This week’s podcast is a series of interviews with a handful of physicians who are involved with the Institute for Functional Medicine (IFM).
Dr. Luby is the Director of Medical Education Initiatives at IFM, which works to scale functional medicine and make it more accessible and easier to adopt into larger healthcare systems. The pandemic brought to light weaknesses in our healthcare system for which functional medicine offers solutions!
Dr. Penn is an infectious disease specialist and works in epidemiology and infection prevention at Nebraska Methodist Hospital. He has worked closely with Dr. Luby, and Dr. Penn is planning to implement more of the IFM’s principles into his healthcare system. Dr. Nancy Cotter and Sharon Williams are from the Veterans Affairs (VA) in New Jersey. They are also working towards integrating lifestyle medicine into their systems in part by utilizing group visits.
Listen to the full panel discussion to learn more about:
- The benefits offered by functional medicine for the VA in New Jersey
- The problems in our healthcare system, which functional medicine can help
- How Nebraska Methodist Hospital has seen the IFM’s principles improve their COVID outcomes
- And so much more!
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Hello, and welcome to the podcast. This week, we are talking about how functional medicine is scaling inside health systems right now. If you watch the functional forum at the beginning of the month, you know that one of our focuses here at the Evolution of Medicine moving forward is really showcasing the ways in which institutions are taking on functional medicine, who the players are and how they’re facilitating that. So today, we’re super excited to make this episode in partnership with the Institute for Functional Medicine.
We’ve got Dr. Robert Luby, who’s their head of education and has been working on this. We’re going to hear from doctors working in the VA. We’re going to hear from doctors working in Nebraska, of all places, taking functional medicine forward. So I’m really excited about it. This weekend is the IFMs annual conference. It’s all virtual and there’s a lot that is going on this weekend to talk about this topic, and different ways in which functional medicine is being scaled inside institutions. If you doubted that this is happening, I’m super excited because you’ll see that this is happening and this is just a couple of examples. So super grateful for the opportunity to connect with some real pioneers in the field. Enjoy.
So a warm welcome to the podcast. We have doctors here from all across the country who are helping implement functional medicine inside health systems. Maybe I could start with you Dr. Robert Luby. So doc, great to have you here on the podcast and excited to connect today.
Intertwined with the story of the Evolution of Medicine podcast and the Functional Forum has been this Cleveland Clinic story because on the fourth episode of the Functional Forum back in 2014, the first time we got the stream working. Dr. Hyman, I think kind of unannounced, had just flown in from Cleveland and announced to the audience that was in the room and also on the stream that there was going to be a Cleveland Clinic center for functional medicine. Over the years we’ve taken the cameras there to go and see what it looks like and see the small medical appointments interview, the doctors, and PAs and health coaches, and dieticians working on that project.
Why don’t we just start there? So that was really the first formalized functional medicine work happening in a system. So, do you want to just sort of give us an update on that end and how it leads into this conversation here today?
Dr. Robert Luby:
Sure. First of all, James, thank you for the invitation to participate here. It’s a real pleasure to be with you again. And yes, this is now quite a long story, this story with the Cleveland Clinic Center for Functional Medicine, and over the years, the evolution of how IFM has been supporting the center has changed. At the start, we were supporting with training of the physicians and other practitioners who were being used there in the center, and we provide resources for them to use, point of care clinical tools for them and for their patients.
We’ve also provided support for their research activities. As you know, they’re trying to demonstrate that the model of functional medicine can work in an academic institution, in a large community setting, in an underserved community setting, and with a wide variety of models. The first publication showed that functional medicine achieved superior outcomes to the usual care delivered there.
And then another study beyond that showed that a shared medical appointment model of care was even superior to the individual model of care. So those are some innovative models of patient care delivery that are really gaining traction and really turning heads there. So in a community based setting, this is really huge, James. I know that’s something that’s very close to your heart as well. What it does is it really provides wider access to a wider panel of patients, quite frankly.
Yeah. One of the things I came to recognize was that in functional medicine, I guess 1.0, where it’s long appointments with the doctor, I’m sure it’s capable of reversing and supporting the reversal of chronic illness but ultimately, since the beginning of the evolution of medicine, we’ve been thinking to ourselves, in what structure must this be delivered in order to facilitate chronic disease prevention and reversal at scale?
I’m grateful that everyone’s sort of thinking in this way now. There’s a push to think about it. I guess, in the conversations that you are now having, how does that sort of make itself known from the different organizations that you’re working with?
Dr. Robert Luby:
Alright. This has been a long time concern of yours too, is this scalability and what we’re actually seeing accelerating the need to become scalable is that the healthcare landscape is changing. More practitioners entering the workforce out of their training are expecting to work for a large organization or a large practice as opposed to be going solo. So IFMs historical audience was the solo, independent practice or the very small practice. We are going to continue to support them for sure but the large institutions now, are seeing the value of lifestyle based medicine, integrative medicine, and functional medicine, and we are adapting with the times.
For me, it’s one of the greatest challenges as it challenges us as educators to develop resources for this expanded setting and to make sure they are scalable. So with that long appointment that a solo practitioner can have, perhaps that’s not usually the case with a large institution. What we’ve been doing at IFM is developing resources for practitioners, those point of care tools that can be used in much shorter visits with patients and similar resources for patients, as well as those resources for shared medical appointments. That’s really key.
In these institutions, you often have a much wider range of practitioners in the collaborative care team than you would in a small practice as well. So another challenge, another opportunity for IFM to develop training pathways for non-physicians but those who contribute so importantly to all aspects of patient care. And that’s something we’re developing now is, specialized training pathways, one size does not fit all for patients. One size does not fit all for training for these different types of practitioners. So that’s another area that IFM is really going deeply into elevating the quality of our training for just the whole spectrum of practitioners in these institutions.
Yeah, I’m so glad you mentioned that because I think as someone who went to a lot of functional medicine conferences and met a lot of doctors that were passionate about functional medicine but had a day job right where they didn’t do functional medicine historically. Our first thesis was, let’s make it easy for these people to leave medicine and follow their heart. That was really our early thesis about the low overhead practice but we’ve been sort of going against the trend on that, which is that most clinics and this especially accelerated during COVID, most clinics, independent clinics sold into health systems.
Because, in the way that medicine has been structured with fee for service, it became very difficult for the independent clinic to survive during COVID because they couldn’t bring in any revenue and so forth. So I guess, how critical has it been from IFMs point of view to actually build for, not what we hope might happen, but what is happening?
Dr. Robert Luby:
You make a very good point. Of course, with the COVID condition specifically, we created a rapid response team and we immediately put together resources of scientifically plausible and evidence based interventions for the acute COVID early on in the pandemic and continuing to work on resources for long COVID or the post post-acute sequela of COVID. What was interesting, we really found is that the institutions with whom we had existing relationships became overwhelmed by the COVID influx of patients, their urgent care settings, especially. And not only of patients, but the employees as well. We know the strain that it put on employees of healthcare systems.
And this was one of the great opportunities that came about is, not only could IFM provide resources for those patients and they were widely used. We haven’t published anything yet but we certainly heard the anecdotal reports from institutions that, “Hey, our patients who are using the IFM protocol, they’re not getting hospitalized. They’re not getting severe cases.” We’re now hearing low rates of post COVID for those who were treated according to that protocol for acute COVID.
But, institutions turn to us as well for the health of their employees and this is where one of the great stories comes in, one of your guests today, is that one of the infectious disease specialists at Nebraska Methodist college in Nebraska Methodist Healthcare System reached out to us after taking IFM’s training course on the COVID pandemic and how to respond to it. He reached out to us and we created a collaboration in which he and I, and both of our teams developed training and assistance for their employees in terms of how to stay resilient and healthy through the COVID pandemic.
Well, let’s jump into that now because I’ve got Dr. Penn, is right here from Nebraska. From speaking to entrepreneurs over the years, they tell me that you can tell when a movement really has traction when people in Nebraska start doing it. And so, here we are. Doc, thanks so much for agreeing to be part of the podcast here today. I know you are an infectious disease specialist and working in epidemiology and infection prevention at Nebraska Methodist Hospital. Can you give us the story of how you ended up interested in functional medicine and sort of your journey to be here on the podcast today?
Dr. Robert G. Penn:
Thank you, James. It’s an honor to be here with you and Dr. Luby. I’m just a little Nebraska farm boy. I grew up on a farm, although there was a state college where I was at. There was a school I went to, we were the Guinea pigs of the practice teachers at that point in time. I learned about circadian rhythms in the third grade and it was really an exciting, stimulating experience. From there I went on to college, majored in zoology and got interested in a lake where Dr. Luby lives actually, Lake Mendota. Learning about limnology and the fascinating ecosystems you encounter as you go through different layers of lakes and so you go out in Western Nebraska and see the water. It was red because of the microorganisms there. So my senior thesis in college was perinatal nutrition.
Wow, was I amazed how important nutrition in pregnancy was for the IQ of a baby? Went on the medical school, ended up going out and practicing general internal medicine for a year after my residency. My health system here where I’m at, needed somebody in infectious diseases. So I went away for a couple years. They recruited me to come back after training in microbiology, epidemiology, infectious diseases and Immunology and have directed the program here. And I’ll age myself, since 1981. It’s been kind of a codependent, independent practice.
I have an independent clinical practice but then serving as a medical director for what we call healthcare epidemiology and infection prevention, addressing various ongoing endemic infections, outbreaks, including over time norovirus and mumps. And also looking out for the healthcare of our healthcare personnel.
That’s great. So tell me about how you got involved with IFM.
Dr. Robert G. Penn:
Well, as we were getting into January of 2020, and actually it was just before Christmas, I brought to the attention of our service leader in our department, there’s this interesting outbreak going on in China, in the Wuhan area. And I said, we better pay attention to this and as we got into January and it became apparent we were getting into a true pandemic, we began to prepare for a pandemic, which a lot of unknowns at that point in time.
It turned out in early March, we encountered the first patient in Nebraska that was diagnosed with COVID-19. It was a 36 year old female, came in, she was hospitalized. Over 30 healthcare personnel helped care for this patient. None of them got infected in part because of the preparations we had made in terms of emphasis on personal protective equipment and barriers and so on. She ended up being on the ventilator for three weeks but did survive her infection.
It became very apparent we were dealing with what was referred to as a Corona-coaster of uncertainty in a Lancet article. And as we got through the 2020s, it became even more apparent we were dealing with an outbreak that was not like any other outbreak that we had encountered. We began to raise questions about, how is this going to affect our healthcare workers?
We started seeing those looking at alternative careers, looking at nurses leaving to do traveling. We looked at, as I rounded the anxiety, the depression, what looked like increasing burnout, even some suicidal ideation that was emerging. So we got together a research group of five of us. We were four faculty members at our Methodist College, which is a leading national nursing college to kind of sit down, ask some real basic questions about what was going on. That included three of the faculty and a statistician.
We designed this study that we carried out. It was a survey that we carried out in April and we completed that through the month of April, collected data, started analyzing and then I came across this course that IFM was offering. I’m not sure even when I initially linked with them, I think it was back in 2017. It was probably in part because of Mark Hyman, who I kind of followed periodically. There was this course on COVID and I said, they share very similar foundational principles to infectious disease in ways. They look at the root cause of what’s going on. And in part, because I have a practice where we look at medically unexplained symptoms, I thought maybe I can gain more insight into how to organize and approach the patients, not only with COVID-19, but with medically unexplained symptoms.
So I had this interesting link to Dr. Luby one day as the course was nearing its completion. I hadn’t gotten to his one presentation on the Statue of Liberty yet, but I completed that and he in a very timely way responded. And from there, we connected and had developed I think a very rewarding relationship at least for our health system and hopefully through IFM as well.
Yeah, that’s great. I guess one question I have is, I interviewed last year a doctor who ran the COVID response for seven hospitals in Oklahoma and he felt like there wasn’t a lot of positive reinforcement for, let’s say the role of nutrition in recovery. How were you able to sort of overcome some of those institutional barriers to now start to bring in IFM, get the education to the doctors and to your team? What was it about your approach that you feel made it that your hospital was open to this kind of conversation?
Dr. Robert G. Penn:
There’s those that sow the seeds and there’s those that do the reaping, but I kind of am a sewing of the seeds. And from the beginning, ever since I’ve been here in part because of my interest in nutrition and understanding the importance of healthy lifestyle habits, as I’d rounded, I’ve always kind of scattered those seeds. There’s one care manager and she said, “It took me two years to understand what you were talking about in terms of optimal nutrition. It’s not a diet, it’s healthy lifestyle habits.”
And after losing 90 pounds and coming back and I asked her, what’s going on here? Well, it’s healthy habits. And so I kind of all along kind of set the seeds for this. In working with the Methodist College, in part having addressed some outbreaks within the college, I connected with various faculty there and it turns out they have a course in lifestyle medicine. So there likewise, the seeds had been sewn for understanding the importance of a healthy lifestyle and how that can affect one’s quality of life, adding years to your life and life to your years.
Yeah. What sort of training have you guys done now and who’s taken the training there? And what sort of response to the new training for what I would call, allopathic doctors in the system?
Dr. Robert G. Penn:
At this point in time, this has been directed at the system house wide. We have around 8,000 healthcare personnel within the system and 30 healthcare clinics. So we have a large audience that we’re trying to reach out to at this point in time. We’ve set up a series of webinars. The first two last September and October, we’re reviewing the study results from this survey study. In fact, we’re at a point where we’re hopefully going to be submitting a paper for publication in the coming week, as we kind of do our final dotting the Is eyes and crossing the Ts.
It was around that point in time, I connected with Dr. Luby and said, we want to extend this out and emphasize, what is optimal health? How do we provide optimal health and tools for our healthcare personnel to work with, to be sure they’re optimizing resilience, resistance, and if they’ve had COVID-19, recovery? It was at that point in time, we designed two additional webinars. One we presented already on, and this is kind of centered around my passion. It was a passion I started to develop perhaps going way back to my youth and then especially reinforced in my fellowship years of infectious diseases was, what we called bacterial interference back then.
They said, “You can come and be our first fellow, if you design a research study for two years looking at the normal oral, what we now call microbiota.” We used to refer to it as a flora but microbiota, and how the bacteria in the oral pharyngeal area interferes with Group A strep. And so I designed the study and we were able to demonstrate that certain strep species like strep salivarius would interfere with adherence and Group A strep. Boy, was that really fascinating to me. I’m presenting at some national meetings.
And then we got off into antibiotics. And so for a number of years, my focus has been on antibiotics but now we’re coming back and focusing more and more on antibiotic stewardship and stewardship of our microbiome. So these webinars that Dr. Luby has been participating in, is centered around weeding, seeding and feeding your microbiome, which is the control center as we now understand, of our health or if we have chronic disease, it contributes to damping down chronic inflammation or maybe ramping up chronic inflammation.
It communicates with all our ancestral bacteria, those little powerhouses in our cells called mitochondria. And either it’s communicating a cell danger response or it’s communicating, everything is calm. You can relax and digest and provide energy to this complex body of ours. So the next webinar which will be on the 27th of May is going to extend this out to the seeding and feeding. We’ve gone through the weeding portion. And you’ll be able to provide a link to these webinars on your podcast by the way, so that anybody listening to this can sign up and listen for a very small fee.
I’m just interested to know what the provider feedback is. They’ve never had a training in the microbiome before, they’ve maybe know that antibiotics are being used too much but now there’s a real framework to help them really think about how to manage a healthy microbiome. What sort of feedback do you get from doctors and medical students, as you share this information out to them? Is there a hunger for it or is there resistance?
Dr. Robert G. Penn:
I would say there’s really a hunger and being the co-director, one of our ways of manipulating the microbiome, the microbiota transplant program, AKA fecal microbiota transplant, where we’ve transplanted over a hundred patients now with a fecal microbiota transplant, who’ve had very severe Clostridioides difficile infection or C. difficile. We’ve had a real welcoming, if you will, among our GI doctors because often we will do that transplant. It will be a colonoscopy. Although I have to admit during COVID-19 pandemic, it’s been kind of put on the back burner a little bit because of our source of getting stool through open biome.
But there was one door that really opened up. C. diff is a disease of dysbiosis of antibiotic manipulation of our microbiome towards a dysbiotic space. So that door has really opened up, that our healthcare workers do understand. In terms of the next level that we are aiming for and on an individual basis, I always get positive feedback. But what we’ve been searching for is how do we do an organized approach of not only education, but implementation of the tools that are available in turning around dysfunction through functional medicine?
We’re at the stage now where after our next webinar, I propose to our administration, we went to put together a central core group to address now what we’ve learned through the survey study we completed. Identifying anxiety, depression, hopelessness, why our healthcare workers the turnover, how we can re-add joy to their career, but also from what I’ve learned through IFM, we need a central healthcare coach. My hope is that we can then identify and maybe get a good donor to provide us with a healthcare coach coordinator to now really get into how do we do a more universal education and offering tools for implementing a functional medicine approach to all our healthcare. Not only the personnel, our nurses and everyone else within that pool of individuals, but also to our healthcare providers. How they can now start directly applying this to their practice in optimizing health, not only caring for patients, but true healthcare and just not sick care.
Beautiful. I’m glad you shared that. Speaking of joy Robert, I just want to come back to you. How much joy does it bring you to know that this is happening in Nebraska and there’s good feedback for functional medicine and providers are in to it, and they’re hungry for the information? I know you’ve been at this a long time. It seems like a big moment.
Dr. Robert Luby:
Right, thanks James. It clearly is. This is everything we’d hoped for in the face of adversity of a pandemic. Dr. Penn’s colleagues there, the experience really had the look and feel of a shared medical appointment when we were in those webinars, and especially in the Q&A sessions. You asked, were they hungry for this? They were extremely hungry for the lifestyle and the nutrition recommendations and all of the work that IFM has put into those patient care resources.
The IFM toolkit now, coming close to 500 items for patients and practitioners to use at the point of care. That was called into use heavily there and what was so special about it James, is that the practitioners at Nebraska Methodist were in essence, the patients. And in the Q&A sessions, we talked about how they could use these tools for themselves to keep themselves healthy, to steward their own microbiota.
They really understood that concept that we talk about at IFM that we are not humans with microorganisms in us, we are a microbiota having a human experience and we really need to take care of that microbiota. That was something that really resonated with them. Then they started sharing as if they were patients in a shared medical appointment, sharing ideas and sharing then how they were going to apply these tools, not only to each other and themselves, but to their patients. So it really went from taking care of Dr. Penn’s colleagues and staff to the colleagues and staff, seeing how they could apply it to patients.
This really gets into that idea of IFM being able to reach wider audiences now through institutions, not just patients from a solo practitioner, but huge numbers, tens of thousands of patients in the Nebraska Methodist System, many practitioners in a scalable level.
To call out another specific example if you’d like, is the work that we’ve done with the Veterans administration. There’s a New Jersey section there that has received a grant and we’ve been helping them with shared medical appointments and application to underserved settings. Many wider patient populations, such as veterans who have had social determinants of health affect their chronic care. So if that’s something you’d like to speak more about, take it from their James.
All right. Well, I’m super excited to welcome also to the show today, Dr. Nancy Cotter, who’s the director of the VA in New Jersey and their whole health program. And also Sharon Williams, who works in the Whole Health, as the nurse manager. Part of the reason why we wanted to bring these guys on is because the VA and IFM are doing some exciting work, bringing functional medicine to the VA’s Whole Health initiative and there’s some exciting things that are happening with veterans, with the social determinants of health, with shared medical appointments, all the kind of stuff that we love here at the Evolution of Medicine.
Why don’t I start with you, Dr. Cotter? So the last time we were hanging out was the 2015 Functional Forum there in New York and sounds like you’ve been busy in the last seven years. So tell us a little bit about what you’ve got going on there and how you are working with IFM to support veterans and population health inside the VA.
Dr. Nancy Cotter:
Sure. First, I should probably talk about Whole Health, which really works hand in glove with functional medicine and why we’re really able to be able to support functional medicine initiatives. So Whole Health, it’s really a system of care and it’s a radical departure from sort of business as usual in patient care. It’s a system that what we say, empowers and equips veterans to take charge of their own life and health.
So what does that mean? So empowers veterans, so helps them to understand that they are the most powerful agent in their own health. It just talks about all of the different factors that contribute to one’s health. Less about sort of reaching different numbers, blood pressure numbers, hemoglobin A1C numbers, and more about realizing all of the things that influence our health.
So those would be things like what we might call the matrix in functional medicine, especially the bottom of the matrix. So, food and drink and exercise and good relationships and how they can modify their own lives to better their own life. That’s sort of the empowerment. And then the equipping is giving them skills, helping them to learn skills so that they can really live their best life. And then the third part of it is what we call clinical care, which is the excellent clinical care that the VA already gives but in this context of whole health, in this context of empowering and equipping.
Central to all of this is what we call the personal health inventory or PHI, where the veteran works with a health coach. It could be a peer health coach, it could be another veteran, or it could be a professional to look at what is really important in my life. In other words, what are my goals in life and why do I want my health anyway? I want my health to reach those goals. And then, what aspects of my health do I want to work on?
So, that’s a descriptor of the Whole Health system in brief. Indeed we have, week long conferences on Whole Health. So it really is a nutshell. We have a big educational arm, we have a clinical arm. Of course, we’re the VA so we are always measuring our steps. We do a lot of research and that’s really it’s present in literally every VA in the country. Some VAs have progressed more along that line than others but we all sort of work together at the national and regional and local level, to promote this Whole Health.
So that is really why we can bring in functional medicine because there’s really a broad understanding of what Whole Health is and how all of these factors come together to give us good health. So we have something called the wheel of health, which includes like I talked about before, things like the power of the mind, food and drink, moving the body, spirit and soul. And those of course go hand in hand with functional medicine, which recognizes the multiple influences on one’s health.
One of the ways I think that functional medicine and Whole Health go so well together is because of this sort of systems approach. So in Whole Health, we use kind of a systems approach to one’s whole life. In functional medicine, we drill down a little bit more and use this systems approach to one’s health. So functional medicine is sort of perfectly, I was going to say perfectly equipped, but perfectly designed to help us focus on areas of health and wellness within that whole health circle of health that I talked about.
And so functional medicine, again, we already have this understanding of this Whole Health concept and functional medicine really gives us the tools. So first of all, the understanding of how our physiology works in a systems approach. So it teaches that beautifully and helps clinicians to understand that. It also gives us so many tools to work toward that holistic approach to health.
I’d love to know what some of those tools are because I imagine you start having conversations about how we’re going to implement this. What are some of the tools that you have found useful in the implementation into the system?
Dr. Nancy Cotter:
So some of the functional medicine tools, really of course, the timeline. We are doing a shared medical appointment project right now, which maybe we can talk about later, where it’s a group approach and we use functional medicine approach to teaching. The project is about diabetes. I want to start that part all over again.
So what are some of the tools that we use? Some of the tools that we use are of course, the timeline, which is integral to the functional medicine approach, the matrix to better understand veterans problems. There’re multiple tools that we use, handouts. We use the… I’m just forgetting the word, the go-to-it approach, which is our systematic method of approaching patients concerns and creating a holistic plan within the functional medicine model. And then of course, there’s the functional medicine library, which has lots of tools and handouts that we can use to aid both our clinicians and our patients.
Can you contextualize sort of what that looks like in terms of outcomes? When patients use the wheel and go through the small groups, what is the sort typical or an outcome that is possible in that case?
Dr. Nancy Cotter:
Maybe I should talk about our shared group project, which we’ve worked with the Institute of Functional Medicine. We’ve worked on this together from the start, really. So this is a project that is actually funded by the Office of Patient Centered Care and it is a project that seeks to help patients with gaps in their social determinants of health. It’s for black and brown veterans with poorly controlled diabetes, defined by a hemoglobin A1C greater than nine.
And so what we do is we consulted with the Institute of Functional Medicine from the beginning about this process. We talked about the important elements in a shared medical appointment and talked about important questions that we might want to ask veterans about their experience with diabetes. So we designed a 10 week intervention, which combines functional medicine teaching. We think it’s important that they know about their own physiologic process, how diabetes happens but importantly, how they can heal from diabetes. How the things that we teach them, like nutrition, cooking, mindfulness, how those things when implemented, change their physiology.
That’s a lot of what we learn about in functional medicine. I like to call it positive physiology. Each class me contains an element of didactics, mindfulness and nutrition knowledge and skills. Everybody who participates in the course has learned functional medicine. They attended AFMCP. That was part of the project also, is to train a number of clinicians in our facility to give them at least the basics in functional medicine, so that when after veterans are finished with this intervention, when they go back to their doctor, their doctor will understand what they’ve been through. I have no idea if what I just said made any sense.
So Sharon, I’m really glad that you could join us here as well. I know you’ve worked closely with this groundwork with the VA in New Jersey. Can you share a little bit more about your role in the project?
So my role as the program manager in this project was more of pulling all of the pieces, all of the moving parts together. It is a project with a multidisciplinary approach. We have a variety of staff on board and many of which are functional medicine trained, which is lovely because we all speak the same language. So we have nurses, we have a nurse practitioner on board. We have a research scientist, we have our psychologists and health coaches. I’m sure I’m forgetting someone or some people, but just a wide array of staff members on board.
So just creating spaces for us to collaborate and for us to brainstorm and then to implement and execute all of the ideas that came through for this project. Also, helping with creating and ensuring we have a blueprint for future classes. After we had our first group, we reviewed their feedback and went through surveys and figured out what we needed to tweak for the second cohort of veterans in this project. So just a lot of moving parts and trying to get everyone together.
We are so fortunate to have the functional medicine training because we find it to be so critical with teaching veterans about their diabetes and empowering them and giving them hope that they don’t have to continue on this path with having an A1C of nine or greater. There is so much that they can do and that requires just little changes from them.
I know you did the shared medical appointments and that 10 week pilot program. Can you share a little bit more about your role in the design and implementation?
Sure. I basically help mainly with the health coaches. So we have health coaches and Dr. Cotter mentioned their role and what they aim to do, which is empower veterans to set goals and to take charge of their lives. So working with the health coaches, creating a blueprint that kind of helped to standardize the process because we have a variety of health coaches. We have non-clinical health coaches, we have clinical health coaches. We have acupuncturists as health coaches. In the VA, it allows for a wide variety of staff to serve as health coaches.
So creating a blueprint that helps with some type of standardization but also leaving wiggle room for individualized care. Going over the timeline with the health coaches, so they can talk to their veterans more and just learn a lot more from the veterans and allow them to basically connect the dots as to what happened to them in the past and how it may affect their health now. So things like that, working with the health coaches was one of the key elements for me.
That’s awesome. So I know previously to this, you were just working inside the VA as a conventionally trained provider, and now you’ve gone through the functional medicine training that’s been delivered. Can you share a little bit about how that’s changed the care that you deliver and I guess, how that impacts then the veterans?
Prior to my nurse management role, I did work in the VA as a staff nurse. I would say that the functional medicine training really empowered me to be able to share different modalities that maybe 10 years ago wasn’t readily acceptable in conventional medicine. So for instance, I remember being hesitant to share certain things with veterans that I know as a nurse, because we’re trained holistically. I felt hesitant to suggest certain things to them.
For instance now, today since the pendulum has switched so much and wellness and holistic care is more acceptable, I’m sure myself and other nurses or other providers may feel the same way that you’re more comfortable with suggesting acupuncture for example, as a treatment of care or an option in their wellness journey, right? Opposed to years ago where it may have been frowned upon, or maybe not totally acceptable as a method of care. Same thing for massage therapy or suggesting how powerful your nutrition is in your healing. It’s not just about taking medication that you can make some changes with your diet and see a world of difference.
So feeling more empowered to share more of a holistic approach to patients is something that the training has given to me. And also given me and patients I think, a greater sense of hope that you don’t have to live with your chronic disease. It doesn’t have to be your life sentence. There’re things that can be done that you could do to heal yourself and those are things that we didn’t hear before when it came to chronic disease in conventional medicine. We just didn’t hear it. It was more of a life sentence. You have diabetes, and this is what you need to do to manage it until it gets worse, and that will happen eventually. It’s just a matter of time, right? So now with IFM, we know that it doesn’t have to be that. You can stop it in its tracks or sometimes even reverse chronic diseases.
Beautiful. Nancy, I just wanted to ask you, I know the VA historically has done some really interesting things with bringing in veterans to play different roles. I think I’ve heard about sort of a call center role or otherwise, or a suicide hotline. I know you mentioned some of the health coaches are veterans. How does that add to the energy of the groups and have you seen sort of a difference when coaches are also veterans and what kind of engagement that leads to inside the groups?
Dr. Nancy Cotter:
Sure. Yeah, I think allowing diversity in any of its form is always helpful because we understand that representation matters. So if a veteran is meeting with a veteran health coach, there’s a certain lingo, a comradery that happens that they may not have with a non-veteran coach. So, yes, and there’s a sense of you understand me. Once that rapport is created, a lot of amazing things and behavior changes can happen.
Beautiful. Well, Dr. Cotter, come back to you. What do you think about where this is going? Obviously, you’ve been working at the VA now for a long time. It sounds like you’ve made incredible progress. What’s the vision here for the sort of integration of the whole health program and the VA, IFM and the future of functional medicine?
Dr. Nancy Cotter:
We Whole Health folks, and we are in greater and greater numbers every day. So Whole Health really is the future of health and I think we see that within the VA but I think we’re also starting to see that outside of VA. More and more, you hear people talking about connecting to what is meaningful to them, especially after the pandemic. And of course, bragging a little bit, but we were doing that well before the pandemic and also people more and more are looking to take charge of their own health and be more of a partner in their own health. Again, I think there’s a groundswell of interest in functional medicine. I’m getting emails by the week about, how did you start your program, and could we know more?
We have a number of other regions interested in training. We’re moving beyond our own facility this year and bringing in practitioners in New York. And of course we’re in New Jersey, but our region is New York and New Jersey. So we’ll be training about 30 people in the New York, New Jersey region. I hear that other regions are interested in how it turns out for us and maybe doing the same. I think there’s a bright future for Whole Health, both within and outside of the VA. Of course, we know there’s a bright future for functional medicine. It’s much needed and given the interest, both of clinicians and veterans, I think there’s going to be a big demand.
Yeah. It’s interesting because obviously for a long time, functional medicine was known as hyper-individualized medicine with long appointments from doctors. Obviously what this project is showing, which is something we’ve been talking about for a long time here at the Evolution of Medicine podcast is that we need to sort of have a different delivery system if we want it to be scaled inside systems. What are your hopes for sort of the precision medicine elements of functional medicine and how you see that part of things being delivered inside the VA? Because I get the groups totally but how do you see that rolling out?
Dr. Nancy Cotter:
Of course, we need the individualized, the personalized but I think maybe in the VA and who knows, but maybe we’ll do a combination that perhaps starts with the group and then moves to individualized as those needs are identified. So maybe in the group, we work more on the matrix and then from there, move to the more individualized. Whereas in private sector, at least for me when I was in private sector, we started and remained with the individualized approach and that worked. That worked for the setting that I was in.
I think though that the group because of some of the unique characteristics of the VA, this really works for veterans. They already are a community and they are comfortable in a community and they enjoy each other’s support. They’re used to each other’s support and they seek it out. So I think that’s why the group approach works really well. Also, we are the largest system in the country and we have to choose things that scale well.
Yeah, absolutely. I guess one other question I have for you is, what are the unique needs? This could be for either of you. What are the unique needs of the veteran population? Dr. Cotter, I know you did a lot of practice before in functional medicine before the VA, is there a different sort of cluster of diagnoses for veterans?
Dr. Nancy Cotter:
I’ll respond and Sharon, if you want to chime in. Certainly so many of our veterans have seen trauma. They’ve seen the trauma of war and so certainly the VA clinicians have a lot of experience with PTSD and anxiety. I think that’s one of the places where we can identify certainly PTSD and trauma as needs that are perhaps not unique to veterans, but perhaps more prevalent than in some other populations.
Great. Do you see the same thing Sharon?
Yeah, I would agree with that. I think one of the takeaways that we’re hearing from our first group, and even now during the second group, it’s just a need for the mindfulness approach. So part of the program, we offer mindfulness, a lot of mindfulness practices. I, myself, I was blown away by the feedback for it. So there’s definitely a need for just learning to calm the nervous system down. Yes, I think that. Right now post pandemic, I don’t know if I can say that’s specific only to veterans. I’m sure it’s something that’s beneficial to all of us but we are definitely hearing that’s important to them.
Just to wrap up Robert, I want to come back to you to finish up here. I know over the last couple years, IFM has had a strong focus on health equity. I know that obviously one of the things about cash-based functional medicine, that kind of model, which was version 1.0, which was definitely necessary for all of us is that it doesn’t really create the right kind of equity if we think that if functional medicine needs to be really functional and needs to get to everyone.
Maybe we could just finish on that. In this work that you are doing with the VA now and with these institutions, how much of a role do you think this can play in addressing health equity? And not just access to care, but the potential for chronic disease reversal because it’s one thing to make sure that everyone has access to drugs. Its quite another thing to see that everyone has access to being a resilient human.
Dr. Robert Luby:
Right, great question. James, in my own practice, academic medical center, underserved populations, my entire career, when I became interested in functional medicine I had that, “Hell, but this seems like it’s just for those who can really afford a lot. Can we possibly do this for the underserved population?” You talked about practitioners keeping the heart at the center of what they’re doing. I didn’t want to give up that population and found that I could actually apply it there. So this is now with institutions embracing functional medicine and alternative models of care, this is just the dream come true.
COVID in some ways accelerated this. So we’re not going to stop supporting our small practices, our solo practitioners, but the resources that this COVID pandemic and other factors have forced us to grapple with are really going to help us reach wider audiences in ways that we never thought possible. I try to look at this philosophically. There’s so many times that history is littered with great innovations that need to come to everybody and yet for historical necessity, they have to come to the wealthy first before they can be more widely disseminated.
It’s unfortunate that some of these advances in medicine have been that way but we’re now at the point where functional medicine is not just for those who can afford it anymore. Dr. Penn’s work at Nebraska Methodist has reached employees and a wide variety of patients in a diverse setting in rural states in the Midwest. Dr. Cotter’s work with the VA has reached veterans that we have never been able to reach before. Those who served our country and we have so many practitioners whose heart is set on working with that population.
To sum it up James, it’s been our response to COVID, the heads that we’ve turned in institutions and larger organizations. It’s those tools and resources we’ve developed over the years for patients and practitioners, which now are being modified to be used not only in smaller practices, but in large institutions with very short visits. And the shared medical appointment model that’s so close to you and me. It’s all those combinations.
It’s just a broad pallet of interventions and tools that have allowed IFM to really start reaching its mission in a scalable way that we couldn’t in past years, reaching that wider audience of patients. It’s great to see it come about and James, we really thank you for the role you’ve played in catalyzing this effort.
Awesome. Look, it’s been great to be with all of you and just to hear about the work that IFM is doing on this level. These are the things that if you’re just a regular doctor doing functional medicine and you’ve been trained by IFM, you don’t really know what’s going on. You’re just having your own experience of being in practice. There hasn’t been a conference in person for a while and so it’s hard to kind of see what’s going on. So it was important for us to find a way to share this. I would also just say to wrap up that this weekend is the IFM annual conference and it is virtual, but certainly created more access to it. There’s a lower price point. There’s actually a discount code that we’ll put in the email for anyone who is listening to this today.
If you show up this weekend, you’ll see that there is a particular focus on these institutional incentives and initiatives to try and grow functional medicine in the system itself. If you go back to our hundredth functional forum that was less than a month ago, we really signaled that for the first 100 functional forums in the last eight years, our focus was helping individual practitioners’ be able to practice on their own terms. I think for all of us involved in the movement, we see that for it to reach its potential, it has to get to everyone.
I’m super grateful for everyone on the call today for their participation and not just the podcast obviously. The work that’s going on, the grind, the grunt, convincing the people at the clinic and doing all the patient care. It’s really the Lord’s work. So I’m grateful for everyone for being here. If you want to find out more what IFM is up to, please feel free to get in touch with them. Check out the annual conference this weekend.
Grateful to all the guests. This has been the Evolution of Medicine podcast. I’m your host, James Maskell. Thanks so much for tuning in. We’ll have more great content in a couple of weeks. In the meantime, thanks so much for listening and we’ll see you next time.
Thanks for listening to the evolution of medicine podcast. Please share this with colleagues who need to hear it. Thanks so much to our sponsors, the Lifestyle Matrix Resource Center. This podcast is really possible because of them. Please visit goevomed.com/lmrc to find out more about their clinical tools like the group visit toolkit. That’s goevomed.com/lmrc. Thanks so much for listening and we’ll see you next time.
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