What a Better Model of Functional Medicine Looks Like

Clinician roundtable with Dr. Rob Abbott and Dr. Joe Mather.

On today’s podcast, I sit down with Dr. Rob Abbott and Dr. Joe Mather, who work with me at the Austin Center for Functional Medicine. We talk about the exciting things that we’re doing at the clinic to contribute to meaningful scientific research, foster collaboration, and get better patient outcomes.

In This Episode

Intro … 00:00:45
Research … 00:03:29
The Collaborative Approach … 00:14:59
Background – Dr. Mather … 00:21:38
Organization is Key … 00:25:03
Personal Health … 00:31:50
The Culture of the Center … 00:38:25
Episode Wrap-Up … 00:50:05

What a Better Model of Functional Medicine Looks Like - Podcast294 JoeMather RobAbbott

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Hey Everyone. I had a clinicians round table today with the two other doctors from my office, and they also have a little bit of an announcement to make more, to follow on our next podcast, but we are hiring another doctor at the office. So if you are an MD or DO, keep your ears open, more to follow there. Today I had a chance to expand upon what we’re doing at the clinic with doctors Joe and Rob from my office, and some of the initiatives that we’re taking on. How we’re trying to publish more research out of the clinic and hopefully set an example of how our field and clinicians within our field could publish more research and how it’s not that hard to do but can be very impactful and beneficial. Also what a healthy clinical culture looks like and what we’re doing as active personal participants in healthcare to keep ourselves healthy so that we can do a better job for our patients.

Then of course, more about what it looks like to participate in this kind of new age, newer model of Functional Medicine, really as a clinician in the practice and sharing some of our insights and pearls, not only for patients, but also for providers so that we can all talk this language of “here’s the good, here’s the bad”, and here’s how we can be selective in what we do and how we do it so as to have the best model possible. More to follow here with Joe and Rob. I think this was an insightful conversation and I really hope that you will also.

➕ Full Podcast Transcript

Intro:

Welcome to Dr. Ruscio radio, providing practical and science-based solutions to feeling your best. To stay up to date on the latest topics as well as all of our prior episodes, make sure to subscribe in your podcast player. For weekly updates visit DrRuscio.com. The following discussion is for educational purposes only and is not intended to diagnose or treat any disease. Please do not apply any of this information without first speaking with your doctor. Now let’s head to the show.

DrMichaelRuscio:

Hey Everyone. I had a clinicians round table today with the two other doctors from my office, and they also have a little bit of an announcement to make more, to follow on our next podcast, but we are hiring another doctor at the office. So if you are an MD or DO, keep your ears open, more to follow there. Today I had a chance to expand upon what we’re doing at the clinic with doctors Joe and Rob from my office, and some of the initiatives that we’re taking on. How we’re trying to publish more research out of the clinic and hopefully set an example of how our field and clinicians within our field could publish more research and how it’s not that hard to do but can be very impactful and beneficial. Also what a healthy clinical culture looks like and what we’re doing as active personal participants in healthcare to keep ourselves healthy so that we can do a better job for our patients.

DrMR:

Then of course, more about what it looks like to participate in this kind of new age, newer model of Functional Medicine, really as a clinician in the practice and sharing some of our insights and pearls, not only for patients, but also for providers so that we can all talk this language of “here’s the good, here’s the bad”, and here’s how we can be selective in what we do and how we do it so as to have the best model possible. More to follow here with Joe and Rob. I think this was an insightful conversation and I really hope that you will also.

DrMR:

Hey everyone, welcome back to another episode of Dr. Ruscio radio. This is Dr. Ruscio with Dr. Joe Mather and Dr. Rob Abbott, the two other doctors that are part of our growing clinical team. Today we’re going to be doing a clinicians round table talking about all the stuff that we’re doing at the clinic, good and bad. Try to share with you and pull back the veil a little bit of what it looks like inside of a collaborative, Functional Medicine practice. What we’re trying to do better, where we think the field could improve and the culture that we’re trying to build here at the office, both for clinicians and for patients. We just want you to be able to hear more about all of those facets and domains of healthcare and the practice. Hey guys, welcome back.

DrRobAbbott:

Happy to be here.

DrJoeMather:

Good times. And I think this is still gonna come out after, but we’re about to have our first get together as a team in Austin, which I am so excited about.

Research

DrMR:

Yeah, we’re going to have an in-person pow wow which will probably go off the rails, I’m hoping in a good way. There is a lot here that I wanted to unpack and maybe go into for our audience. Maybe to start with one of the nerdier would be the commitment that we’re making in the practice to research. If you go over to the Austin Center for Functional Medicine website, AustinFM.com. You’ll see that there’s a section for our clinic team and a section for our research team. I think that’s important to point out because one of the things I think the field could do better is have a commitment to research. Especially as people grow their clinic or their platform or their podcast or what have you, I’d like to see it become more commonplace for providers to be participating in the research process. It’s not easy.

DrMR:

It definitely takes a collaboration of all sorts of professionals and a high level of organization, and systemization to kind of make this possible, but that’s one of the things that we’re doing there.We already have a list of research objectives that we’re either tracking data on now for publication or that we will publish in the future. Again, really hoping that we can help perhaps make this more of the norm and obviously published research that answers questions. One I’ll just throw out there to really kind of nerd out, if you guys remember back to maybe a year and a half ago, Dr. Richard McCallum came on the podcast. He was the GI researcher that found SIBO seemed to be a top-down, meaning an oral downward phenomenon instead of a colon upward phenomenon. So we’ve been tracking gastrin on our patients for about a year, because gastrin according to McCullum could tell you that someone’s not secreting enough hydrochloric acid.

DrMR:

That might be why he was seeing SIBO more commonly occurring from the top down. So we said, okay, let’s add this simple blood marker to our LabCorp or Quest requisitions. Now that we’ve been running that for a while, we can do what’s known as a retrospective chart review, or we can look back in time and say, what was the agreement between these subclinical elevations of gastrin McCallum was positing and people having a SIBO breath test positive. Then we can learn from that and say, yes, there is an association or no, this doesn’t identify over chance, meaning it’s not significant. That can be really helpful because if that finding does predict SIBO, then that’s something the community should know about and should be more commonly incorporated into a workup. If it doesn’t, I wouldn’t say it rules it out completely. We’d want to have more follow-up research to either rule that more firmly in or out, but this is the kind of thing that we’re trying to do at the clinic. So, Joe and Rob, if you have anything you want to add…

DrRA:

Yeah, I guess it makes sense for me to chime in because I’ve been sort of leading the research organization front. I’ve been kind of fortunate to come in to our collaboration having designed and carried out every aspect of a full-on interventional clinical trial including a randomized controlled trial. So not doing that with a massive academic team you learn all the processes and the nitty gritty details of that. It’s a great experience. In those studies themselves, as Michael was getting at, we want to ask the right clinical questions. I really don’t care about finding an association between depression and IBS. That’s kind of obvious. We don’t need to study that or find that association anymore. Let’s ask meaningful clinical questions for the integrative Functional Medicine community.

DrRA:

We’re not trying to pretend like we’re an academic center that’s doing these massive clinical trials. We want to, in a methodical and curious manner, see how can we extract meaningful data from what we’re already doing and help to better answer questions. In the process, literally as we speak, we are building an organizational framework for us to build automations for patient forms, using validated questionnaires, such as the PHQ9, PROMIS 10, SF-36. Some of these questionnaires that we build into our practice and build structures to take that data and start collecting. Then we can start going back and asking questions. We’re already caring for patients. We just need a little refinement to collect that data. In the beginning, building a team that’s committed to that and systems that help you.

DrRA:

That’s what we’re trying to do as clinicians. We’re not trying to be researchers. We’re clinicians, but we’re clinician researchers. We’re trying to extract meaningful information. It’s something that just excites all of us, but I think there’s no better area to push into and to build systems that will help encourage other clinicians to see it. It doesn’t have to be that hard. Yes, there’s going to be some investment of energy and time to build those systems, but we need this perhaps more than ever, if we’re going to continue to push this field forward. That’s just one of our commitments but we’re also not trying to make it harder than it needs to be.

DrMR:

One thing to slip in there really quick would be that we used to use these general “how are you feeling” indices, but now we’re converting all of those over wherever possible to a peer reviewed symptom measure. This is important because now if we’re using something that’s peer reviewed, we can document that the change has actually been validated. So, questionnaire has been screened and vetted to be accurate. So when you show change via this questionnaire that change isn’t chance, and this now translates into the scientific body of knowledge. I think is really important for clinicians to understand and try to move toward. If we’re collecting this data, month over month, or however often we have a patient re-fill out a form, that is valuable data. They aren’t difficult to change. Maybe the form you got for gut symptoms from a weekend seminar over to something like an IBS visual analog scale. It doesn’t take a tremendous amount of work, sometimes some attention, but just to clarify for people it’s not very hard to do. But it now makes your data something that is much more able to be translated into the scientific community. Then those trends can be published and then people can really learn from that.

DrRA:

I think it’s just important to smack home, again, we’re not interested in metrics for the sake of metrics. There’s are all of these silly traditional medicine metrics that I’ve heard from traditional medicine folks in these board meetings. Things like “this percent of people need to be on statins”. All these metrics that don’t mean anything at all. That’s clearly wrong. But also, we can’t just have willy nilly clinical assessments that are difficult to extract something that can be taken on a larger scale. So trying to find that middle ground of, yes, you want to extract information that’s meaningful for you as a clinician, but also can this be meaningful for others? I think we just have a duty in this profession broadly, but even a stronger duty as integrative and functional providers to start doing that and to help others in that process.

DrRA:

Because I mean, that’s kind of how Joe and I are even here in some ways. Some of the work that Michael has been doing as a clinician, and sharing that and sharing the process and through that, we all get better. It’s not just Michael getting better. I’m a better clinician. Joe is a better clinician. We don’t want to just like stay in our little silo and sell books or whatever. We need to do more. I think that’s really the ethos of the three of us. Each of us could, yes, do great work as clinicians individually. But the type of work we’re trying to do is meant to make us all individually better and make this movement better. This is just one of the bigger elements of that.

DrMR:

Yeah. It’s a great point. That speaks to something else that you had mentioned before, Joe, which was enjoying the collaborative nature we have here at the clinic. We’ve had the chance to really put our heads together on something like, let’s say, recalcitrant fungal overgrowth as best we’re able to diagnose that or have a clinical suspicion of that. We discuss what is the best way to grapple with this? Do we stay with herbals? At what point do we consider pharmaceuticals? When, or if at all, do anti-biofilm agents make sense? So it has been nice to compare our notes. Its also been nice to have adjunctive research staff to pair up with. Then we can say hey, can you go into the literature and look at these five fungal conditions and look at what’s been used in terms of the various medications, various dosing protocols and give us a high level summary of what the trend is. If we are thinking clinically, here’s a time to transition over to, let’s say, Fluconazole what sort of dosing regimes have been used and perhaps been shown to be the most effective. Joe, do you have any thoughts there you want to throw out?

DrJoeMather:

Yeah, just from my perspective, simply going into Functional Medicine, you operate in a gray zone a lot of the time. There isn’t a definitive black and white answer to a question, it will depend on the patients in their particular situation. In that vacuum of clear black and white evidence, I think as good clinicians, we have a responsibility to number one, publish, to increase the evidence base so that other doctors can learn. We can all learn from each other. For myself, I’m just having so much fun being a part of this collaboration comes back to that. We’re operating in gray areas so the more responsible doctor’s opinions that you can incorporate into your thinking the better. I see a lot of patients with mold toxicity, and I know I can really rely on Michael’s deep background in gut health to help me understand the intricacies of bio films as a recent example. We’ve had a fun behind the scenes conversation on biofilms and what the roles are in getting some of the complex patients better. So the collaboration that we have going, this is just so much fun. I love it.

The Collaborative Approach

DrMR:

It really is nice to have other people to bounce things off of. Just as one example, in the biofilm realm, I think Joe and I had had both been the leaning away from using biofilms synergistically then toward. There was this patient that we were co-managing, a long-term recalcitrant fungal case. Rob elected to use Fluconazole, but also an antibiofilm agent. What was interesting about this case was, and I’m giving a rough summary here, but when he initially went on Fluconazole, he saw a fairly pronounced Herxheimer’s and then he saw it again when he added in the anti-biofilm agent. That for me, and I think for Joe also was really like, okay, here’s some really good reinforcement of certain time in place patients for whom the biofilm agents will be helpful. That’s probably the minority. But, just that perspective was helpful to make us as kind of honed and precise as possible.

DrRA:

Yeah. I think that’s a great case. I think one of the big take aways for folks is that with this process that is exactly the type of exploratory conclusion that we’re able to create as a team. Insert a specific clinical case, this isn’t even theoretical. This is a real person, real symptoms. We see that a lot of times. I love what you were saying, Joe. We’re operating in the gray, we have some foundational tools that allow us to first enter there, but sometimes, it stays murky. We don’t have a clear black, white, yes, no, or even a clear idea of something getting better or worse. And you need to make sort of decisions from that hierarchy.

DrRA:

The more I see things, a lot of the phenomena that are described in integrative medicine, they exist. You’ve got to avoid the, Oh, well, everybody who has this symptom has this and everyone has this symptom has this, those things definitely exist. It is the balance and the nuances. How can we, as clinicians, hold space for that and acknowledge that can be going on, but in the beginning, don’t jump too far down the hierarchy, too far down the road and get stuck without realizing it. Holding space for those more complex things and seeing where a therapy has a role in the right setting but maybe shouldn’t be the first thing you go to. But it also isn’t thrown completely off the table.

DrRA:

That’s one of the challenges in our movement, holding that. Because once we see something work, the first reaction as a clinician is I need to do that in every single scenario that even looks remotely like this. And we need to hold on. Not necessarily. Just like if you get one bad outcome, don’t say that treatment will never work for anyone. That’s the wisdom of medicine. This is where the research is.

DrJM:

This is where the research checks the maybe overzealous parts of the functional medicine movement. If you take a long view, Functional Medicine has really kind of exploded in the last few years. As a guiding principle of root cause analysis, you’re looking at 20 years really. The evidence-base has not caught up with the theories and the ideas. So it’s critical at this stage in integrative and functional medicine for us to ask the questions in a really strong way. Is what we are doing being proven in the research and can we show others that our results are reproducible? That’s just going to be so critical in moving Functional Medicine to the next place. There are going to be places in Functional Medicine where the what’s kind of dogma or standard idea that X, Y, or Z has to happen, just won’t bear out in the research. That’s where the research and clinical trials are really going to hold everyone responsible. So that ultimately patients get the best outcomes. That’s what matters, getting outcomes for patients. I’m so proud to be a part of an organization that is constantly tweaking our systems based on the latest scientific evidence. I can’t wait to start to contribute to that evidence. I think it’s going to really push the field forward and ultimately help a lot of patients

DrMR:

Agreed and well said. And that’s why I’m so excited about the research objectives that we’re currently working on and continuing to build. I think that functions as one of the primary antidotes to the other valence, which is Functional Medicine is willing to do more and look underneath all the rocks for where there could be an answer or where there could be a cause. If there’s nothing to kind of counterbalance that, then what you end up with an extreme. To get started it’s $7,000, because we’ve got to do all the tests because if we’re not assessing, we’re guessing. Now we’ve gone too far and you have net harm at both extremes. The net harm on the conventional side can be, we don’t think anything’s wrong with you and they’re not willing to do more, or they don’t know what to do, which that’s harmful because it doesn’t give the patient anything else to move on.

DrMR:

It’s not harmful from the perspective of cost and emotional turmoil. That’s what happens on the other end of the spectrum. They’re willing to do so much, but then this can lead to unnecessary costs encumbrances. Also a bunch of fictitious diagnoses that make someone really afraid and is antithetical to their emotional wellbeing. So it’s that balance point. This does hit on one of the notes that you had made Joe about the cost-effective and patient-centeredness. I know you made some remark about the things that you hear on the podcast really do happen when you are behind the curtain and actually in the clinic. So I’d love for you to maybe offer that. It’s one thing if I say it, but I think it’s definitely to your point about external validation, if others are doing it and seeing it. So I’d love to hear more about that.

Background – Dr. Mather

DrJM:

Well, you know, I was reflecting before this call. What the audience should know is that we have three clinicians now at our Austin clinic. I’ll just share my background here. I went from having my own individual practice, being a long-term listener of Michael’s podcast to kind of going deeper with the monthly Future of Functional Medicine Review, and slowly and steadily getting to know Michael better. Eventually the point where I wanted to join on because of how exciting it was to find someone else really trying to be a cost-effective, responsible practitioner of Functional Medicine. Most importantly getting results. That’s what we all care about. So I found a kind of a kindred spirit here in Michael and went from behind the scenes, nodding my head in agreement with the podcast as I was driving in the car, to being plugged in behind the scenes.

DrJM:

Reflecting before this call, the values that you hear on the podcast are real. I got the privilege of peeking behind the curtain and helping drive this ship a little bit. There’s just so much energy, time and work that goes into building an operation like this. You’ll be able to figure out pretty quick if people are full of it. The values you hear on the podcast are real. I’m happy to report that Michael is the same person offline as he is on the podcast. There is a huge amount of energy that Michael is extending to get great outcomes for patients. I’m here to report that what you hear is what you get. This clinic is only going to get better and better as we keep researching, tweaking and helping patients. So that’s my big picture perspective.

DrMR:

Well, I’ll send you the check for that that endorsement in the mail here soon, Joe.

DrJM:

I’ll be looking for that. Thank you.

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Organization is Key

DrMR:

Thank you. As you’re saying that you reminded me of something, when you say there’s a lot of energy expended. One of the ways in which the energy is exerted is with organization. Yes, everyone needs to be organized, but there are vast differences in levels of organization. One of the things that I’ve noticed on the patient side of things in working with some clinicians who were clearly very, very well-informed in whatever the area was, but there was this other issue that drove me nuts as a patient, which was how many times do I have to tell you the same thing? Or why are you spending a third of our visit time together just trying to get up to speed on what we’ve done in the past, or what I did last visit, or just generally getting your bearings.

DrMR:

This taught me that you can have someone who has a good memory and knows the science, but in applying the science, that’s a different endeavor. It’s not just Dr. So-and-so who knows the literature and can answer a question eloquently. That’s another domain of cognition, which is having a real commitment to organization and data reporting so that we can see what we’ve done. If you’ve been working with the patient for seven months and you’ve done various lines of treatment and various tests, it’s not easy to have all that right at your command. This is one of the areas where I’ve really worked diligently to make sure that when a patient walks into a room or virtually walks into a room with a clinician, the clinician already knows what they’ve done together. Even what they’ve done with other clinicians prior to seeing us, what tasks have been done, what with diagnoses have been rendered.

DrMR:

What’s worked, what hasn’t worked. Then to be able to look at that in juxtaposition to the personalized hierarchy we’ve built for them. So we know, depending on how they’re doing today, where we’re going to go next, and I really want to hopefully impress upon our audience. That it’s one thing to have a lot of knowledge. It’s another thing in knowing how to apply it effectively. This is something that’s frustrated me in working with some consultants who are really smart, but I felt like they just were not able to piece together me because every time I spoke with them, it took a third or half of the energy that they had and the bandwidth that they had just to catch up to where we were at current.

DrJM:

What I love about the system that we have in place is just the ability at a glance to remember everything that’s been done with the patient, where they’ve been. It takes some work on the front end and that’s why we have our visits structured in a specific way. Structuring the visits in that way, taking that time initially, and then setting up that note, really sets us up for success moving forward. It’s almost like you spend some time walking up a hill and it’s hard when you’re going uphill, but then you get to the other side and you can kind of just coast down and it makes subsequent visits much easier. .I hope that patients are seeing that perspective. That they appreciate “oh yeah, Dr. Joe actually remembered that we did a paleo diet, but we decided to skip the histamine support because of this reason”. It just makes the whole process a lot smoother.

DrMR:

It does. We try to do a lot of the work before the visit. I think that’s another really important point because I was speaking with a naturopathic colleague of mine and they were saying, Oh boy I’ve got to do about an hour of charting today and I thought, so you do your charting at the end of the day? His answer was yes. I couldn’t help, but be struck by if I saw a patient at 9:00 AM and now I’m doing the charting for them at 5:00 PM, there is, for sure, going to be a loss of important contextual data.

DrJM:

There is no doubt you lose it like an hour after. So if you don’t have a good reporting system that you can use immediately, you just wasted time.

DrMR:

Exactly. That’s why we spend time before we see the individual, then we see them and then we spend time after we see the individual to make that while we’re with you, we are 100% with you. Just locked in. Then we go on to the next person. All these little things really do add up to making the whole clinical experience much more effective and much more efficient.

DrRA:

I’m so glad we’re talking about this. It really is kind of pulling back the veil to really see behind the scenes, what a clinic can and should look like.To give more praise for Michael, it has been so wonderful to kind of find someone sort of equally, if not even more maniacal about systems and having the system working smarter, not harder. I see the whole purpose of building these systems, the whole purpose of all these other things behind the scenes, as Michael was saying is so we, in the moment with the patient, can fully show up for you and what you need. There are these little things that you probably don’t know about. How we set up the notes, the automations that are built in, the charting that we’re doing. This will be kind of a segue to another discussion about how we are trying to take care of ourselves.

DrRA:

Like all of these things that we recognize as clinicians are imperative for us to actually be able to show up and help you, especially if the history is really, really complex. All of these things from organizational systems to our personal care to team collaborations. All of these things matter because if we’re bogged down with some charting system that is just tearing hours out of our day, how in the world can we show up and really be present with you and really help you? Not to go way off in the weeds through all the things that are wrong with the traditional system, but we recognize all those things, cumulatively, add up and must be focused on to actually allow us to be the best clinicians that we can for you, the patient.

Personal Health

DrMR:

It’s a great point. And I’m glad you mentioned this because another aspect of this is an individual’s personal health. All these things add up. If we don’t have a good history done and we don’t have all the information organized in a way where it’s easy to see all the trends and we’re not doing charting at the right time. Then you leverage that with having to do all this laborious paperwork and you yourself not being at peak health and peak condition. You end up with a sprinter who got drunk the night before, didn’t tie his shoelaces and is now trying to run against the guy who’s been doing bodywork, eating all organic and has the best new Nike sprinting shoes. You could have the same athlete capacity, meaning their raw genetic potential, but one person is going to outpace the other person clearly because all those factors make a difference.

DrMR:

This clinical work, it is very cognitively demanding. If you’re three hours into a patient block, you have to be a healthy clinician to still have all your mental faculties there at your command. This is something that I want to thank you both for. I’ve really tried to make sure that we are all healthy because I’ve seen in myself that when I’m not, the clinical days can feel daunting. Any day can feel daunting. So as we’ve been working more together and talking about things like this nerve impingement thing that kept me from sleeping well for about a week. That was a really poignant reminder of how important sleep is. Joe, I know you had some environmental stuff that was bogging you down and it really hit home for me to make sure that our priority is keeping us all healthy. Maybe we can talk a little bit more about that and how we’re trying to build this culture of the clinic. Not only do we sell healthcare, but we’re also trying to make sure that we are as healthy as possible because that’s going to directly impact the level of our work.

DrJM:

I want to start there because I feel like for a good chunk of the last six to nine months, I felt like that hung over sprinter. And I have not had new Nike shoes. I’ve been healing from mold toxicity myself. So all of the chronic fatigue, all of the limbic problems, the cognitive issues, depression and anxiety, that’s really rocked my world. I’ve been a part of clinics and groups where you’re just expected to produce. It’s been such a joy to be a part of a group that really takes all of our health seriously. So what readers or listeners won’t know, Michael really cares. He and I have been talking about the mold toxicity behind the scene and he heard that I had been really benefiting from a sauna before COVID and when I was going to the gym and using a sauna and he’s actually shipping me a sauna.

DrJM:

So I feel so grateful to be a part of a team that’s investing in it’s people’s health. Michael can say all day long that he wants to be a leader that invested in people’s health, but he’s putting his money where his mouth is. I have no idea how a sauna gets shipped from Austin, but it’s going to happen. So it’s pretty fantastic. I’m just grateful to be a part of a group that that takes everybody’s health seriously.

DrMR:

Well, thank you. As our audience knows, I suffered from these things myself. I remember going to an office that had an environmental contaminant. Driving in to the office I would feel great, then within 20 minutes I would feel foggy. I would have given anything to not have that brain fog any longer. It was the most frustrating thing in the world. For me, it was more a gut health issue where my gut was causing me to be hypersensitive to the environment. But irrespective of what the underlying cause was, the take home is the same. If someone isn’t as healthy as they could be, they’re not going to be doing as good of work for the clinic or for their family or for their friends. This all kind of cascades. I don’t understand how the clinic can say “we need Joe to produce”. We can whip the horse, or we can say perhaps the horse needs some, some more food or some special horse parsley that makes them run faster or whatever. If you take care of people, it would make sense that they’d be able to produce more for you. Not, not because you’re forcing them to, but because they just have the natural capacity to.

DrJM:

That’s right. That’s right. Please don’t feed me horse food or whip me. I’m a nice physician. You don’t want to do that to me.

DrRA:

I feel like I need to jump into this discussion with team vulnerability over here. You know, it’s interesting, as I’ve been reflecting back to when we started this endeavor organizationally, it’s been a process to structure things. It was in the middle of 2020, and to be quite candid, through this entire period I’ve been going through one of the most tragic, horrible circumstances that I could ever imagine. I also can’t imagine having gone through that and growing this clinic without the investment from Michael, from the team and from Joe to invest in each other and invest in me. The willingness to continue to invest in the things that have been critical to maintain my wellbeing and so I could feel nourished. To show up and value that and to get concrete about, what exactly do you need? Showing up in that regard, as Joe said, there’s the action behind the words.

The Culture of the Center

DrRA:

That’s the culture that we have and kind of why we’re getting together this upcoming week, because that’s what’s going to make us as clinicians and as a team better. It’s kind of the in thing, even in like integrative health, but certainly in traditional medicine. Self care and all these things. Sadly, I think too often, it’s just lip service and just words and marketing junk. But this is very, very real. Also, we ourselves are humans too with the exact same needs and desires to feel nourished as our patients and trying to make those commitments and recognizing we have to do those things. We’re not just gonna wake up out of bed and be like Russell Westbrook and just dunk a basketball. It’s just, it’s, it’s humbling and I feel so grateful to be a part of something like this. If you’re a clinician and also patients like to know that. This is a thing, this isn’t a fantasy. This is happening and we want to be a part of sharing that for everyone’s well-being.

DrMR:

It’s the values that we all embody. If health is so important to me or to Joe or to Rob, then it would make sense that would extend not only to our patients, but also to our personal lives and also into our professional lives. It’s really nice to be able to be building this clinic team where now we have the real fortune of being able to do things like, okay, let’s all do an experiment with X variable. Let’s say the variable, as one arbitrary example, is mouth taping. Let’s all get Oura Rings, let’s get a baseline score. Then let’s start mouth taping. Let’s see how our sleep score changes and see what we notice in terms of the carryover or the correlation between sleep score and just our general energy levels.

DrMR:

Then guess what? Whatever we learn, that’s going to be codified into the clinical model and make our clinical model that much better. Then hopefully that could even be drawn up at some point in terms of the data that we gather from patients and published in a journal. All the incentives here are really aligned. This is not an environment where we would say “Well, I don’t really care about health too much, but I talk a good game and there is a lot of market demand for supplement XYZ. So let’s just score it out a supplement for XYZ”. That would be a real perversion of incentives. I hope, and I think we’re really trying to make sure that all the incentives are aligned, where we get healthy, we learn how to be healthier. We codify that into a model and we publish about the model and it’s just a game of let’s feel and operate as best and in the most healthy way that we can. There are numerous benefits from that. So it incentivizes us to keep doing more and more of that. It’s really just a joy to be a part of that kind of process.

DrJM:

Let’s be honest, I think what you just described for the market research and supplements, I think that represents the worst of the field, but that is a real reality. I just kind of want to share with everyone. We want to really lead the pack here. We feel like we’ve hit upon a really great model that helps the vast majority of patients that we are able to see. We think we’re building an organization that’s going to really compete with anybody in terms of getting excellent results for patients at a fair and cost-effective price. So we could have fun while we’re doing it. We’re having a good time here.

DrMR:

We are. I’m having a blast. It seems like we’re all having fun. That extends even to Jasmine and Morgan and Darla and Nora and Hannah and Gavin. Some of the growing members of our research team, it’s really cool if I just kind of step way back just to see that more and more talented people are wanting to be part of the organization. They’re resonating with the work that we’re doing. That gives me a lot of hope that the worst of the field example that you remarked about Joe, even though sadly, there’s a strong monetary incentive for there to be more of that. I’m hoping that we’re putting together an alternative hypothesis here of how the field can function and hopefully giving people a better market segment to invest in where it’s not just about promising people that they can heal everything with the en vogue supplement that has a lot of SEO demand. It’s just being diligent, consistent, methodical, and scientific. It’s not as flashy, but it seems that this really has some legs to it. It’s really humbling to see how more and more people are getting behind this. I think this poses, the antidote to some of the misdirection that is occurring in the field.

RuscioResources:

Hi everyone. This is Dr. Ruscio. In case you need help, I wanted to quickly make you aware of what resources are available to you. If you go to drruscio.com/Resources, you will see a few links you can click through for more. Firstly, there is the clinic, which I’m immensely proud of. The fact that we deliver, cost-effective, simple, but highly efficacious, functional medicine. There’s also my book, Healthy Gut, Healthy You, which has been proven to allow those who’ve been unable to improve their health, even after seeing numerous doctors, to be able to help them finally feel better. There’s also our store where there’s a number of products like our Elemental Heal line, our probiotic line, and other gut supportive and health-supportive supplements. We now offer health coaching. So if you’ve read the book or listened to a podcast like this one, or are reading about a product and you need some help with how or when to use, or how to integrate with diet, we now offer health coaching to help you along your way. And then finally, if you are a clinician, there is our clinicians’ newsletter, the Future of Functional Medicine Review. I’m very proud to say, we’ve now had doctors who’ve read that newsletter, find challenging cases in their practices, apply what we teach in the newsletter and be able to help these patients who were otherwise considered challenging cases. Everything for these resources can be accessed through drruscio.com/Resources. Alrighty, back to the show.

DrRA:

Probably a reasonable tangent from these points, a couple points I’ve been reflecting on sort of connected to this. We were talking about research earlier. I think many people, both clinician and patient alike,have probably heard the saying or the statistic that it takes like 15 or 20 years to take something from the bench or research to practice. That model, for what we’re trying to do, is not helpful in the least. What we need to be doing is thinking how can we bring the research to the clinicians doing the cutting edge clinical work and make it easy for us collectively to extract information from that and not have such a disconnect from the research that takes 20 years to bring to clinical practice.

DrRA:

We need to switch the paradigm. That’s what we’re trying to do. We’re clinicians, but we have a duty to do research with our work and actually can change that paradigm so that it changes clinical practice much more quickly. I think one of the challenges with anything that’s sort of novel, which Functional Medicine, in its core essence isn’t, but in it’s specific forums is novel. It’s easy to seek novelty for the sake of novelty. It’s our culture. Yesterday’s news is yesterday’s news. It’s like somehow no longer important. The novel thing we somehow assume must be better and constantly needing something novel, novel supplement, novel lab test. You can get caught up in that really easily and forget, there’s a basis of core fundamentals that we should be leaning into universally, but also not being complacent with those.

DrRA:

Seeing that we do need ask more questions, but we don’t need to seek novelty for the sake of novelty. We need to seek evolution, the sake of improvement. In the process, leaning on the fundamentals. That’s what we’re trying to find balance in because they’re, at its worst, Functional Medicine is sort of novelty for the sake of novelty and there’s harm there. We need to find that balance of leaning into fundamentals, but growing and exploring the questions that need to be asked. We’re trying to do that in different ways, the research, but also in the clinician’s newsletter. That is a great example. I mean, Michael, you can’t even imagine, from when you began that to us doing this now and having all three of us contributing and just the diversity of clinical experience and cases. Even though there’s a shared ethos, the diversity, if you’re a clinician, you are now getting three clinicians. Their experience in a shared model. For the price tag, that is unreal.

DrRA:

Mike, I would love to hear your thoughts on that because I think this is the crux of what’s going to move us forward.

DrMR:

It is kind of surreal for me too. Way back at the inception of the newsletter, just wanting to share case studies and also give myself an excuse to go back through some of the research studies that I’ve read and take more diligent note. To see that growth is amazing. Coming back to kind of data organization, I was seeing patterns and I was intervening to try to correct those pattern aberrancies, so to speak, and then seeing other clinicians pick that up. I believe you Rob were the first person that said, Hey, you know, I’m finding the same thyroid thing and I was able to fix a few people by making those modifications that you were writing about.

DrMR:

That was a big light bulb for meIt was also very validating because like you’re saying, other people can produce the same results. Not too far after there was Joe. That that really kind of got me rethinking the amount of change that we can impart by sharing good ideas. I feel that we’re really just kind of getting warmed up. We have some new stuff coming down the pike for the newsletter that I’m not sure exactly when we’ll announce that, but that’s coming soon. We’re also hiring another clinician soon at the office. So an announcement there to follow soon as well. It’s been really awesome to see all that kind of grow

DrRA:

Only going up from here. This is pretty great.

Episode Wrap-Up

DrMR:

That is it. Well, I think we’ve gone through most of the fundamentalists here. I’m really happy to be sharing these thoughts and what’s going on at the clinic because the thing that keeps me up at night, or when I’m showering and my mind is typically running. One of the things that I ruminate on is when people come into the office and they’ve really been hurt and they’ve suffered needlessly and it just bugs me and it’s never stopped bugging me. I’ve been trying to solve that problem as fervently as I can. That’s why I’m just so proud to have the growing team with Joe and Rob and the kind of burgeoning research initiatives that we’re pioneering. So it’s just phenomenally validating for me. It’s been a real pleasure to work with you both. If you guys have any closing thoughts you want to leave the audience with? Again, I want to thank you because it’s just been a real joy to be on this ride together.

DrJM:

My closing thought is just to stay posted because I think that the longer we have a collaboration, the more fun and good ideas will come out of it. The pipeline is opening up. I think there’s going to be a lot of exciting growth and opportunities moving forward.

DrRA:

Just echoing what we’ve been sharing. I have a deep gratitude for this group. It’s hard to articulate it in a way that doesn’t sound contrived, but I really hope like these discussions for people really hammer home how much we are seeking authenticity and to share that and showing that that is a real, that was one of my concerns very early on kind of as a student, getting into this space. Weeing when things can get a little off the rails seemingly and guru medicine coming in. We in this group take it really, really seriously to show up in authentic way. That that’s not for the sake of us looking good, but for the sake of showing you that’s possible, and that we want this to be the norm and what we’re trying to grow. For many reasons in our society, there are many reasons to kind of have distrust and questions, and we are trying to the best of our capacities show up in an authentic way. You’ve heard a lot of that today, and will continue to hear about it.

DrMR:

Well said on both parts. For our audience, thank you for your interest in these concepts, whether you’re a patient or someone who’s thinking about becoming a patient or a clinician who’s benefiting from this work, or perhaps even thinking about joining up with our clinical team or our research team as it continues to grow. Thank you. It’s your acknowledgment of the value in these concepts that allows us to do what we’re doing. With that, we will all get back to work here in the clinic and in a joyful way. We’ll be working to be as informed and as healthy as we can so as to bring you the best healthcare and the best ideas relative to healthcare. More to follow. Joe and Rob, thank you and our audience. Thank you guys.

Outro:

Thank you for listening to Dr. Ruscio radio today. Check us out on iTunes and leave a review. Visit Dr. Ruscio dot com to ask a question for an upcoming podcast, post comments for today’s show and sign up to receive weekly updates. That’s D R R U S C I o.com.


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