offer a lifestyle-based approach to their patients. Better lifestyle choices can prevent many diagnostic procedures and treatments and save an enormous amount of money, which can be invested in other areas, such as personalized lifestyle medicine. A more integrative and functional approach has been shown to be extremely effective when applied to hormones, mood, longevity, stress related problems and disease prevention.
NP: What advice would you give to practitioners seeking to open and cultivate a successful healthy practice?
Dr. Teitelbaum: Give health food store lectures on these topics as well as become an expert source for the local news media to market your practice by supplying helpful information.
Dr. Gottfried: First, take care of yourself and heal your wounds—most practitioners have some degree of adrenal dysregulation, hormone imbalance and gut problems. Deal with those first so that you come from a place of fullness and experience when helping patients.
Second, create your vision of what you want your practice to be. For me, it took 18 months to build a bridge from my McMedicine job at the local health maintenance organization to my boutique practice of natural hormone balancing. Keep iterating until you have the right fit between your nature, your vulnerabilities and your practice.
Stay open and curious. When things become rote or you feel burned out, that’s a sure sign that some part of you is not integrated into your experience. It’s your sacred duty to integrate.
Dr. Lucille: Adopt a willingness to fail again but fail better; learn from mistakes, and tolerate those that didn’t work out too well. Additionally, get good help with aspects that you are not skilled or adept at, such as bookkeeping, maintaining social media, etc. This way, you are allowed to do what you do best.
