At your initial visit, we spend a good deal of time going over your life history–medical, family, social, environmental, emotional. A thorough physical exam will be performed, vital signs taken and then we will sit down to discuss any findings and formulate a treatment plan. Tests may be ordered as indicated. A follow up visit or phone consultation is very important in order to discuss laboratory findings and any progress made since the prior visit. Typically the initial visit lasts 2 hours and follow up visits last 30 minutes.
Physicians who practice functional medicine may be board certified and trained in a traditional medical residency (such as myself)–and employ all of the evidence based medicine available to regular physicians but have additional diagnostic and therapeutic tools at their disposal. Because doctors see fewer patients in this model, they spend significantly more time with each patient. This is often critical for complex diseases such as diabetes, Lyme disease, obesity, autoimmune diseases and mood disorders, to name a few. For otherwise healthy patients, the physician can spend time working on ways to optimize health and prevent future disease.
Regular medical clinics are often very busy–they are usually overbooked, behind schedule and often designed to “put out the fires” (i.e. urgent care or treating end stage disease). They are bound by the terms of their contract with insurance companies to receive very little money for each patient encounter so volume is a necessity for financial sustainability. Some doctors are aware of some functional medicine concepts and may try to employ these into their practice, but time is often the limiting factor. Much of functional medicine is based on education and discussion with patients. Many regular doctors are rushed and have learned to adopt a more ‘paternalistic’ approach to decision making–which saves time, but downplays the patient’s role.
All patients are encouraged to contact their insurance carrier to inquire about payment for “out of network” providers. Patients should submit their bill to their insurance company for reimbursement (each plan is different, so reimbursement varies). Some patients choose to form a health savings account (HSA), with which they can pay for a variety of medical services not covered by their insurance carrier. Pharmacy and radiology fees are processed through insurance, and most tests are paid for by insurance carriers as they would otherwise be covered. There are some labs unique to functional medicine which may not be covered–pricing of these can be discussed at the time of your visit.
Yes, a functional medicine doctor can order and follow up on such studies, but because we do not accept insurance, we cannot be designated as your “primary care physician” by your insurance company. Routine screening labs such as cholesterol levels, thyroid studies, kidney function, vitamin D levels are common studies ordered by functional medicine doctors. As part of your treatment plan, routine screening studies may be recommended, but you may opt to have those ordered by your regular primary care physician.