When I founded Dignity Integrative, my belief was that being able to develop an individualized life plan based on your biology, genetics and current risk factors would result in better overall health and wellness.
This year, I’ve learned a few lessons about starting my own practice and relating to patients in a very different way compared to how I practiced for the previous 25 years. Many of those learnings are from my patients and the business groups I’ve had the privilege to speak with around the country.
One of the most important lessons is that the premise of the four pillars of health and longevity:
...have turned out to be exactly the right focus.
Being able to develop a plan for patients to follow over the course of a year, guided by our health coach Teresa and myself, has delivered some amazing results. The fact that 70% of all chronic disease is PREVENTABLE and 99% of your health care happens OUTSIDE your doctor’s office has been confirmed.
Here are some other learnings from this year:
1. People are looking for a different type of relationship with the health care system. Instead of treating end symptoms like joint pain, fatigue, abdominal pain, insomnia and anxiety with drugs we need to be looking for the root cause.
Prevention and REVERSAL of chronic disease is possible when you take a holistic approach to personal health. My patients want medical practitioners who will listen to them and not rush them along—hence the reason the initial appointment can last two hours. They also want a plan to get better and not just a prescription.
2. Patients are confused by conflicting advice they get and need someone to parse the information for what is right for them. Something as simple as "diet and exercise" has become truly overwhelming. People ask themselves: should I be vegan, low carb, paleo, pescatarian, low fat or keto? Should I do high intensity, zone two, strength, or yoga, and in what proportion each week?
As always, it depends on where you start, your genetic risk factors, and what you want to achieve. The ability to tailor a program, follow biometric and lab markers, and see results is what each patient needs and deserves.
3. Hippocrates' statement 2,500 years ago that "all diseases begin in the gut" has been confirmed. The father of Western medicine was a pretty smart guy. He didn’t know about the microbiome or have advanced gut testing results to review but he did observe his patients and see how foods impacted their health both positively and negatively.
One out of four of my patients have serious gut issues which need to be corrected. I have seen more cases of small intestinal bacterial overgrowth (SIBO) than I ever expected and treating it is both challenging and rewarding. I tell each of my patients that nothing impacts your health more than the 2,000-2,500 calories you place in your mouth every single day. So choose wisely.
4. You have NOT lost the genetic lottery. It is incredible to me that some of my patients have been told this. They believe there is little to do except manage disease with pharmaceuticals. Nothing could be further from the truth.
Conditions such as Type 2 diabetes, non-alcoholic fatty liver disease, and chronic migraines are not only treatable, they are reversible. There is a saying in functional medicine that genetics loads the gun but environment pulls the trigger. That means we are ALL walking around with "bad genes." The issue is how are they expressed. There is clear evidence that a significant percent of cancers (30-40%) and dementia are PREVENTABLE.
5. This isn’t all in your head. I’ve had a few patients actually say this to me after their initial evaluation. They have been told their standard testing is "normal" and there is nothing more that can be done so it is something with which they must deal.
But chronic fatigue, brain fog, or chronic joint pain have an underlying cause in the vast majority of cases. Whether that be a chronic micronutrient deficiency that is impacting the ability for your body and BRAIN to process nutrients, food sensitivity or a gut dysbiosis (imbalance of good and bad bacteria we all carry), there is likely a reason if we look in the right places.
At Dignity Integrative, we will do advanced nutritional testing and gut testing to check for these issues as is appropriate. It is shocking the imbalances I have found, including a significant deficiency in B vitamins in myself despite a very healthy and clean nutritional regimen due to a particular genetic variant called MTHFR.
6. Lifestyle change is hard. On your second visit (about one month after the initial visit) we get together, introduce you to Teresa our health coach and lay out what the next nine months will look like. Most patients are excited to start and fully engage in making the changes that need to be done.
However, about 25% percent start and then fall off the calls with Teresa and do not make further progress. One out of ten fail to get started despite the initial desire to do so. While I tell my patients the pillars we will talk about are simple, they are not easy! If they were, then we would not find ourselves with 40% of the adult population being obese in the US as well as the rise in chronic disease we are witnessing.
The critical nature of personal behavioral change can’t be overemphasized. It is a process of small changes made monthly that will lead to dramatic results at the end of a year. How we can keep patients engaged in this process is something I continue to ponder.
It has been an honor for me to treat patients over this last year. In those conversations as well as speaking to hundreds of business leaders I’ve had the opportunity to be challenged and humbled. It is all I expected about doing something new and different. In the modern day version of the Hippocratic Oath there are three lines which resonate deeply with me:
I will prevent disease whenever I can, for prevention is preferable to cure.
I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.
I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.
Each doctor who practices is aware of this sacred oath. My intent is to continue to follow it with every day I am privileged to do so.