Meet Our New Functional Healthcare Doctors

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. Today I spoke with Doctors Hannah and Omar, two of the new clinicians at our office, and I’m really excited to be introducing them to you. This podcast was partially inspired by wanting to introduce other people on our clinic team so that people will be comfortable with them and will be able to hear their voice, hear how they think, articulate different rationales, and navigate the picture of improving someone’s health.

DrMR:

But I’m even more excited to say that I have been absolutely shocked at how quickly these two have booked out at the office as well as the demand that you guys have for competent, cost-effective, conservative, evidence-based functional medicine care. They’re about half-booked after only about a month, which to me is just surreal. I share that not as a brag, but just because it makes me so proud that many, many years of hard work are being recognized by people in what I like to think is building up trust and confidence with you. Not just in me, but in the systems that I’ve developed. And now the team of us that are working together can really help with what I think might be the most important thing, your health, and therefore your energy and your condition and how you show up every day as a mother, father, daughter, cousin, son, employer, employee, or what have you.

DrMR:

So it’s just a real privilege in so many ways to be building this team and to be seeing how well the team is working together, how much demand that you have for this type of care, and our helping these new doctors live their dream of getting busy at our office. So we’ll go here to the conversation in a moment with Doctors Hannah and Omar. They are the two new doctors at our office, and gosh, I am just so thrilled and elated and cannot thank everyone enough for the support of the clinic, and also can’t express just how wonderful it is to see multiple doctors all executing this practical, pragmatic, cost-effective and evidence-based functional medicine care.

DrMR:

And not only that, but that behind the scenes we are now tracking data and getting ready to publish. In my opinion, this is going to be a publishing juggernaut in the sense that we are building these things, the clinic and the corresponding systems, to be able to publish a decent amount of work. And now that we’re a five clinician office, boy, it’s just amazing to me that would take me five months to do in terms of the number of patients I see, we can do now in one month. It’s just amazing. So all of these things here are tying together and a lot of forethinking from years and years ago is now really coming to fruition.

DrMR:

I feel like we’re having this budding impact that’s going to flower into a real substantial impact in the field. It’s hard for me to even believe sometimes. So with that, I will stop monologuing, but again I just want to thank Doctors Hannah and Omar for their great work, as well as all of the clinical staff, Doctors Joe and Rob, and everyone behind the scenes working collaboratively to bring you the best healthcare. And also thank you for appreciating all of our efforts and seeing that healthcare as valid, valuable, and something that you’re coming to get with your own hard-earned dollars and time, effort, energy, and also referring in your family members and friends. So it’s just a wonderful thing to be part of, and with that we will now go to the conversations with Doctors Hannah and Omar.

DrMR:

Hey everyone. Welcome back to another episode of Dr. Ruscio radio. This is Dr. Ruscio here today with Doctors Hannah and Omar from the clinic, from the office, the two new doctors on our team, who I am so excited to have on board. It just feels like such a privilege to even be having this conversation in the sense that the clinic is growing. The work that we’re doing at the clinic really seems to be resonating with people, and more and more people are coming in themselves as well as referring friends and family members. So it’s just really an honor to be part of an operation that in my opinion is doing good work, and that good work is being recognized and more and more people are wanting our help. So, hi guys. Welcome to the show.

DrOmarAkhter:

Hey Michael. Thanks.

DrHannahHamlin:

Thanks, I’m honored to be here.

DrOA:

Thanks for having us.

DrMR:

Well it’s definitely a conversation that I’ve been looking forward to having. Even though I have so much to say on this topic, I’m going to try not to say too much. I’m going to try to let you guys share with our audience what you’ve learned as you’ve been going through the training. There are just a couple of things that I’ll remark on before we get rolling.

Training Clinicians

DrMR:

My clinical model obviously is something that I obsess over, and that being said, it has been something that has been in my head. I’ve noticed certain patterns and I’ve noticed where I can be more efficient, not fall into excess or waste, and be more precise. We’ve talked on the podcast before about how everything is done with a high level of intention. Every question on our forms inform certain things in our dashboard that we build out to have this overview of an individual, and that informs our differential diagnosis, or said another way, our problems list.

DrMR:

But really part of my day now is just obsessing over how best to teach this, document this, and making sure that there are not things that I’m just doing in my head that I’m not sharing with other people. Just by doing that, I think I’ve been able to really get to another degree of precision. I was just so happy with how quickly everything was able to click and come together for you guys, because I had spent a few months really obsessing over how to get everything mapped out and make this user-friendly on the clinician’s end. To both of your credit, that was combined with the fact that you had both been following the podcast, the blog, had read the book, and had been following our clinicians’ newsletter.

DrMR:

So I was also surprised at how familiar with a lot of my work you guys already were, and how you had done a lot of functional medicine training in general. So we had two really bright minds combined with external training plus following some of the work here on our platform. And boy, you guys just really impressed me with how excellent the work that you’re doing is in such a short period of time, which really gives me a lot of hope for the field. With the right people, the right training, and the right team, we can do a lot of good together. So before I editorialize and monologue for too long, why don’t we start with you Hannah? Just tell us a little bit about yourself, then we’ll go over to Omar and then we’ll flow from there.

The Doctors’ Backgrounds

DrHH:

So I am an osteopathic physician. I graduated medical school in 2019 and did one year of family medicine residency training, and then went on to do the Institute of Functional Medicine curriculum. I’ve completed that up to the point where I’ll sit for my certification exam later this fall. But with that, I grew up as a patient. I was diagnosed with Type 1 diabetes and autoimmune disease as a teenager. I grew up in conventional medicine and had a lot of questions just on how to feel better in my body. So it really led me to find functional medicine and find a lot of answers there. I started medical school knowing that I wanted to practice functional medicine. Before my medical journey started, I was listening to Dr. Ruscio’s podcast and was really impressed with the way that he interpreted the science. And so that has led me to continue to follow him through my traditional medical training, and I’m just honored to be here. So thank you.

DrMR:

Well, it’s great to have you here, and I’m glad that the podcast was able to give you something to follow. I know when I was going through my training, it was challenging to find people that I trusted. So it’s actually kind of cool to be on the other side of that equation, hopefully as a trusted resource. So thank you. And Omar, let’s go into your background.

DrOA:

Yeah, Michael. I come from a family of physicians and I’m originally Pakistani. So that’s where I did my medical school, and then I came over to the U.S. to New York to do my residency in internal medicine. So I was very much trained in the conventional realm, and I was working in a large hospital system which really burned me out from the practice of medicine. I knew that I had to make a pivot into something that I was more passionate about and that I believed in more. That’s when I came across functional medicine and was really just wowed by the approach taken, sort of the holistic approach to chronic disease management.

DrOA:

That’s what drew me away from the conventional system into a functional medicine model. And just like Hannah, I was listening to the podcast for a number of years, actually through my residency, oddly enough, when I started to have that light bulb moment for myself. Also reading the book Healthy Gut, Healthy You has just made me so aware of how to treat these chronic diseases with more nuance and more precision. And so I really appreciate that approach of yours. I found your approach so balanced and methodical, so it’s just surreal to be working with you now, and I’m very appreciative.

DrMR:

Well, thank you. It’s another level of validation when I have a chance to speak with another doctor who’s been following the work and to really see the impact that it’s had. I have to keep thanking both of you because it’s very validating for me because I don’t get a lot of this feedback. So it’s just a real pleasure to see that all the time put into the podcast, the book, and all these things are impacting not only lay people who are trying to figure out how to navigate their own health, but clinicians with how they think through how to take the person in front of them who isn’t feeling well and help improve how they are feeling. So just awesome, awesome stuff all around here. Lots of thanks in both directions.

New Perspectives

DrMR:

Maybe we can pivot back over to you Hannah. One of the things that I would like to try to use this podcast opportunity to do is not only to introduce you both to our audience so that these new faces and minds at the clinic aren’t strangers, but also I’ve found that when someone is new to a system or a process, it’s valuable perspective. They’re seeing things from a different vantage point than as someone who’s been working in this model for almost 10 years now. I know there are a few things you had mentioned before we started the recording in terms of thoughts you wanted to share. Let’s maybe start with one of these, and then we can pivot back and forth between you and Omar just to share some of those insights that you’ve found as you’ve had a chance to go through the clinical training. Share with people what you think it is that we’re doing that’s special, unique, and worth mentioning.

DrMR:

To clarify briefly for our audience, my goal here is not to be self-promotional, but I’ve learned that there’s a lot that’s done at the clinic that I haven’t been explaining. One of the things I’ve been trying to do is share, like I said a moment ago, how every paperwork question is asked very intentionally. These things are organized into a dashboard of the individual and we have all this data reporting. I wasn’t really explaining that before, and I’ve been finding that explaining that to patients really helps them better understand the process and better wrap their heads around how it sometimes seems easier than they were expecting it to. So that’s really what I’m after here. Just sharing more about the model, more about what we do, and using these fresh eyes of Hannah and Omar to help patients and other doctors have a better understanding of what we’re doing over at the office. So Hannah, not to paint these big shoes for you to step into here, but let’s start with you.

DrHH:

Yeah, absolutely. One thing that really stood out to me and that I think differentiates this model is the attention to evidence-based actionable steps, and really the extent of detail you and the team go into as you are creating your treatment algorithms in the training that we’ve received. It really comes not just from evidence-based as in, “there have been studies that point to this lifestyle change or treatment protocol as the right direction,” but truly meta-analyses and systematic reviews. And that to me is very important. It’s a high level of evidence that you’re using, and throughout the training that’s very well-documented. As a physician, it makes me very confident that what I’m promoting my patients to do is really helping them and that there’s good data behind it. That confidence is so reassuring, and I think that’s one thing that I haven’t seen in all places when it comes to lifestyle implementation recommendations, but here it’s very strongly enforced by science. So I really love that about your training, and that was really one of the most important parts to me.

DrMR:

Well, good. I’m glad to hear you say that, because that affirms that I’m not saying one thing on the podcast but in the clinic it’s like, “Oh, well anything goes. We’ll use animal data or whatever.” So thank you, because that reinforces consistency in the philosophy, which of course is an important thing.

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DrMR:

Omar, maybe we can ping over to you and go through one of your observations.

DrOA:

Yeah, definitely. I’m very thankful for my conventional training because I feel like it opened me up to the world of medicine and what’s going on out there. A lot of me getting into functional medicine was dissatisfaction with that system. When I found functional medicine at the start, I really thought that this was an excellent clinical model with no flaws and the perfect way to go to and pivot and something that all clinicians should be using. But I also slowly realized coming into the functional world that it has its own issues and challenges as well, which you often also mentioned. And I think one of the things that aligns us so well is that we both have that discomfort with the functional medicine model as it’s practiced right now, which is often overpricing, often extensive lab testing.

DrOA:

So I really see it as conventional medicine and functional medicine falling on a spectrum. On one hand, you have conventional medicine where you’re often told by your physician that if they can’t figure out what’s going on, there’s nothing wrong with you. I see patients like that every day. They’re just told they’re fatigued, have insomnia, or are just getting older, but they’re actually 35 years old and shouldn’t be having those symptoms. On the other hand, with functional medicine, you have all of these diagnoses, testing, and supplements that are thrown on someone, and that doesn’t do them a whole lot of good either in most of the situations. So what I really love about this training and this approach is it’s so methodical where we’re trying to strike a balance between both approaches and just taking a middle road. And I think that’s what really attracts me to this model.

DrMR:

Yeah, thank you. There is what I think is almost a human concept now. I was having a conversation with a friend of mine about this the other day. In every field that I’ve studied, I’ve run into this. I ran into this with exercise and exercise rehab, I ran into this when I did my training in chiropractic, and then in natural medicine. It just seems that this is something that permeates every realm. I’d argue the same thing in nutrition, although that’s kind of underneath the umbrella of functional medicine.

DrMR:

There might be a broader life lesson here that maybe there’s this human impulse to make things more complicated than they need to be. I’m trying to be better about not saying that’s wrong or definitely that it’s not done with poor intention, but these things do tend to be damaging to people. This is actually something that Paul Chek and I had discussed on the podcast a while back. One of us encapsulated it as, “any value system that is adhered to too ardently ends up damaging people.” This could be Catholicism through gluten-free dieting. I think that’s part of what you’re hinting at there. There are some differences, but overly meticulous and ardent following of a system, let’s say lab testing, can cause undue harm.

DrOA:

Yeah, absolutely. You use the branches and the root analogy often. I like an archery metaphor or analogy. I think a lot of functional medicine is very much a machine gun approach, just trying to hit all of these different hammers and trying to knock everything out. We’re really trying to do a very precise, functional medicine model, which is more like archery, where we’re taking aim and methodically one by one, trying to use a model that has real clinical benefits. So I like to use that analogy often, so patients can understand where we’re coming from and how we differentiate ourselves from other practices.

DrMR:

Yeah, I like that a lot, the analogy of archery and focus. I was thinking about this earlier today in preparation for our podcast. In order to solve an equation, it’s extremely helpful to reduce variables and solve for one variable at a time. And I think that’s a real lost art or method in functional medicine. It could be because functional, natural, integrative medicine, whatever rubric we want to assign to it, attempts to be more holistic and multifactorial. Which is good, but I think what ends up happening is there’s this multifaceted aim and also this multifaceted therapeutic interventional model, instead of looking at this in more of a stepwise fashion or as an archer focusing on one bullseye and then the next, or however we want to explain this. We’re reducing to one variable, solving or getting feedback, and then moving in this stepwise fashion.

DrMR:

Unfortunately, I understand where both patients and doctors don’t want to do that. The doctors want to try to do as much as they can to help someone, and the patients want as many options to try to be helped, but what I’ve learned and what we’re of course doing at the clinic is really coming to the realization that it’s almost the tortoise and the hare. It may seem like we’re going a little bit more slowly, just pulling back the quiver and releasing that one arrow, but that tends to get us closer rather than the machine gun where you can just knock over the entire array of bullseyes in front of you. I guess the collateral damage with the machine gun approach is undue financial harm, undue psychological harm by making all kinds of fictitious diagnoses, and then reduction of the valuable biofeedback signal, meaning if someone’s improving or they’re feeling worse, we know exactly why that’s happening because we’ve reduced the variables and now we have a better ability to learn from the person’s system. I’m hoping that these conversations are helping doctors and patients alike to see that less is really more in a clinical model.

DrMR:

Hannah, anything else on your end? I’m trying to ping-pong us back and forth. Anything in this regard specifically that that you’ve noticed with going slower, narrowing the focus, what we internally term the vertical differential diagnosis, where we’re putting things in a list from most probable to least probable? Anything else here you think is worth mentioning?

Minimizing Variables

DrHH:

I completely agree with this stepwise, methodical approach of implementing new lifestyle changes, supplements, or diet recommendations. One thing that really stood out to me is just the way that we are very strategic in implementing a change, giving it enough time to see whether or not that change would impact the person symptomatically, and then implementing the next change. We’re recommending things that work, and we’re able to draw back on things that don’t work. And I think that this really comes out to a patient not being on supplementation long-term that wasn’t really moving the needle for them feeling better, or having a patient who is not doing a very strict diet for many years because there could be possibility for them to open up their diet and have more food choices because we were able to really figure out what it was that helped them to start feeling better.

DrHH:

I just can’t say enough about this methodical approach in minimizing the variables. It’s so crucial in my own life as a patient as well as helping patients. Omar touched on this, but I really think it’s so tempting to want to try a lot of things at once. I think we all naturally do that because when you’re not feeling well, you want to feel better faster. And certainly that’s our goal here, but we find that implementing so many things at once really muddies the waters and makes it really difficult to determine what it is that’s helping.

DrHH:

So I think that there’s much more long-term benefit by doing a low variable stepwise approach. That’s very much documented in everything that we do here at the clinic. Whether it’s testing, supplement recommendation, or diet changes, everything is methodical and waiting for the biofeedback. I admire that, and I think that it truly is the right way to do it. Certainly it can sometimes take a little bit longer, but I think from a long-term, overall health approach, it’s the right way to go.

DrOA:

Michael, if I can just add a point to that. I think that in our medical training as physicians we’ve been taught to do more and do more at each step. I think it’s important to realize that so many patients across this country have been harmed by physicians doing more and more, whether it’s conventional medicine or even functional medicine. Sometimes it’s important to take a step back and allow the body to heal itself and just push it in the right direction with a very precise, scientific approach. I think it’s very important to understand that most of the time doing more can be more harmful than doing good.

DrMR:

Well, thank you guys for both echoing that. I think this is a point that really can’t be said enough. It’s kind of a philosophical point that I feel is always running up a hill. That hill is the understandable feeling that you have, that I had when I wasn’t feeling well, which was, “I’ll do anything to get better. If it could be adrenals and it could be toxic metals and it could be inflammation and it could be mitochondria and it could be thyroid, why not support all of those at the same time? It’s just so appealing.” So I think there’s that natural inclination to want to do more. This is where I think it’s really incumbent upon the clinicians to have the wisdom and the foresight to explain this to patients and not to give into that.

DrMR:

That can be challenging sometimes when you’re in the clinician’s seat, but hopefully these conversations that patients are listening to will help them better wrap their heads around that doing more is oftentimes the worst thing that you can do, and doing less and being measured actually gets you to the point of feeling better more quickly. So, yeah, thank you both. The more we can just state this, because it’s so easy to fall into the other way of thinking, the better.

The Treatment Hierarchy

DrMR:

One of the things that I think helps with how we frame this in terms of a stepwise approach or a hierarchy is a lot of the way that we not only have set up our paperwork, but the integration process of the clinician examining the paperwork and using that to inform our problems list that we organize hierarchically or from the top, most probable, to the bottom, least probable. Maybe this is something that you guys could speak to. I don’t know if this is something that IFM or other bodies harp on or if this is a little bit more unique in terms of how we’re doing it here, but I’d be curious to get your perspective in terms of our clinical training and how the training and the way we’re setting things up in the clinic may make that hierarchical process easier because it’s mapped into our data analytics.

DrHH:

Yeah, absolutely. I think that the treatment hierarchy and the problems list really give us as a team a solid framework of things to consider as we’re going through common symptoms that we see coming in. Having everything laid out in front of us with each patient allows us to really make sure that there’s nothing that we’re missing, but also are able to think about the most common or likely things based on literature review and really consider those first.

DrHH:

I think this helps us to address the things that are most common and not get stuck kind of looking at the things that may be worth looking at a little bit further down the line if other things don’t check out. I think that we’re able to help more people faster and then also not spend extra patient resources on testing, going through extreme diets, or lots of supplementation trying to rule out the things that are less common. And so I believe that the way that we have it set up is very beneficial and it allows us to help the majority of cases coming in and then also to help the people who have things that are a little bit less common and not forget to consider those things in their treatment plan creation.

DrOA:

Yeah, I definitely agree with that, Michael. I would just say that when I was joining you initially, I knew that we aligned well in philosophy, but I didn’t know how practically we would mesh and if my training was a little different. We’re seeing these patients in a common setting, but perhaps we’re doing things differently. And that’s where the training really came in and got us all on the same page so we know exactly what the next step of the practitioner is going to be, no matter who it is. And so I think that’s one of the great things about the training where whoever the patient sees in the clinic, they can rest assured that they’re going to have the same methodology going through the hierarchy in their treatment. So I’m just very impressed with how that all came together for me and how Hannah and I meshed so well with that.

Deep Work and Treatment

DrMR:

Good. One of the things that I’ve been thinking about and have done in my head, but am now mapping out, is trying to have these systems created in such a way where as much of the thinking for the clinician is done ahead of time as possible. Now for a patient you may be saying, “I want the doctor to be doing as much thinking about me as possible.” No, you don’t. You want him to be doing the thinking on only the unique things that require unique problem solving. You don’t want him saying, “Oh, geez, what was more prevalent, IBS or IBD? What was more prevalent, this or that?” And then re-jogging their memory to just come up with the basic guideposts of a treatment algorithm.

DrMR:

So if that can be done with me and our team of research assistants over months and years we’ve really refined the general hierarchical structure. There are exceptions, and this is only the starting point, but now we’ve taken 50% of the pre-thought out of the equation. And you can be looking at nuances of how the patient answers our paperwork let’s say. Does that flag limbic? Or what we’re seeing in terms of environmental. Could there be a signal here of there being mold exposure in the home? Perhaps there is, perhaps there is not. Maybe we missed the subtle nuance of them being on a paleo diet, but they’re actually on a very low-carb paleo diet, and you don’t pick that out until you see that they have dizziness, fatigue, and insomnia that started around the same time that they went on the paleo diet. You’re making a note to ask them if they’re eating any starchy carbs and fruits when we get to the exam.

DrMR:

So that’s what I’ve tried to lay out for us. Again, a lot of the thinking about the hierarchy is laid out for you already, and you’re thinking about the nuances of the patient. I think that frees up a lot of mental bandwidth so that you’re not remapping everything out from scratch. You have your starting point framework, and now the thinking is really dedicated to those individual idiosyncrasies of the person. This, at least in my estimation, makes it a lot easier to see where we make the personalization. Is that something that you’re seeing? Let me know your thoughts on freeing up your mind for thinking about the important things. I guess that’s the question that I’m asking here.

DrOA:

Michael, if I could just add to this. I think that learning about deep work coming into this was such a transforming experience where it really shifted my perspective. When I was just practicing and seeing patients, I realized that not every theory or thing that they’re brining to me is necessarily relevant in their process of getting better. That art that you’ve developed over the years of knowing what is important, like you say, separating the branches from the roots, in what a patient is coming to us with and the hurdles to get them better has been such a transforming experience. To learn how to do that, the importance of that, and realizing that you don’t necessarily have to go into all of the fine granular details in order to be an excellent clinician to these patients. There’s a temptation to make that patient happy just by giving them so much of your time, allowing them to go on all of their tangents and so on. So just that idea of deep work has been so transforming. I’ve certainly benefited a lot from that.

DrMR:

I’m so glad to hear you say that. For me, as I’ve shared on the podcast before, deep work and focus really allows you to problem solve it at the highest possible level. And so not only do the system structures and the hierarchy structures in place help guide you to reduce some of the wasted thinking so to speak, but to the point you just made, they also reduce the amount of noise that we allow the patients to impart upon the clinician. Part of what I think works so well at the clinic is it not being an hour and a half exam where we’re just awash in context. Clinicians can filter, but we can only filter so much until our cognition just starts to get drained.

DrMR:

I can’t state how important it is for patients to understand this. The longer that you spend in an exam visit with a doctor does not equal better results, just like more testing does not equal better results. This is why we have focused exams that are 20-ish minutes, because we’ve learned what questions matter. And we’ve put them in paperwork and the paperwork is very detailed. Then we obsess over decoding and translating that data, those questions that matter in the paperwork, into the dashboard. And we organize, refine, make notes, and we use that to update the potential treatment hierarchy. This is also enhanced even more from the fact that we have the health coach review the paperwork and meet with the patient for 20 to 30 minutes and give us those notes also. So this further refines what we have, and this whole process is built to reduce the noise.

DrMR:

To your point, Omar, patients sometimes feel good if they have a chance to vent. I don’t ever want to withhold that from the patient on principle, but what ends up happening is if the clinician just allows the patient to vent, you’re using up all the mental energy that you have trying to filter out, “that’s relevant, this is relevant, that’s relevant.” You’re trying to filter all this out and get the couple of important pieces of information that you need. So what we’ve done is we’ve designed these filters into the intake process, where this is not going to be the hour and a half telling of your story, but rather you’re going to tell your story through a very selective questionnaire honed over almost 10 years. And then we’re going to obsess over that before we see you, and we’re going to have this problem, or at least the structure to solve the problem 80 or 90% completed before we even speak to you. And then we’re going to be able to be precise, ask some clarifying questions, and get from that 80 to 90% to 100%, and then we’re ready to go into the problem solving process.

DrMR:

So for patients, I think there’s a new paradigm emerging that in conventional medicine you oftentimes feel shortchanged because you’re in a visit for seven minutes, and then functional medicine comes in and makes the promise of a long visit being better. But just like more lab testing isn’t better, longer visits aren’t better given that they’re doing it with the correct systems that we’re using here. And so it’s a really key point, Omar, and I appreciate the way that you said that, because I want patients to know that we do have shorter exam history visits than most, but I think they’re far more effective because of that filtering that we’re applying.

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DrMR:

We do have shorter exam history visits than most, but I think they’re far more effective because of that filtering that we’re applying.

DrOA:

Michael if I can add one more point to that, I think that patients really need to know something from our side. Over the years of me seeing patients, and Michael, you probably have that same experience, I have learned how the psychology of patients work. Whether I’m in the clinic setting or I’m in the hospital setting, I know the key phrases and certain things that I could say that lead to a patient reaction and patient satisfaction. That is something that I’ve developed that’s there, but that doesn’t necessarily mean good outcomes. And so that’s a new concept that I think I’m learning more of, but I think patients should also realize that sometimes just being satisfied with a clinician hearing you for an extended period of time doesn’t necessarily translate to better clinical outcomes. And that’s what we’re trying to focus on, to lift the curtain and have better clinical outcomes in the background, rather than that superficial feeling of necessarily feeling great with that clinician. Just an important point for patients.

DrMR:

Yes. A phenomenally important point. And again, of course, we’re not ever trying to shortchange anyone. We’re trying to focus them. We’re trying to focus them, and that’s the key right there.

DrHH:

Yeah, and I love that the paperwork is so detailed, because we all spend quite a bit of time going through that and extracting the patient’s story from their answers. By the time we meet the patient for the first time, we’re at a place where we have a good understanding of what they’ve been going through for the last couple of weeks, months, or years with their symptoms. And then we can really connect on the pieces that are more important and ask those specific questions. So certainly I do feel that the patients we see are feeling heard. I think that the shorter appointments allow that get to know you time to solidify our understanding of what’s going on, and allow us to thoroughly create a treatment plan and next steps that we think are best.

DrHH:

I think that form of taking information from patients and really getting a lot of it first allows us to spend time thinking about it as opposed to just thinking about it in the middle of a conversation and then spitting out what’s on the tip of our tongue or what comes to our mind first. We really have this premeditative time to come up with the next best steps based on this protocol we have that’s thoroughly science-based and then apply the art and the clinical experience that you’ve also incorporated into it. I do believe that it results in better outcomes, but I also think that the patients feel very well taken care of with that process. And so even though it’s different, I believe it’s more effective. I think as a patient, that’s something that I would be interested in and something that I would want.

DrMR:

Yes, and thank you for raising that also. To the term you used a moment ago, Omar, we’re putting ourselves into a deep work situation. Before we even see the patient, we are really extracting the story from their paperwork, and then we’re thinking through, “Should step two of the hierarchy be this or that?” And then we can cross-reference the dashboard and say, “Based on this, I’m going to put Step 3 as ‘X’ and Step 2 as ‘Y.’” You can really think on these things deeply, rather than to your point, Hannah, more of a reflexive, “Well, you said you have fatigue and brain fog. Well, maybe it’s this.” You kind of do this superficial tic for tac. A good clinician can probably do a fairly good job with a reflexive recommendation, but what you miss is what if it wasn’t that simple? What if there’s a red herring here or a layering? That’s where the deep work, where you’re looking at everything collectively and you have that time to really process, just allows that problem solving that we’re really trying to get to.

Practice What You Preach

DrMR:

What about the practicing what you preach? I think it was you, Hannah, who had said something about enjoying that aspect of the clinic.

DrHH:

Yeah, that is so important to me. I think that practicing what you preach and really the team as a whole is very health-oriented. The decisions that we make about our own health and lifestyle are very intentional and in line with what we are recommending other people to do. And as rigorous as going through medical training is, it’s easy to get lost in your own health and minimize sleep or skip workouts, trying to make it to the next board exam and things like that. But really I feel like in my career, I’ve come back to a place where I’m working with a team of people who are all aligned in what we’re recommending and what we’re doing. And I think that comradery creates a setting for true credibility and real empathy for our patients.

DrHH:

What we’re recommending are often things that we’re doing ourselves, so it gives us this deeper meaning of where we’re coming from and how genuinely we believe in what we’re recommending. And so this kind of, “we’re all in this together” mindset really makes it feel like we’re on a team with our patients, and that we’re all in this together. We’re all making decisions each day to better our health wherever we’re starting from. That just creates a different atmosphere that’s almost more of a healing environment. I love that; that’s something I’ve really wanted going through medical school and I feel very honored to have found it. I think it is hard to find in a clinical or physician community. So with that, I am so glad to be a part of the team, because that is very important to me.

DrOA:

I definitely agree. As a clinician, it’s taken me some time to understand that in order to help your patients, you also have to help yourself first, which means taking good care of yourself and living a healthy lifestyle first and foremost. And so I think getting out of that mindset of the clinician having to be in the grind and just working non-stop hours as some sort of a measure of success is something that has taken me time to unlearn. What I really love is that here on this team, we have such an emphasis on good health, rest, and all of those adequate pillars of well-being that we recommend to people. And so practice what you preach is something that we’re actively doing and not just saying to patients.

DrMR:

It is also just something that I’ve noticed. I perform better mentally when I am well-fed, well-exercised, and not highly-stressed. There is, and there was, a time when I felt like my hair was on fire 24/7. That can be starting a practice on your own and not having the financial resources to start the practice, but doing it nonetheless. Those were challenging days. It’s a real privilege to have this ship built up to the extent that it is where new members of our team don’t have to go through that suffering. We can go right to, “Let’s get you optimized. Let’s make sure that you’re well-fed, well-rested, and are attentive to those things so that you’re going to be performing at the highest level possible.”

DrMR:

So that was a painful point in my life. I got through it, but if I can save others from having to go through that purgatory, then that’s a win for everyone involved. It’s a win for everyone on our team, it’s a win for that individual clinician, and of course, for the patients that the clinician is trying to help.

Performance Metrics

DrMR:

Maybe to throw you both a little curve ball, we’ve been tinkering with the idea of posting the performance metrics of all of our clinicians and staff on the clinic’s website. So this would involve an Oura Ring sleep score average, their Cooper’s 12-minute time test, and maybe something like a deadlift and squat. So I’ll just plant that seed, Hannah and Omar. That’s something that’s probably coming soon. I want us to be able to focus a little while longer on getting all the systems totally refined. But once we have a little bit of bandwidth left, I think we’ll have a board of stats that we can put up there for people to see, and also we can talk a little trash to one another about who’s doing good and who may need to get to bed earlier or work on their run time.

DrOA:

There’s no better motivation than that.

DrHH:

And the accountability too. And just the ability to check in on each other and see how we’re doing, I love that. So it sounds fun.

DrMR:

Yeah, I think it’s going to be a blast. I will say that as of right now, I think the leader of the run times is Dr. Rob. He’s an avid runner, and I’m more of a goon, so I’m trying to catch him, but he’s got a runners build. So he’s given me something when I’m running and I’m wanting to slow down, I’ll picture Rob 300 yards ahead of me. It’s good motivation and it’s fun. I love building this kind of culture at the office.

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.

Episode Wrap-Up

DrMR:

As we move over to a close, I’d like to give you both a chance just to offer any closing words or thoughts that you want to share with people. Omar, why don’t we start with you?

DrOA:

Sure, Michael. I just wanted to reiterate to you again a thanks for bringing me onto the team and everything you’ve taught me in a short period of time. And I just want to stress to people, patients or whoever they may be, that it’s so important that your practitioner and your provider is extremely passionate about what they’re doing, the position they’re in, and their care for you, because too many physicians and too many practitioners are burned out, not enjoying the work that they do, and not able to be in an environment where they can thrive. That’s ultimately going to affect their care for you. And so I think people should know that here at the Center, we really have created an environment in which practitioners can find their passion, thrive, and then take excellent care of their patients.

DrOA:

And so I’ve been very blessed to come on board and be a part of the team. I’m just extremely passionate about getting people healthy in an affordable way. I could go on talking for a long time about this. So I’m just really grateful for the opportunity and really looking forward to seeing more people and getting them better.

DrHH:

And I’ll echo that, Omar. I am so honored to be working with this team. Not only the knowledge of the science but the clinical experience that you’ve brought into training us. It uplifts my confidence and ability to feel like I’m providing the very best that I can for my patients. Also, the collective teamwork approach where we’ve gotten together and talked about cases and learned from each other. Certainly we all come from different backgrounds and we bring in different experience, and the ability to get together and discuss things on a weekly basis has really allowed for us to learn from each other, grow much faster, and learn and prove our knowledge much quicker than we would on our own. And I think that is a true benefit of what you’ve created as well.

DrHH:

I’m so honored to be in this type of practice and truly at a place where I feel as though I’m helping patients in a way that feels authentic and feels like the right thing to do. I’m so glad to be here and just really excited to continue getting started, and I think there’s a lot of good that will come of it. So thank you.

DrMR:

Well, thank you both. Thank you also for helping me to see what would happen when we expanded from just a sole providership to a multi-doctor clinic. I’ve just been so incredibly elated that as things have grown, things haven’t got chaotic and unorganized. We’ve actually become more organized because more attention has been given to these systems. And as you guys both have said, you’ll have a similar experience across providers because this is a system that we’ve all worked to build together and we’re all operating in the same system. This whole experience has given me a lot of hope that this clinic is going to continue to grow, and as it grows, it’s going to get better. I think some operations grow, they can’t handle the growth, and things get sloppy and unorganized.

DrMR:

So for me, this ha just been something that I really find so compelling and moving. I want to help more people, and I can’t obviously, because I’m only one person, so I’m limited in how much I can do. But boy, if we’re able to build this thing that works and expands in a quality way, then what a gift to be able to offer to people.

DrMR:

So Hannah and Omar, thank you guys so much for your hard work and your dedication. And for our audience, I hope this has been insightful. If you’re in need of functional medicine care, I am extremely biased, but I would love for you to reach out to the clinic. My mother, my father, and my sister are now all being seen as patients at the clinic, and none of them are being seen by me. Firstly, I think everyone knows why, because working with your family is always hard to do, but also because I just have so much faith in our team that this is where I have the people that I love go.

DrMR:

So Hannah and Omar, you guys are awesome. Thank you so, so much. And to our audience, thank you guys for your interest in the work and supporting what we’re doing because this is growing, and we’re really making a dent in healthcare and I just really, really appreciate everything. So thank you everyone, and we will talk to you next time.

Outro:

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