A short interview clip (FMU July 2010) with Dr. Pam Smith and Jeffrey Bland, PhD. Dr. Smith emphasizes individualized, personalized care in her practice, stating that each patient’s testing and treatment are tailored to their history and presentation rather than using a fixed battery of tests. She stresses documenting baseline problems and improvements, and highlights patient responsibility—saying clinicians provide information (~10%) while patients do the majority (~90%) of work toward health. The conversation references use of the functional medicine matrix to address multiple domains (e.g., depression, insomnia) and that sequencing of interventions varies by patient.
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Because I'm a physician, it's really important that we can document what we're looking at in the patient, that they do have a process that needs augmenting or fixing, but it's also important to document that they're doing better, that they're improving. Not just for the legal aspect, but the patient likes to see that they're improving as well. It's a good encouragement because as I always tell my patients, I'm there for 10%, I'm there for information. They're really 90% of this. And my goal is to guide them, but they have to really do what they need to do to be healthy and stay healthy.
So is there a standard portfolio of value of tools that you use, or do you tailor the individual tests that you might select the panels of tests based on the history and physical and your acumen as you look at the patient and talk with them?
Really, every one of the patients in my personal practice has totally individualized and personalized care. I don't go in with a preconceived notion. You've read the book, as have I, about how doctors think, and I think a lot of us have a preconceived notion, and I've turned that part of my brain off. I literally listen to the patient. And I think that's the most important thing that most clinicians have forgotten about. Unfortunately, in functional medicine, we do listen to the patient, and the patient will tell you what needs to be done, and you have to address why they're there. But in addressing their key component, for example, depression or insomnia, you do go through the entire functional medicine matrix, and before that person is really healthy, you will have fixed all of those modalities. It just varies on which one you start with first.
