Functional medicine is growing extremely fast. Doctors across the fields of medicine, chiropractic, nursing, & nutrition are seeking out advanced training in functional medicine. I've read now that at least 1/3rd of medical schools now offer some functional medicine training in their curriculums.
Many doctors are taking the easy approach and are offering cookie-cutter approaches for their patients that involves testing every patient for functional discrepancies & letting the lab test dictate all of their treatment choices.
Instead of taking a detailed history, these doctors let the functional test dictate the course of care with pre-determined protocols. You deserve more than that... Recognition of our biochemical individuality is a key component of functional medicine!
Doctors should take a detailed history & only order functional tests when it will significantly change their diagnosis and initial course of care.
One of the largest reasons doctors turn to testing is that while the testing may not be necessary from a clinical standpoint, it may be crucial to gain patient compliance to our recommendations. As functional medicine can be difficult to explain, seeing your own lab results in black & white can be the difference between taking action or not.
When push comes to shove, testing can be incredibly useful and sometimes completely necessary, but is often done too frequently. I tend to be more conservative with testing than other doctors, and here's why:
Do You Need a Functional Test?
Doctors are taught in school that 90% of the diagnosis is dependent on your history-taking. Traditionally, many professionals utilize 15 minute time slots to see their patients. "Cookie-cutter treatment" is cheaper to perform & makes a smarter business strategy as you can see more patients during a day.
Some doctors depend on testing because they are not spending enough time with their patients to be doing this type of work. A full consultation allows me to personalize herb and nutraceutical recommendations based on patient individuality - not a test print-out.
Tip: While functional testing is interesting and exciting, look more closely at doctors who perform the same exact tests or screens on all of their patients.
2. Functional Lab Tests are Not Typically Covered by Insurance:
Most functional lab tests are confirming what a doctor is already thinking based on history and consultation. If a conservative trial of treatment has minimal chance of causing harm to a patient, and no "red flags" are signaled to the doctor, most guidelines would direct a doctor to simply begin a trial treatment before seeking testing. Testing can always be performed to check progress or to rule out hidden problems later on. Functional tests are not always covered by insurance plans, and some states allow doctors to make money off of mark-ups on functional lab tests (NJ does not).
What I find is that I end up learning more about the patient by seeing how their body responds before jumping right into testing. It also allows me to focus on some initial behavioral changes, learn more about my patient, as well as order better tests & make better recommendations in the future.
Medical costs are the number one cause of bankruptcies (at least 62.7%), I look for ways to save my patient's money without sacrificing quality of care. Other times, I may take a firmer stand on why I need to conduct a particular test. Sometimes, higher expenses in the beginning lead to lesser expenses down the road.
Tip: Just because your insurance does not always cover functional medicine, does not mean that you cannot afford it. Many doctors can work within limitations. While testing is useful, it doesn't make it 100% necessary. Testing is never 100% accurate either. There is always chance of lab error, false positives, & false negatives!
As nutrition works by assisting the body in a natural way, as opposed to "dominating" over physiology with man-made drugs, a natural trial of treatment is often safe with minimal chance of harmful side effects. If I am misguided in an approach, the chance of harming the patient is very low. As a functional medicine clinician's intent is to promote health, & not "treat" disease, most patients still benefit from a wellness approach, it just might not be 100% tailored to their unique health profile until the doctor and patient learn more.
Most concern for side effects comes when clients are taking existing prescription drugs or they have severe food allergies. Other examples are when functional clinicians are working with hormone replacement therapies, or aggressive detoxification protocols such as metal chelation or dental amalgam removal.
It is important to note that the overall severity of a patient's complaint may also direct a doctor to seek testing earlier than later.
Functional medicine doctors are trained to be careful when patients are on existing medications, and know what herbs may actually help a prescription work more effectively.
Because I do not recommend testing for all of my patients, my patients tend to trust me more when I do recommend a test! This means better compliance with my recommendations, and hopefully a higher likelihood for results!
Tip: Ask your clinician if a trial of natural conservative treatment is right for you before exploring more aggressive medical treatments.
4. A Conservative Trial of Care is Safe and Cheaper than the Testing:
As functional medicine is time-consuming. not offered in all areas, & often not covered by insurance - it can be expensive.
When it comes to functional testing, finding a lab that will draw blood for a patient can be difficult. Labs tend to only draw blood for their own lab panels. Many doctors may offer blood draws at their office, but may do so on a limited schedule.
The direct costs of the tests can be rather expensive as well with lab tests running hundreds, even thousands of dollars for comprehensive panels. On the other hand, supplements may range for much less ($10-$100). If more supplements are needed, sometimes testing can verify the need for added cost of advanced wellness protocols.
Tip: Ask your doctor what their recommendations would be without having the results of a functional test, how would testing change the treatment approach?
5. Many Clients Already Have Had Bloodwork Completed & Further Testing May Not Change the Treatment Approach:
Many tests are ran simply because an insurance company needs to verify a diagnosis before they reimburse for patient visits. Functional medicine doctors do not emphasize the "diagnosis" as much as other practitioners. Functional medicine doctors are focused on function and how limits in function may lead to a range of future health problems. They are more independent from the limitations of an insurance-based healthcare model.
Many patients visit a functional medicine doctor after conventional medical approaches have failed. They often come in with bloodwork from other physicians.
Tip: Most physicians analyze bloodwork based on "normal" ranges. Functional medicine doctors look at "functional ranges" or "healthy ranges". Just because your previous bloodwork came back "within normal/average limits", does not mean that you are healthy.