Fifty years ago, doctors spent much of their time addressing minor trauma, infections, and the like. Would you contrast the presentation of those patients with the circumstances of the patients most often seen in today’s practice? How has this profile evolved recently, even over the last five years?
Dr. Kamani: There has been a significant shift with less time spent by doctors on acute infections and minor traumas and much more time spent on addressing the symptoms and sequelae of chronic conditions. A most remarkable statistic is that one in four Americans has multiple chronic conditions, or MCC, including one in 15 children resulting in over 65 percent of total health care spending associated with care for those with MCC. Of note is that women are more likely than men to have MCC.
Has anything changed in regard to the reason patients seek medical care? Are they asking different questions?
Dr. Kamani: There has definitely been a shift in the kind of care that people are seeking, with significant growth in out- of-pocket spending for complementary health approaches. Visits to complementary practitioners are the largest portion, followed by purchases of natural products as you can see from the slide excerpted from my presentation.
As far as the type of patients that seek functional medicine care, LivingMatrix is the first and largest database of functional medicine cases. Of the patients typically seeking functional medicine, 76 percent are female and the bulk of patients—78 percent—are between the ages of 31 and 70. They report having an average of four active chronic conditions and two past conditions.
The top reasons for seeking a Functional Medicine practitioner include:
- gastrointestinal, IBS, or abdominal complaints
- neurological or psychiatric issues
- cardiovascular, circulatory, or lipid issues
- thyroid issues
- skin, hair, or nail issues
- sleep issues
How has access to information changed the conversation with patients?
Dr. Kamani: The functional medicine patients are quite well informed and many of them have already experimented with nutrition and lifestyle changes before coming to a functional medicine practice. For example, more than a quarter of them have attempted a gluten-free, dairy-free, or other special diet; 70 percent of patients report doing some form of exercise, even though the majority report limitations with exercise; and over 50 percent report using some form of relaxation techniques.
Is the gap widening between patients that are extremely invested and those that “just want to be fixed”?
Dr. Kamani: The patients that end up at functional medicine practices are highly invested and are actively seeking alternatives to the pharmaceutical model of care. They are also highly activated, and on the LivingMatrix Readiness Assessment they report high levels of willingness to make changes in their lifestyle, diet, etc. This is in striking contrast to most patients seen in a primary care practice where activation levels are low. For example, national rates of primary adherence for medications are only in the 70 percent range. In other words, a full 30 percent chose not to fill a prescription given to them by their doctor.
Are patients more likely to have been treated by another practitioner? How about other modes of care?
Dr. Kamani: The majority of patients coming to functional medicine practices have been through the regular medical system and have not been satisfied with previous care. Many have been told by specialists that there is nothing more that can be offered. The IBS patient is a classic example where an extensive work-up, often including a colonoscopy and multiple tests, results in being told that there is no evidence of serious GI issues. The patient, however, may still be in significant distress and unable to be fully functional.
As research reveals that a common dysfunction in the body may manifest as multiple chronic illnesses, depending upon the individual, what tools and skills must a clinician sharpen in order to get to the root cause?
Dr. Kamani: The health condition or conditions that a patient presents with are often the outward manifestation of multiple biochemical and physiologic imbalances that may trace their roots prior to or during birth, in childhood, or early in one’s life. It is important for the practitioner to understand the antecedents—the patient’s genetic profile as well as the environmental and other triggers that may be playing a role.
To effectively assess what is going on, it is important to understand the patient’s entire history. The timeline is a powerful tool for summarizing this history and identifying patterns, potential triggers, and mediators. If these are not effectively identified and addressed, the patient will likely fail to progress.
Additionally, mapping issues to the seven imbalances of the Functional Medicine Matrix helps the practitioner directionally determine where imbalances are likely and generate the test-treat strategy.
What are the two or three primary points that you want practitioners to take away from your presentation?
Dr. Kamani: Functional medicine patients are typically different from the conventional primary care patients. They are often educated, have likely experimented, and are typically ready to take action. However, they also come with a healthy sense of skepticism, having been through the system. The most successful practitioners make sure that patients feel their story has been heard, spend time educating them so they understand the “why,” and effectively harness the power of a strong therapeutic partnership with the patient. Providing a personalized plan to the patient, the most successful practices use subjective and objective measures (like the MSQ and the PROMIS Global Health Assessment) to deliver superior health outcomes for their patients.
Priya Kamani, MD, is founder and CEO of LivingMatrix, Inc, located in Glen Allen, VA.