From Confused to Confident: Your First Steps After an Autoimmune Diagnosis

Welcome to Integrative Medicine with Dr. Leland Stillman, the podcast where we explore the best of East and West, old and new, conventional and unconventional, in search of answers to medicine's toughest cases and most difficult problems. This podcast is for informational purposes only. Diagnostics and therapeutics discussed on this podcast may or may not be right for you, so talk to a qualified practitioner before taking action based on what you learn here. If you'd like to become a patient at my practice, go to stillmanmd.com to schedule a complimentary discovery call. Thank you for listening and welcome to today's episode. Hello everyone. Dr. Stillman and Amy Arp back again for another episode of our autoimmunity. Today we are talking about from confused to confident, your first steps after an autoimmune diagnosis. Good morning, Amy. How are you?

Great. Good morning. It's a fun topic.

Yes. Okay, so first of all, most people who wind up with a diagnosis of autoimmunity have had some kind of severe episode that triggered them to go see a doctor, see a clinic, present to the emergency room, urgent care, that has then led them to further care evaluation, lab testing, imaging, et cetera. And so if you've got a clear diagnosis, the disease is actually already very well progressed. We've touched on this before, you know, there's always signs and symptoms of disease before the full-blown illness arrives. If you're in the position to have received the diagnosis, one of the first things that I, you know, I have to say is it's important to ask questions about what's recommended to you and not be afraid to engage with the standard of care and then gather more information. So what I mean by that is what I saw in the hospital was what we, what we would do is we would generally give people anti-inflammatory, typically often prednisone, sometimes other agents. We'd give them in the hospital or in the ER or in the clinic, and we would get patients' diseases under control so that they could live their lives. In my own practice now, if someone comes in on an immunosuppressant, I will keep them on that until I can really see their fundamental physiology changing. I want to see their nutritional markers improving. I want to see their inflammatory markers improving. I'd like to see big eliminations of metals on hair testing, but I don't need to. We have to know that they're moving in the right direction, and then we can start to make decisions about, okay, well, what are we gonna stop as far as medications? Are we gonna try and taper? Are we gonna try and stop medications entirely? Many of the patients who've come to me over the years with autoimmune diagnoses are not on— are not on any kind of immunosuppressant at all, but they're living in fear of their disease coming back. And so I think the biggest thing that you can do, most important thing to do after an autoimmune diagnosis is engage with the standard of care to get the disease under control and to deal with your acute inflammation, then start to gather information about, well, what else can I do in order to improve my chances of a complete recovery from this illness? Amy, your thoughts?

Absolutely. I mean, I'm gonna take two steps back here. I'm gonna say when you're first diagnosed with an autoimmune disease, it's okay to feel all the feels. I guess that's what I wanna say. I think that is something that is so overlooked. I think we get so focused into problem-solving mode or trying to figure it out. And I think I just want to say, take a moment. When you're diagnosed, it is a huge emotional thing that goes on in your, in your body, in your life. And so take a moment. It's okay to be frustrated, upset, emotional. Take some time, grieve. It is a huge thing. And know that there's so much hope. And so I think that was something that I feel like I didn't do well. I, I don't know, I had so many emotions and I felt like I had to stuff them or I couldn't have the emotions of being diagnosed with something. And it was so helpful to have a mentor of mine say, hey Amy, it's okay to just cry. Like, it's okay. Like, you can cry and feel the emotion. So I just want to say that first of all, because I know we're getting into problem solving and the medical side of it and all these things, but I just want to address the human of it, of just take a moment before we get into all the things, and then we can go into all of that. But yeah, and I would also say gather support people around you. Get people that are in your corner that are going to support you when you have some bad days, when you do feel the emotions again rising up. It's a very emotional process. I think that's one thing, as I work with a lot of people who come in newly diagnosed, I always want to make sure that we are also touching on the emotional side. And not just getting into, okay, do these protocols and do these things. We want to get there, but that's what I also want to say first. So, okay, now we can go back.

No, that's so important. And I'm so glad that you mentioned that because I agree that's very important. And I definitely forgot that part and jumped straight into the problem solving bit because that is how my brain is very much wired.

Yeah.

And I think that, and that's, that's such an ongoing journey though. You know, it's not like you're going to feel the feelings like you said, just the first day, first couple of days. It's, it's a constant— I don't know if I want to say battle, but it can be a constant— it's daily work to remain positive.

It really is. It really, really is. And it's going to come up at times. I think even as you're starting protocols and into the healing part, it is going to come up, and that's okay. And so I think I just want to address that first and foremost, because some people come in and they, they want to pretend like it's all okay, and I say, hey, take a moment. Breathe, cry. It's okay. It will be okay, but feel the emotions right now.

Absolutely. When you're ready.

Yeah.

One of the things I always tell patients when they're going to see subspecialists and specialists in medicine or any doctor, but particularly specialists, and partly that's because I really only tend to refer to specialists because I already know or have a pretty good idea of what's going on in the case. And so I rarely need the opinion of another generalist. If I do, it's probably something that I can't deal with virtually, which is most of our work. You know, it's a, it's a sprained ankle, maybe a broken bone, something like that, right? But I generally only refer to specialists. And what I always tell patients to do is ask them questions and make sure to take notes or record the meeting. I encourage my patients to record their meetings with me because there's always questions that come up. It's very, very important to take notes and ask the right questions. The right questions in my view are what are the numbers? What are the statistics? Because what people tend to do is they say, well, the treatment for this disease is this. And like, for example, I'll use one that I know the statistics for pretty well off the top of my head. When people have pancreatic cancer, the treatment is a Whipple procedure, which is a very, very invasive, very extensive abdominal surgery. And if you don't get the Whipple, your survival at 5 years is something like 20%. And, you know, don't quote these. They may— they're old and they may be wrong, but I'm just using them as an example. So something like 20%. It's 80% if you have the Whipple. But 5 years is not a very long time in the grand scheme of things. So you might ask questions like, well, what is it at 10 years? What is it at 15 years? And regardless of what those numbers are for that, always be asking questions about what are the risks, what are the benefits. The reality is that I found most doctors don't have hard answers for these kinds of questions. They can't even tell you, well, this drug induces remission in this percentage of people for this period of time. And one of the reasons why I'm so enthusiastic about practicing the way that I practice, where we're trying to reverse disease and get people off of medications, is that overwhelmingly what I've seen in, in autoimmunity as well as other types of disease is that the idea of suppressing the symptoms or trying to just destroy the disease, say in cancer with chemotherapy, it's very flawed because you're not correcting the underlying cause. And as the disease takes root and digs deeper and deeper and deeper into the patient's physiology, you need more and more medication. You need different medications. And that's where a lot of patients come to see us is they've tried everything, been on every medication, done every surgery, and they're really at the end of the line and no one has anything really meaningful to offer them. And unfortunately, I don't think that there's a lot of— I think some of it is that doctors don't want to give patients such bad news. You know, and I'm thinking of, of a case where there was really no treatment, and if the person needed a lot of prednisone to keep the disease in remission, they would have had to take lots of, lots of it at high doses, and it probably would have ruined their life, ruined their bone mineral density, caused them to gain a lot of weight, caused them to gain a lot of water weight, caused them to lose their muscle mass. Your appearance really goes because you start to gain fat in all the wrong places. Your skin starts to break down. Prednisone overdose effectively. It's really a horrible disease, and it doesn't treat autoimmunity well. You can use low doses for long periods of time safely, which we do sometimes do, but really we try to avoid it at all costs. In the case I'm thinking of, he radically changed his diet and lifestyle and even moved across the country and has been able to go without any of these immunosuppressant medications for long, long periods of time. Or he's been able to maintain, you know, when he's needed them, low, low doses, and then been able to come off of them. So that's why I care so much about this root cause approach, and why when you're in the first days and weeks of a diagnosis, gathering that information is critical. Because if there's a good chance of them, say, resolving or healing your disease with a medication, they should be able to tell you. And if it was me, in most of those cases, I would say yes, because I've seen sometimes the drugs work very, very wonderfully on a short period of time. But after that, no matter what's going on, whether I've got a full remission thanks to the drug or I'm still crippled by symptoms or affected by symptoms, I would still pursue the root cause approach because it is so— even if your autoimmunity is, is knocked out by a drug, the reasons that you developed it are still there and they will predispose you to cancer, stroke, heart disease, all the other causes of death and disability that end up afflicting people later in life, which is why there's a really strong incidence of cancer in patients with autoimmunity. So that's definitely the first thing I would do. Get data, get information after feeling all the feelings.

And I would say one of the things that I'm thinking of is when you're newly diagnosed, as you had briefly mentioned, but ask a lot of questions of your doctor. I remember going into the doctor's office and they just matter-of-factly said, this is what the plan is. You will be on these drugs. There, there was no room for discussion in there. And so this is, you know, unpopular in a lot of people's perspective, but you can challenge your doctor. You can definitely challenge them. You can ask them hard questions. I remember even though when I was diagnosed, I was not deeply entrenched in this holistic world at all. I was very much follow the medical model. I was, you know, en route to go to medical school and I, it, it was hard for me to really challenge my doctor. I had to think about, okay, I really had to think critically, which is not always something people do, but you, I had to sit down and say, okay, what are they saying? But it felt very uncomfortable because I had been taught you just trust doctors, you're not supposed to have a different opinion than them. And so it was challenging, but I do remember when I finally got to the place of asking more questions, you know, when they had said, these are the drugs you're gonna be on, this is what your trajectory's gonna look like. I was, once I started asking questions, they started agreeing, you know, for, so my first question was, hey, I don't have kids yet. My husband and I want to have kids. What does this look like if I'm on these drugs? I'm reading up on them and seeing that I could have a worse relapse after I take the drugs, you know, if I had stopped to get pregnant, have a baby, you know, get back on them. And as I asked those questions, the doctor did say, yes, that does happen. But he never was going to tell me that ahead of time. And so it just took some time of, you know, pushing back And even one more thought or one more story is that I remember he had said, "Hey, we wanna enroll you in a study, a drug study." And so it wasn't even, his perspective wasn't, "Hey, we're gonna give you the best drug possible for you." His thought was, "Hey, I wanna enroll you in this study that I'm doing and we're just gonna randomly assign a drug to you." And I thought, it doesn't feel like you care about me. It feels like you care about this study that you're gonna put me on some random drug that may or may not be the best fit for me, but it fits in your study. So I, I asked some questions on that and kind of pushed back and got to some answers that I didn't like. And so that was really where I turned a corner and decided I don't want to be on these drugs right now. I do want to have kids. I want to see what my body can do. But all that to say, in summary, I would, I would just say to people, encouragement, ask hard questions of your doctors, even if they don't like the the way you're asking, or they may kind of squirm as they're responding. That's okay. We want to be in a place where you can ask questions and then make an informed decision based on the answers they give you.

I would also seek doctors who are reasonable, friendly, kind, understanding when answering questions.

You don't always have that option, but yes, that would be the ideal.

You may not have that option, but if you, if you can, it's worth sorting through some of the doctors who are available to you to find one who will You know, genuinely listen. I really think that's important. I really think it's also important to have, you know, a doctor who you really feel like you can share with. Like, I was struck— I've been struck by how many young men come to see me, and it, it dawned on me that they don't want to go to an old man for their care. They want a man who's more relatable to them, and they want a man because it's very hard for men to talk about intimate details of their life with women for various reasons. And so I think it's important that you find a doctor you really like. It's going to take time, some, some sleuthing. The funny thing is, is smart doctors put out who they are on the internet, just like I do. And that way people come to work with me, they know who I am, they know what I do, they know how I am, they know what to expect. I'm the same person in consult that I am on podcasts. Uh, and, uh, you know, I think that the doctors who are not putting themselves out there on social media in some kind of way at this point, they are usually working for big healthcare systems and they're not going to have the time to really get to know you. The way that you are going to want. They're not going to be able to. And we have patients ask me questions that I don't know the answer to, and I'll actually go back and, and look things up. Like, I had a patient ask me recently about the link, a possible link between taurine and leukemia, and I said I'd never heard of that. And so this was just sort of a cell culture study that where they put taurine in with leukemia cells, and of course the leukemia cells divided more rapidly because taurine is a great fuel. So I said, okay, that this is not like, oh, if you take taurine as a supplement, which we'll often use in the practice you're more likely to get leukemia. It's like saying, you know, gasoline fuels the cars of criminals. Well, you're not gonna stop taking gasoline, right? In your car anyway. I really think that asking the questions, I mean, the questions I care most about answering when I send patients to specialists are how well does the treatment work? How long does it work for? What can I expect for side effects? How severe are the side effects? And beyond that, I don't even frankly trust what my colleagues say about this. I remember this is recent on, On the FDA had a, a panel recently on SSRIs and they had a lot of people who were critical of them on the panel. And I, and this has sparked a lot of chatter on, on X. And one of my friends, Chris Masterjohn, tweets this out. He says something, says something like, you know, a subscriber of mine due to SSRI withdrawal lost her family, marriage, finances, job, ruined her life. Her doctor said it's safer than Tic Tacs. Real story. I'll never forget the first patient of mine who came to me saying, "I will never take SSRIs again." He was a young man, father of 3, married, and he said, "That drug made me so suicidal. I could never take it again." A guy who was sad, depressed maybe, but not suicidal before the drug. And that's, so what I would do is I would take what they say and then I would go do my own research. And I will do this with patients. You know, if I've got a, the other week I had a patient ask me, because they have something called a hydrocele in their testicle, which is a very rare problem. I've not actually seen it before this, and it's a fluid accumulation in the testicular sac. And the treatment is either a needle drainage or an open surgical procedure where they cut open and they remove it. And he just said, look, what are the— what are the— like, what do I do? And the problem with interventionalists or surgeons, people who get paid to do things, is that every one turns into a nail when you're a hammer. And so sometimes they don't make good recommendations. This unfortunately is really more rampant in medicine than I think people know. You know, for example, the evidence on back surgery is abysmal. There's no real benefit to almost 99% of back surgeries. Maybe I'm exaggerating, but it's a huge proportion. There's very little benefit beyond placebo for a lot of orthopedic procedures, joints, joint procedures, et cetera. And the problem with that then becomes that if you're trusting the subspecialists, they're gonna tell you to do what they are incentivized to have you do. This does come down to treatments because while you may think your doctor's recommending the best drug for you, there are, there's been a lot of movement in medicine to try and get the perverse incentives out of doctors' practices and offices. Unfortunately, the people who run these offices and practices still have the perverse incentive baked in. Let me explain. The rheumatologist or other doctor who's dealing with autoimmunity, doesn't necessarily make any extra money for prescribing you X, Y, or Z medicine, but the guy who owns the practice or the private equity firm that owns the practice that he works at makes more money when you go for their infusion center, right? And so then they have a reason to do infusions. So we see this all the time. And if, if, if an informed patient comes into a consult with a doctor and says, hey, my understanding of my diagnosis, how I'm presenting, there's no indication that this procedure is better for me than doing nothing. What do you have to say about that? Frequently doctors will say, well, you know what, maybe we won't do the procedure. It gets very uncomfortable very fast. You definitely wanna go armed with the facts and you definitely wanna ask questions, hard questions, and get exact numbers from people when you can regarding what your care is likely to look like. And like I said before, a lot of the time they don't have good answers. They can't tell you what the percent, this, that, or the other thing, survival or remission or whatever it may be. I must say that when they do have good numbers, they generally know them. So it's worth getting that answer. And again, I'll say this, get answers about time. 5 years is not the same as 10 years. 10 years is not the same as 20, 30, 40, 50. I don't know what the median age onset of autoimmunity in this country for diagnosis is, but I imagine that somewhere in the 20s or 30s, because you have some people diagnosed in their teens, you have many people diagnosed in middle life, you have many people die you have some people diagnosed in later decades, but it's got a cluster in the middle years, which means that you really don't need a game plan for this week, this month, this year. You need a game plan forever, which is a big part of why we have— at the practice, we have these memberships where we can monitor people, we can make sure that they're healthy, we can intervene before they become sick because we'll see their biomarkers changing. So ask those questions, find out what your prognosis is, find out how well the treatments work, find out what the side effects are. If you're looking at surgeries, find out what the surgical outcomes are. Amy, did I miss anything?

Absolutely. I would say asking questions is the best thing, and that's for anything, whether you're working with conventional medical doctors or you're trying to find a holistic practitioner. I remember asking so many questions of every person that I was wanting to work with or potentially work with. You know, if in— I think we've covered enough of the conventional world, but let's say you were looking for a holistic practitioner. I would ask really hard questions of What are your outcomes? Can I see some testimonials? What have you done? What have you seen? Because a lot of people out there unfortunately are advertising things that just don't get results. And it's sad and it makes me so upset. I think when I ventured into the holistic world, I was, you know, bright-eyed, bushy-tailed. I was like, they all want to help me, they really care. And that was just not true. And it was so sad that even in the holistic world where you think, okay, I finally have some hope. And then there's still so much sifting and sorting that you have to do in the holistic world. And it makes me so sad that people are taking advantage of people who are sick and don't feel well. And so we just say this as like a word of caution as you're going through this, ask hard questions of the practitioners that you might wanna work with. Ask them what they have seen, ask them, you know, what does that, what does recovery look like for certain things? And just really ask results. I had searched for someone who had seen MS be healed, and I asked every practitioner that I was interviewing, have you actually seen this at least in recovery or remission, or someone that has been symptom-free? What does that look like? I know that Dr. Stillman loves doing this as well. He has so many patient testimonials that he records all the time, and that's only a snippet of what you see. I feel like you don't even have time to record record all of the testimonials that you see anymore.

I have you and Eva record the testimonials because I can't, I can't get time in my schedule. I'm seeing patients.

Yeah, there's just, there's so much good stuff happening. I think my biggest takeaway, if you're newly diagnosed, is ask questions. I know it's challenging in the midst of the emotional turmoil that you're going through, but when you are able to sit down and really think, ask hard questions of any doctor that you're working with and find Find someone that you want to work with and then go from there.

And I have to add to that, you know, in my journey towards creating the practice that, you know, we now have, I really didn't like the fee-for-service model. I think the whole model there is broken because the incentive is for the provider to sell as much to the patient as possible, as fast as possible. I just had a visit the other day. I won't say for what. And, you know, I'm looking at the itemized bill and I'm looking at this, thing. It's $82. I say, hey, what is this? They're like, oh, that's your comprehensive exam. And I just think to myself, that took my practitioner maybe 3 minutes and you're charging me 80-some dollars. So if you stack up 100 people in a day, it's less than 6 hours of work and it's a huge amount of money. And the truth is, I know why they do that. They do that because if they don't sell you something while you're there, They're not gonna be able to meet their overhead. They're not gonna be able to make their revenue goal. You know, practitioners have to make a living. They've gotta pay off very large school loans. They wanna live in a nice house. They wanna drive a nice car. I personally think that they should. Reason being is you want smart, highly motivated, intelligent people to go into medicine because whether it's medicine, surgery, dentistry, you want the person who you're going to, to be very serious about what they do and be really smart. You know, I want someone like a dentist or a surgeon. I want them to have really good hands and I want them to really know their craft inside and out. And you cannot expect people to do that if you're not being paid well. But the fee-for-service model just creates this— I call it this churn and burn cycle— that I think is so dehumanizing, quite frankly. And I see a lot of patients just— or not a lot of practices, because I went out and I sought some business mentorship in medicine, and what I found was a lot of the business coaching in the space, it was basically become a salesperson and then sell people as, as much as possible, as quick as possible. And, you know, it was just very, very disillusioning, just as you mentioned, because I'm sitting there thinking, okay, people are coming to me. And a lot of practices like mine don't get people who are really sick, and they just get people who they need to lose weight, they need to, you know, clean up their diet, they need the basic stuff. And that's fine, we can help with that. However, we get really sick people, sick people who I'm calling other doctors who are like, you know, I called Amy Offutt for a case the other day. She's the current president of the International Lyme and Associated Diseases Society. I have other colleagues like her who I call for occasional cases if I think they may be able to help. These are not people who I don't want to sell them. I want them to make an informed decision. I like Dr. Stillman's approach. I believe in his, you know, his team, and I recognize that what they're offering is an investment that makes sense for what it is. In other words, we're giving you really significant value in lab testing, supplements, clinical time to get you results. And I cannot tell you how— I mean, it's, it's rare enough that I don't work for anybody else, let me just put it that way. And I tried to work for other people, and I'm not saying everyone I worked with over the years was ill-intentioned, some of them were very well-intentioned, but they ran their practices in this model where You know, people just ended up on 40 different supplements. They couldn't take them all. They couldn't stomach them all. They couldn't afford them all. They're going from visit to visit. They, they can't see their practitioner for 6 months. You know, it's like, well, you know, get some more this, more that. Then just people would just go bankrupt chasing their wellness. And, you know, sometimes it can be very expensive to get well, and I can't pretend that it's not. But at the same time, what I try to do and what we do is make it as efficient as possible and maximize the likelihood of success. Which, you know, the business coaching mentors who I went to didn't seem to care about that. It was just this same old model. And I'm telling you, it's, it's everywhere in the integrative functional medicine space. This culture that I think is very insidious of just frankly taking advantage of people. And, you know, maybe some people need to spend really exorbitant amounts of money for accountability. That's fine. That's what you need to achieve your health and wellness goals. I guess it's better that you achieve them than not. But I know I wouldn't want to be treated that way as a patient, and so I don't treat my patients that way. And that's why we have a membership model, because the idea is, you know, by having a membership model, the membership dues cover a lot of our overhead. And what people don't realize is the reason urgent cares and ERs are exorbitantly expensive is that if they don't charge a lot of money right now, then the other 6 days of the week when they're slow, they may not be able to make their rent or their overhead. By having a membership model, you're able to control prices and not have to charge really exorbitant fees. So I know our patients love that because they keep renewing and they keep sending us their friends and family because they know that we're not just treating people in an opportunistic, exploitative way. We're trying to create a real win-win for everyone where you get great care, you get reasonable pricing. We're able to provide a really high quality service with plenty of touchpoints so that you get the direction, the coaching, and the medical care that you need. And you get most of all the results that you came in for.

Absolutely. And I've told you this before, but I wish that I had— that someone like you existed. I had found someone like you, um, when I was healing, because I did do the same thing. I ran around, spent so much money, and I wish that someone would have said upfront a little bit more transparently, hey, this is what it's going to look like over the course of time. Whereas they just said, oh, it's $300 here, it's $800 here, it's $200 here, it's $1,000 here. And you keep thinking, okay, well, when's the end? When are we be done. And then, you know, you're thousands and thousands and thousands of dollars in, still not exactly where you want to be, and thinking, how much more? How much more do we have?

About a membership that I love is that I can track my outcomes, which we're still pretty early in doing. But, you know, for example, I started to have an exit interview for all of our practice members, people in programs or memberships. And the question we would ask is to start was how much better are you compared to when you started with us? And on average, patients who have joined the practice and gone through that interview report that they're 68% better. And you can watch our testimonials. And by the way, if you register for discovery call, a practice membership evaluation, you will get an email with a Google Drive folder. Maybe it'll be different in the future, but currently it's in a Google Drive folder of dozens and dozens and dozens of testimonials. And I try and get my team to pick one or two that they know, cuz I tell my team to watch the testimonials. On a regular basis. And then I say, look, pick one or two that the person reminds you of so they can hear someone like them in their own words going through the process. The other thing is I really have a funny way of doing testimonials. It's not just kind of like, you know, how much better are you? Oh, it's so great. It's, it's not like a pep rally. It's like I actually ask my patients, what gets the credit for your results? And then they tell me what's working, which is also how we pare down what we're doing in the program so that we're not overwhelming people with 40 different supplements. I mean, how are we supposed to get better results with 5 or 6 different supplements than other people get with 40. We have to be really good. So the patients tell me, they're like, this worked and that worked and that didn't really work, but then it'll work for somebody else. So I think that's so valuable. And I did that in part because I saw all these other practices that were just like flashy and like doing all this clever marketing. And I thought, I don't wanna be like that. I just wanna be very real. I wanna be very transparent. If you're gonna work with us, watch all the testimonials. You can get a really clear picture of what you're in for. You know, don't come to work with us if you don't want to do the work, because we're not going to just give you a bunch of pills and send you on your way. We might say, hey, you've got to get outside a certain number of times a day. You might need to do some sauna. You might need to do a coffee enema, which you may never have heard of, but we'll talk more about those later. But seriously, it, it really to me is about the transparency of this is what we do, this is how we do it, this is who we work with, this is the— these are the results that they got in their own words. You know, I'm not making this up. You can go confirm it yourself. Right.

And you are so transparent. I remember when I first started working with you, it was almost uncomfortable how transparent you were.

Really?

I was. Yeah. I mean, just like you just shared so much and I love that though. Like, I was like, wow, you were really giving away so much for people. And as I worked with you, I'm like, that's the way we should do it. We should be—

What are you thinking of?

I mean, just how you do your models. Like you shared so much of your pricing and share much, so much of your how you structure things and shared so much about, very publicly, about everything. And I thought, wow, we have a good, good thing going. But that is, I, I loved what you did.

Well, you know, on that note, it's really funny you say that because the advice I got from business coaches and mentors on that was essentially, don't do that, you'll fail. But I, I then asked my newsletter subscribers, who I love asking for advice, I said, how important do you think it is for doctors to post the pricing of what they do prominently. So it's like really, it's really clear. You don't have to like search for it, right? And they, 90% of them said it was unethical for doctors to hide the price. And I thought, wow, that is so compelling. And some of the comments were very intense because I actually related as a story of having a conversation with another physician who was doing this. And one of my subscribers, who I remember exactly who this was, she was like, you should never have anything to do with that physician ever again, Dr. Stillman. And I was like, my gosh, like, you're not Like you're not mincing words about this whatsoever. Right. And that really stuck with me. And another thing that happened recently is I was getting some more business consulting with a different group that I really like actually. And I told them that they were like, what proportion of your patients commit on the call with your team? And I was like, well, none of them. This is like, you know, we want them to think about it. We want them to like really be committed and ready to go. And we don't want them to have like buyer's remorse. And he was like, you don't? I was like, no. He's like, no one else does that. I'm like, what do you mean no one? He's like, well, I consult with thousands of businesses. I was like, you consult with thousands of businesses and we're the only people doing this? I don't know, sounds like we could, like, it's possible. Clearly we're doing it. But it was because I think people just, when I talk to patients who come to see us, usually they've, they've consumed hours and hours and hours of content. And that's great. That's great. I want that. Because you know who you're working with and you're going to be happy. And that's why 98% of our patients would send their friends and family to us as referrals. And our net promoter score is insane, which is a business metric or marker of how much people will refer to you. Typical in healthcare is like, I think, 30 to 50, and that's, you know, middle of the pack. Ours is 75, so we're doing all right. I like to think we're defining a new model that will define healthcare in the coming years and centuries, because I really think this model is so superior. Because— and I'll just, I'll just put it out there. Look, our model is that we need to work with people who are committed to their health. So if you're committed to your health, you're going to do the work. You're going to take the supplements, the medications, but you don't want us to overload you and overwhelm you. You don't want us to give you what's called treatment fatigue, which is, I'm tired of the therapy. I just want to go have a cheeseburger. I just want to not take these supplements this morning. We get it, right? If I don't make what I do sustainable, is what I'm doing really all that great? So my incentive is essentially, if I have like tons and tons of members who are paying membership dues to the practice and I keep them all perfectly healthy, then I can just go sit on the beach. If I have members who are paying membership dues and are not doing well, I have to work a lot, right? And I want to keep them happy and I want to keep them as members of the practice. So I have to deliver, I have to like really show up and we have to do a good job, right? If the model's fee-for-service, it's just how much service and how many goods can I sell you right now while you're still a patient? And then maybe I get more, more people from you as a referral, but otherwise I just market, put an ad in the paper, put an ad in a magazine, put an ad here or there. We've had weekends at the practice where something like 80% of our patients were referrals or direct family members of existing patients. So anyway, my model is, you know, we should be financially incentivized to keep you as healthy as possible. And we only work with people who are gonna put in the effort so that they're not going to— because if you allow everyone into that model and they're not committed and they're not invested, you're gonna get people who just suck the practitioners dry. And that doesn't work either. And that's where most of, a lot of practices are. A lot of the burnout in healthcare, it's something like 3% of patients consume 97% of healthcare resources and they just suck the life out of their practitioners, and they're responsible for the vast majority of burnout in the practitioner population.

So if you're newly diagnosed, come see us.

I know, right? You know, we talk a lot about taking action before your diagnosis, which I firmly believe is the best thing you can do, because I got to tell you, when we get the patients in who they've had psoriasis for 10 years, they've had rheumatoid arthritis for 5 years, they've had, you know, MS for 10 years. Their labs are— problems. I'm just going to say there's problems. And it's not like just pulling a weed out of your front garden bed. It's like removing a tree. It's a lot of work. And so I want people— I wish people would just stop worrying as much about the diagnosis. You know, like, let's not worry about labels.

So much agreed.

What framework can we apply to your life to optimize your health so that you aren't even thinking, what's my diagnosis? You're just, I'm healthy. I don't need a label. I don't have a problem list for my doctor to update or a medication list. Obviously there are times and places for medications, but I think that's really important.

So it's very important, but I think that's just the environment and culture we live in is people are, they think that a diagnosis is the only way that you have some sort of sickness or illness or something. Which is just so twisted of like our, what we, how we think of disease or how we think of health in general. We don't think of health, we think of diseases. That's really what it should be called.

It's all part of the pharmaceutical marketing plan. Yes. Yeah.

Yep.

Is that, you know, you need labels and you need, and, and this is really so interesting. We talk to patients about this occasionally, but, but all of the, all the language about disease. People don't realize it. It's, it's hypnotic language. Hypnotic language is when you say things like, I'm bad at math, or I have joint pain, I have brain fog. When you say that, you are programming your subconscious to have it. And that might seem like not a big deal, but I ask patients this, and it started to happen unsolicited in the Stories of Hope Stories of Healing podcast. The people who got better and who are on the Stories of Hope Stories of Healing podcast series they all would, would endorse that they had an attitude of, I'm going to beat my disease, I'm going to win, I don't have this thing, I currently have these symptoms, so what, and I'm going to find a way out. Instead of this— and I've noticed myself as a, as a business owner, a doctor practitioner, and, you know, occasionally a patient— if I have this mindset of, it's not that I'm bad at math, it's that I had a math teacher I didn't like in elementary school, and so I didn't focus on math, and no one in my family liked math, and now I love math. I think it's fascinating. I'm not particularly good at it. So like, that's got to be the attitude. That's a winning attitude. The power of the placebo effect is wild. Like, when you tell patients they've had a surgery and they have like an incision— it's called a sham surgery. They'll do this in double-blinded, um, when they blind surgical trials. So the, the patient is blinded. There's a group that has had a surgery and hasn't. They'll do what's called a sham surgery. Where all they do is they do the initial incision and that's it. So the patient's got a couple of stitches, little bruising, but they had no surgery. The sham surgery patients have often better results than the patients who got the surgery. That's how powerful the brain is. And that's why your first steps to bring this full circle after an autoimmune diagnosis are so important because if you're like, I have this and I have that and I have to take this for the rest of my life, you're telling yourself, your subconscious, You're telling your body, we are this way, we're gonna be this way, and that's how it's gonna be.

This is so true. That is, mindset is huge when you have a diagnosis of anything, especially when you're newly diagnosed. You definitely want to figure, figure out a way to get to that place. And so I think that's why I often come back to this concept of like, or just my, I love to shout it from the rooftops, like there's hope, there's hope for you, there's hope for your diagnosis, hope for your disease. There's so much hope. And I will say that for the rest of my life because I want people to know that. And once someone knows that there's hope, I think that is a huge turning point in their— in the mental game where you're like, oh, there's hope. I actually can have hope. Someone told me this. I've seen something. Then it's easier to then get in the place of, okay, I will get over this. I will fight this. I will overcome. But without the hope, it's hard to get to that place because What are you, you know, hoping for?

So, absolutely. Well, on that note, thanks everyone for joining us. We'll see you in the next episode. Amy, great to see you.

Good to see you too. Bye everyone.