Facilitated

14| Beyond Diagnoses: Reimagining Healthcare Systems for Patient-Centered Care

• The Facility Denver • Episode 14

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We explore the frustrations and challenges within the current healthcare system while envisioning a more connected, transparent future that prioritizes patient wellbeing and biological understanding over isolated symptoms and quick diagnoses.

• Lack of communication between healthcare providers creates cascading symptoms and prescriptions without addressing root causes
• Limited time with healthcare providers often leads to rushed diagnoses and inadequate patient education
• Health costs remain confusing and non-transparent, with dramatic differences between insurance billing and cash prices
• Rise of health-literate patients is shifting the dynamic from dependency to empowerment
• Technological advancements like wearables, telehealth, and AI offer promising solutions for personalized care
• Diagnoses often become labels that negatively impact patients' self-perception rather than guiding effective treatment
• Healthcare providers should focus on understanding the underlying biology rather than simply categorizing symptoms
• Mind-body connection and stress management are fundamental aspects of primary healthcare

Want to take the next step with functional medicine? Learn more about our new patient process and lab testing at www.thefacilitydenver.com

For more insights, tips, and behind-the-scenes content, follow us on Instagram @thefacilitydenver

Stay curious, stay proactive, and we’ll catch you next time!

Mitchell:

Welcome to Facilitated, where we bring you real stories, strategies and science from the world of functional medicine. I'm Dr Mitchell Rasmussen, a functional medicine practitioner.

Kate:

And I'm Kate Daugherty, a certified nutritionist. We are the owners of the Facility, a functional medicine clinic here in Denver, Colorado.

Mitchell:

We help people improve their biology and get out of their own way. We help people improve their biology and get out of their own way. In my view, our work is about getting to know the person with the condition much more than it's about understanding which condition the person has. As I always say, diagnose the biology, not the disease.

Kate:

On this podcast we break down complex health topics, share real patient cases anonymized, of course and explore cutting-edge wellness strategies so you can make informed decisions about your health. Quick heads up before we dive in this podcast is for education and general information only. We're here to share insights, not to diagnose or treat. So if you're dealing with a health issue, chat with a qualified healthcare provider before making any changes. All right, let's get into it, okay.

Mitchell:

Good morning, hello, happy Tuesday.

Kate:

Tuesday, oh, today's Thursday.

Mitchell:

Well, you'll be hearing this on a Tuesday.

Kate:

Oh, I thought you were confused.

Mitchell:

I mean, I am am confused, but not about that yeah, I'm excited to sit down today.

Mitchell:

I think this topic was something that I wanted to talk about and then, of course, I came with no structure. So, as per usual, we're trying this again. Hopefully we have a little bit of structure to it. I think currently, this topic that I want to talk about today actually was probably created. The idea was created because of what I'm seeing friends and family currently going through in the medical system, family currently going through in the medical system so I think it's highly relevant for not just what we're seeing people go through, but, I think, what a lot of people are going through. How are you currently feeling?

Kate:

I am currently not firing on all cylinders. Is that what they say?

Mitchell:

When was the last time you were firing on all cylinders?

Kate:

Friday.

Mitchell:

Friday.

Kate:

Saturday, even Saturday.

Mitchell:

And we won't reveal the restaurant. Is that what they say?

Kate:

When was the last time you were firing on all cylinders Friday, friday, even Saturday, and we won't reveal the restaurant.

Mitchell:

I don't think it was restaurant.

Kate:

It was just timing, it was just coincidental. I really thought that I had gotten food poisoning.

Mitchell:

And you did have what I hear is kind of a gross-looking salad. Yeah, it wasn't the best. You know, someone was texting on their cell phone after bringing their cell phone to the bathroom and then they grabbed your salad without a glove and gave you E coli or something.

Kate:

But I really don't overthink those things and I was not doing well Saturday night and it has only progressed since then and today's Thursday.

Mitchell:

I would say yesterday was the high mark.

Kate:

Yesterday was probably the peak, yeah. And so now our current working theory that seems most plausible is I think I'm working on a kidney stone which is your.

Mitchell:

You take such good care of yourself generally, but, um, why do you think? What do you think is going on with that?

Kate:

why do I think it's going on with that? Because of the level of pain that I'm feeling but why did it happen now?

Mitchell:

I don't know things happen spontaneous yeah yeah, and yesterday a patient was having to take care of you emotionally. You had mentioned earlier on the podcast. You kind of like the relationship, this narrative health care as one of our friends, zach Wagner, a doctor of physical therapy out in Boston calls it where we can really get to know people's stories. There's both sides of that, where people get to know us a little bit, and a lady yesterday had to ask you oh no, are you okay? Should I reschedule? But you and your pride, just white as a sheet, just stepped out of the room for 10 minutes and I don't know what happened.

Kate:

But and I will say, you didn't come back any better not I came back to the point where I knew I could tolerate sitting there.

Mitchell:

I've heard that kidney stones are like the second most painful thing a person can go through. Is that true?

Kate:

Yeah, but I don't think you get a vote as a male.

Mitchell:

I didn't say this is what I'm saying. I said I've heard, studies have shown.

Kate:

Yes, you can find a study to say anything really Last night my husband told me that it's worse pain for males having a kidney stone and I said, no, it's probably the same amount of pain, they just experience it significantly more.

Mitchell:

Well, I think, when it passes, because the you know, yeah, going down a male urethra is, I've heard, quite terrible, but we also don't get to experience childbirth. So there is a there's a lack of reference there. My mom once told me that she's sad for me that I'll never be able to experience the horrors of childbirth and I said don't worry, mom, I don't feel bad about that, it's all good. There's other things you can worry about. For me that's not one of them, but no, I someone recently told me that there was a study that said I think it was like losing a limb without anesthesia was the number one pain. Because I immediately said, oh, is childbirth the only thing that's worse? And they said, no, childbirth was like less painful than a kidney stone on some.

Kate:

I also saw it compared to a gunshot wound. Yeah, I can confirm it's a very similar level to labor pain. At times it does come and go, so there's that.

Mitchell:

And also just for reference everybody one time Kate fell on a bike and broke her radius and then got called into surgery and went and worked for hours. Rode down a mountain, got a ride from somebody. Bike was trashed went to work.

Kate:

I also dropped my bike off at the bike shop to get it fixed on the way before I went to work and didn't you tell me, because you used to work in brain and spine surgery, didn't you just go? We can't talk about that oh but I may have put my arm in the ct, in the c arm, and got a quick picture and there we go.

Mitchell:

So this woman knows how to deal with pain and she's, you know, worked with me for six years.

Kate:

So yeah, but here's the difference in kidney stone pain and labor pain is that at the end of the labor pain I get a cute baby. At the end of this pain pain, I get a cute baby. At the end of this pain. I'm just going to have a little tiny rock souvenir. Yeah.

Mitchell:

What would you compare that to the pain of working with me for the last six years?

Kate:

Oh, this is like a three If that's 10.

Mitchell:

Wow, I'm honored. I'm honored to elicit such a response from an annoyance perspective. Yeah, but not so much physical pain, not so much physical pain. You did, we did a little PEMF yesterday. We've got a really we've got a really top end PEMF machine. One of the reasons I kept it when we moved because we don't do a lot of, you know, pt and rehab anymore. I kept it because I wanted it for me and for my loved ones, so it's nice to have.

Kate:

I will say the PEMF machine made a huge difference. Red light therapy has been very helpful and then Dr Ariana, our visceral manipulation PT that works with us. Amazing improvement today.

Mitchell:

Because we didn't know if you had potentially appendicitis, which is why we went and got a bunch of labs earlier this week to look for an infection or you know, and see reactive protein elevation, which was all normal. But she was also able early on in the week to really rule out based on position and where the tenderness was that it wasn't your appendix, which I thought was really helpful because you wouldn't have been able to go get an ultrasound probably until today, correct yeah.

Mitchell:

Are you going to get imaging? You know I was barking at you for 20 minutes yesterday to go get an MRI, but At this point I think we're almost to the bladder. You know I'm the guy that loves data. Anyone that works with me knows that if I can get a quick ultrasound on something or an MRI, let's go get it.

Kate:

But then what?

Mitchell:

Well, you know what it is. I know what it is, okay. Well, and then now we're trying to sit here and record a podcast and I've got someone sighing and moaning and I feel horribly guilty that we're doing this. But she insisted if not today, then when? So Kate pushes through.

Kate:

We have to Well. Okay, so we wanted to talk about the kind of the status of a, the healthcare system, but also the outlook for the future and some of the frustrations that we're noticing coming from patients, but also our own personal frustrations with the current system and what the outlook or the perspective for the future is.

Mitchell:

Yeah, I mean from a frustration perspective. I think the most obvious one that anybody listening can attest to is the lack of communication and cohesion between providers. You go to the dermatologist for a skin issue. You might be put on a corticosteroid or some sort of cream and that might mess with blood sugars or make it hard to sleep. And then your PCP might give you something to help you sleep, and then that causes drowsiness. And then your psychiatrist might give you Vyvanse or Adderall, but then that causes anxiety. And then you get put on Lexapro and we just kind of get into this Holy crap.

Mitchell:

I look back on the last six months of my life. I started with a skin problem and now I've got a sleep disorder and anxiety disorder and I'm sweating with high blood sugars all the time. And I don't know if any of these providers has, number one, stopped to think about what's causing this and where are the faults in my baseline biology. But number two, how are all these things interacting? You know, I like to think that everyone's talking, right as the patient, but most of the time there isn't that much communication between providers. So that's a frustration that I have.

Kate:

And then even the communication with the patient is a frustration. So the lack of time that the provider has to explain things, the lack of time that the patient has to share their full story and even the lack of feeling like the provider has prepared for that patient. So did they even read the chart?

Mitchell:

Yeah, like, how often do we have to explain to somebody when they think they can fill out their intake before they get here, that that is something that we review well ahead of time so that we've already considered you and thought about you before you ever walk in the door? We hear that all the time like, oh, you read my chart. Yes, that wasn't an exercise in busy work to have you do that. That's actually to help us craft a series of thoughts before we even meet you. And from a time with provider perspective. I mean personally, I recently had a family member get diagnosed with cancer and there after surgery, a nurse called them and said we're going to do six weeks of chemo and we're going to wait for four weeks after surgery for the tissue to heal and that's that. And they reached out to me like, well, what's going on?

Mitchell:

And, um, I actually ended up flying home, scheduled a visit with the specialist, and the specialist when we sat down was actually a little bit confused. Well, what questions do you have? Or, essentially, why did we book this visit? And they were like well, I was walking around outside and I get a call from a nurse saying I need chemo. That's completely earth shattering. That's not the news I was expecting and I was given no information and I was just told this is what we do. And you know I have questions and Mitchell has questions and it was great that we got to schedule that time but that took this family member advocating for themselves and rebooking and paying money to be able to sit back down. But I remember the feeling I had in that room was almost surprised that someone might not just want to do the six rounds of chemo without any more information or thought, and I think that probably is quite common.

Kate:

I did. In preparation for this, I read an interesting article, mostly about the health insurance world, and it was talking about how, right now, reimbursement is based on volume and a potential shift in the future would be reimbursement by outcome instead of volume. So it's more incentivizing the providers to get these positive outcomes. Instead of you spent your 15 minutes, here's your reimbursement amount.

Mitchell:

Yeah that I wonder how see. One of the things that I always say is it's hard to do a study on prevention of something you know if and what we work on is physiology.

Mitchell:

you know baseline needs of the of an organism and where are, where are chemical blocks happening in biology? Where our system's not being supported? And where are chemical blocks happening in biology? Where are systems not being supported and where are things that are essentially driving toxicity within a system? When an organ, when a tissue fails because it either has too much toxicity, too much stress or not enough nutrient support, that's when an organ will fail or become diseased and then a system and then the entire organism be kind of falls from there. I'm just trying to think of how that would even be kept track of.

Kate:

I don't know. It's a big challenge.

Mitchell:

Let me get some more studies are needed. Was that the conclusion?

Kate:

Any other grievances you want to air.

Mitchell:

I mean some other thought. I'm online and there's a cardiologist that I go back and forth with a little bit sometimes and he has such a thing against chiropractors and I'll say this so do I as a chiropractor. I went into school knowing I just wanted to practice systems, biology and functional medicine, and chiropractic was a way to do that. I was never interested in doing the actual art of manipulation, of chiropractic manipulation. So I see a lot of what I would consider crap being promoted by chiropractors. But what this guy in particular talks a lot about is that we've got these chiropractors that are selling supplements and making money directly off that.

Mitchell:

And one thing that I mentioned to him was you're right, you get a pharmacist to do that for you. You're not directly giving a medication away, and you're right. A statin costs whatever cents a day a medication away, and you're right, a statin costs whatever cents a day. But when you, like you said, based on volume, the entire medical system is propped up on drugs and procedures. So the more people that you can keep on more medications for more time means more reimbursement to the system. And if you have this, this insulation from actually handing out the pill, because you send them to a pharmacy for it. It's almost like this virtue that they feel like, well, I'm not making money from doing this. And it's like, well, your entire system is based on giving medications and that's not a. That's how the system works.

Kate:

I'm still frustrated by the lack of transparency and lack of understanding of health care costs. Yeah, I mean, it's wild, and even this week I was struggling to figure out okay, if I were to use insurance, what costs am I looking at for diagnostics Versus if I want to pay cash? I know exactly what the cost is. I was struggling to even figure out what my copay is if I were to go to an emergency room, and I feel like I'm a fairly health literate person.

Mitchell:

Yeah, yeah, I mean. And then the difference in costs between you know, I had a family member get a an angiogram with injected dye a few years ago and I think it was to insurance. It was a $44,000 procedure but if he had paid like six grand that day it would be wiped off. It was something like that. I'm like well wait, how much does it cost? Yeah which one is it just?

Kate:

give us a cost yeah, yeah, right and so now I find myself in this position of like okay, well, it's not bad enough that I need to go to an ER and face an unknown bill, but it is bad enough that I need some fairly quick results. I need something stat. So now I'm stuck in this middle ground of I can't really justify using the system, but also I'm kind of stuck outside of the system as well.

Mitchell:

And lucky for you, I have an account with LabCorp so you can just order anything. You want, cash and just show up that day and get it. But for most people that's really tough and I think that's one of the things I love being able to provide for people is I mean I said it yesterday to someone I don't, or on Monday, I don't think you need this test, but it's $500. That's what it costs. If you want to do a full mycotoxin panel to look for what mold might be going through your system, that is, your body, I don't care, you can run it. This is the cost. It's not a nebulous. We don't know what it is. This is what it is. It's up to you.

Mitchell:

I think we're airing all these grievances, but I mean again, I want to reiterate I've said this before but if you have an emergency or a trauma, oh my gosh, we have such a great system intact for that. It's these chronic conditions that most people suffer with, where there's this lack of cohesion and communication between providers. And I mean, you know, one of our main core values is education. I think that that might be one of the best things this week we provided for a few people that we're not even really treating per se, we're more, I guess, quarterbacking their case.

Mitchell:

Where, you know, sent a lady to a neurologist does she have Lyme? Does she have mold? Does she have? Is it old age, all these things, working her tail off and not getting what she wants, with all sorts of random myalgias and paresthesias and send her to a neurologist. Turns out she's got a genetic disease that six people in Denver have. You know, I never would have known that if I hadn't gone into the system and sent to a specialist who could do that. But then she came back with this diagnosis and then we sat down okay, we're sending you to a cardiologist now to work up that piece, considering a muscle biopsy through the neurologist, and like what can we do right here, right now, to start to make progress, now that we have this really big piece of information that we only got because we did go into the system?

Kate:

Mm-hmm. I think we are seeing this rise of health literate patients and it's becoming more empowerment over dependency. So it used to be very much you would go to your doctor and what they said is what you did. People are questioning that now. I think that's a good thing. I think that's a positive thing that they are feeling more empowered to. I want to understand the why. I want to ask questions. I want to get into the details and not just take this word for it at face value.

Mitchell:

Yeah, and sometimes they're the most frustrating patients because then they don't believe anything. So I think there's a tipping point there, but I think more information that can be acted on intelligently is always better, as long as that information doesn't paralyze you into fear and inaction.

Kate:

So let's think about this outlook for the future of health care. We're facing this time where the baby boomers are aging into Medicare, so now millennials, gen Z and younger are taking on the bulk of health care spending, of healthcare spending. This population, this younger generation, is really calling for reactive or sorry, for more proactive health management, and so it's really shaking how our system is built, because they don't want to go, they don't want to pay for health insurance it's kind of funny.

Mitchell:

I feel like we started this at the exact most exciting time, this apex between systems, biology, information becoming more, uh, robust. We're getting plenty of data now to show how all the systems talk together. Biochemistry is not not a linear thing, it's a complex web, and so I think we're at that apex between the information and then the experience that we have doing it. I mean, I'm so excited for how we fit into the next 20 years here, as long as the AI overlords don't take over.

Kate:

So you mentioned it, and I think that's one of the biggest positives is more data, which means more personalized care. We're in this omics boom genomics, metabolomics. I know they've been talking about genomics for what? 20 years, now 25 years. Anyway, we're finally getting somewhere with it where we can be so much more specific with nutrition supplements, lifestyle plans, and it's not just one size fits all. I think that's going to carry over into this, the conventional system as well. With pharmaceuticals, I have a stat for you Did you know that over half of the 8,000 drugs in development have the potential for personalized treatment?

Mitchell:

What does that mean?

Kate:

So I think it's. I don't know if it's just about personalized dosing, but personalized formulation of them, Wow yeah.

Mitchell:

Well, it's about time. I recently heard that up to a third of drugs that get put onto the market end up getting pulled off because of safety reasons, so I think it's about time that we can become a little more personalized.

Kate:

In the same realm as data. I think tech, more tech, has been a. I think it's a huge positive. I know you have your qualms about wearables, but those type of smart devices and biometrics can help guide daily health decisions and catch things further in advance, and I think it's going to take a lot of pressure off of the system if more people adopt them.

Mitchell:

Well, early treatment or prevention will take pressure off the system right.

Kate:

Sure, but also I'm also even thinking recovery, more recovery at home. So getting people out of the hospital sooner, sending them home with some sort of wearable device to monitor instead of let's monitor you for another few days in the hospital, and then it frees up that space for the acute cases. Okay, well, I'm still not wearing an aura ring okay, but other smart devices continuous glucose monitor, short-term hrv tracking, I think. I think they all have their place. Sleep the advances in what they can use for sleep apnea.

Mitchell:

Yeah, absolutely. I would just say don't let your whoop tell you that you're going to have a bad day.

Kate:

Within tech is also telehealth, of course, and for us, I mean, that's been major, and even in the last six years it's been six years now the adoption on our end, but also on our patients, and has been had to go home for something.

Mitchell:

And I felt bad and you actually sat me down and said but this is why we built our practice this way, so that we can have a little bit more time freedom, and we've now started even spend chunks of time back home with our families, where we it's all business as usual We'll see clients throughout the day and then be home with our families. And it's been amazing this revelation that we can impact people all over the country via telehealth I mean with the ability for more testing places and imaging centers all over the country to take care of. This adoption has been exciting for our impact and I would say that was a positive thing from COVID when we shut down the clinic in the beginning for a while and I was very stubborn against telehealth and my reasoning was because I like charts and I like to pull up charts and graphs and studies in front of people and I was struggling with how to do that via a telehealth platform. And what's funny is you notice how somehow I don't Little you use charts.

Mitchell:

Now, yeah, weird, I don't. Turns out a massive, confusing chart. Isn't that necessary to help someone understand what's going on?

Kate:

No, it's not so. You mentioned our perspective on it, but I think from the patient perspective it also allows. Now you can fit a visit in with us in the middle of your workday, so it's kind of the same balance for them. It's like I don't have to take time off to go to the doctor and make sure I have childcare so I can go to the doctor. It's like we can schedule it in on a video and it's a great thing can schedule it in on a video and it's, it's a great thing.

Mitchell:

Yeah, we actually we see a lot of people in denver via telehealth, which is I'm I'm okay with it. Now I enjoy it.

Kate:

The benefits are there I think ai fits into both tech and more data. But I want to circle back to it and I want to first talk about I think there's been a rise in, yes, empowerment from a patient perspective, but also education, with more non-prescribers in frontline roles. So you mentioned chiropractors, but also nutritionists, physical therapists, who are taking on more of the lifestyle medicine. Even you talk about this a lot. How yoga teachers are your primary care providers? They are your primary provider of healthcare.

Mitchell:

I was literally going to mention that.

Kate:

Yeah.

Mitchell:

When I go teach and talk about the nervous system and GABA and its relationships to you know stress and sex hormones and all of this that's my plea to those people is stress precipitates and drives all chronic disease and if you are somebody who helps an individual work on their nervous system, you are providing primary health care. And I, I think and I have these yogis will kind of look at me with eyes wide open like wait, wait, what? And it's like, yes, you are so important. If you don't learn to manage and mitigate the myriad stress conditions you have, you will always have psoriasis, you will always have anxiety or hormone imbalance or whatever you have or hormone imbalance or whatever you have. So anybody that's helping provide an individual with management of their nervous system is providing primary health care.

Kate:

Yeah, there is a a much bigger acknowledgement of mind, body health in general and, I think, another positive there there's more trauma, informed care and there's more of what you mentioned Like we have to get the stress component under control first. I heard you a few days ago you were telling a patient if we can't control your self-talk, then we cannot expect all of the effort to really show up anywhere.

Mitchell:

She was just having a very negative self-talk well, she said she's lazy after describing the 48 things she's doing in the middle of nowhere, flyover state of america, without access to organic vegetables, and she was like not recognizing all the benefit. And multiple times I was like, well, I'm just lazy, it's like, really, I just met you so like I'm not sure, but none of the last 20 minutes tells me laziness is the reason you're here. But yeah, it's a. I kind of just go with it and visits with what I'm feeling. It's like the coolest job, like I'm doing right now. You know, say what I feel, say it with my chest, mind, body medicine great, embody that.

Kate:

Um, let's talk about ai, shall we? Yeah, can't leave that out of here.

Kate:

Overall, I think it is a very positive thing, but we have recognized some pitfalls in it. I think everyone who's played around with it a little bit has recognized some of the pitfalls in it. I think right now some of the best benefits of AI is cutting down in some of the pre-screening time. Reading a few articles about hospitals implementing this, especially for more rural areas who don't have access to as evolved of care. They can do a lot of pre-screening through AI to decide is this a case that needs to be sent out to XYZ location? But even in primary care we talked about intake forms but having a little bit more advanced AI integration to assessment of health going into a visit to. Hey, we know we have 15 minutes, let's use that time.

Mitchell:

Yeah, and even you know, we occasionally will run volumetric MRIs. It's called a neuroquant analysis and this artificial intelligence literally calculates volume of different brain regions, standardizing it to hundreds of thousands of different scans which a human simply couldn't keep track of, and we get actual numbers for how their volume of their hippocampus or their white matter is comparable to thousands of other people in that age group, which I think is a really cool benefit of AI.

Kate:

I think some of the speech to text capabilities of AI has been very helpful in terms of more in conventional care, where a doctor is able to have a scribe, an AI bot, scribe everything, chart everything and then it fosters more connection. They're able to have the eye contact, have a relationship with the patient in front of them and not be so focused on. Let me get every detail down. We have played with it a little bit.

Mitchell:

I'm haven't found a happy medium of a system that I like to take notes the way that I like to take it it's funny when you read it though it is participant number one says chew your food. It's weird. You've shown me a few of those transcripts. I'm like wow, I talked a lot.

Kate:

A lot of participant number one in that document. I think AI has a place in the management of conditions where it can promote adherence. So thinking about more like AI apps who are acting as health coaches for someone with diabetes to check in how were your sugars this week? How was your diet this week? What choices did you make to positively impact or negatively impact? So I think there's a place for it there.

Mitchell:

We did recently have a guy. It was so obvious to me that he ran his labs through AI, yeah, but I actually liked it.

Mitchell:

But my problem was it created more work for me because he only wrote in the flagged results and it would be like we just recommend you know we need to test thyroglobulin and thyroperoxidase antibodies and reverse T3. And it's like it's two numbers down. It's right there. Yes, and then LDL was high. I want to test my LP, little a and Apo B. It was annoying to me because it was right below it.

Kate:

I understand, but what I liked is he fits into this health literate patient who is able to okay, I got these results. Let me pre-screen it in AI so that I know what I want to specifically ask Dr Mitchell about when I see him, when I have that hour and a half with him, and he was able to rule out some things that flagged high or low that weren't relevant just by putting it into ai. He was like okay, I don't have to talk about that, but I do want to specifically ask about xyz. So I like that's true yeah fine

Kate:

but yeah, we have run into that ourselves with ai of it. It isn't quite as good at reading context within a lab report. So just uploading a lab report and asking for an interpretation it doesn't always catch some of the okay, this is high, but also this is low and how those play together. It will just spit out a report of this is high, this is what it means, this is low, this is what it means, instead of reading the full context. So there's a limitation there, okay. So I have a question for you what is your wish list for the next five to ten years? What do you hope becomes normal in healthcare?

Mitchell:

Oh well, on my wishlist is a Audi RS6 Avant. Oh my God, in the next two years. I love wagons and I want a really fast wagon because they're cool and I can carry dogs and camp. So that's my personal wishlist. So that's my personal wish list, but from a health care perspective wish list.

Mitchell:

My hope is that communication becomes more open-ended and that physicians are given time to more deeply connect with their clients and patients to be able to help them understand their health. My wish list is that medical training will involve more systems biology approach, where systems can be taught to be more connected so that your cardiologist will have a little bit more information about skin and things like that. Specialists have so much knowledge. It's amazing their depth of understanding. I think the breadth of understanding is what gets lost, because they'll go to medical school, they'll get an understanding of pretty much the whole body and then they zoom in to one system and they kind of leave that broad knowledge behind in a lot of ways and just refer to a different provider. So my hope is that there's a little bit more remembrance of how we function as a species within the entire ecosystem of our biology.

Kate:

I also hope that physicians can be reimbursed while spending enough time with their patients for them to be able to really connect and understand. I'm hoping that patients have a little bit more autonomy and choice in their providers. So, whether that means in-network, out-of-network or in-state versus across the country, I think being able to choose a provider who you believe in can go a long way. And then, of course, I want a little bit more transparency in cost across the board. I have a long way to go on that, but that's on my wish list.

Mitchell:

Now that we're talking about it, another thing on my wish list is that diagnoses won't be rushed. Think about we were speaking with a client yesterday who's a therapist and one of her frustrations is how quickly a PCP might diagnose someone with something like generalized anxiety disorder and then that thing carries through on their chart and in their conscience for the rest of their lives. Know, oh, I just have gad and. And then that just becomes kind of the narrative around who they are.

Mitchell:

Um, same thing with pcos yesterday, yeah we had a gal who essentially doesn't believe it but it was hurting her self image. Well, I I'm told. On one hand, I can never be able to get pregnant. I'm 29 and I would like to have a child, but on the other hand, I'm being told that I must take birth control to manage this condition that was just hastily given to me nobody asked about her stress, her blood sugar, her activity levels.

Mitchell:

is she ovulating? Nobody tested ovulation. Nobody looked at ovarian function or the communication between the hypothalamus, the pituitary and the ovaries, or the adrenals or the thyroid. It was just a label slapped on this person and, as a person with health anxiety, it was not good for her. So my hope is that diagnoses are taken seriously before they're given to people. But the problem is you go see a PCP, they need to put an ICD-10 code in the chart. That's how it works to get reimbursed and I think not given enough time. It's just really easy to jump into a diagnosis that has a lot more weight to it than just a chart note. People remember that and they take it with them.

Kate:

It's that, but it's also the lack of personalization. So once you have this diagnosis, you get put into this track, this PCOS track. These are the tools and these are the steps we take. First try this medication, then try this medication, and there's no wiggle room outside of it. Same thing with the generalized anxiety disorder she was talking about. You know they have this protocol. This is how we treat it, this is the type of therapy we use for that, and if it's the wrong diagnosis, you can be years behind with the wrong type of treatment.

Mitchell:

And as a therapist she was recognizing that she was having some internal physiological anxiety that started after exposure to mold and at the end of her visit she's like man. I really wish that I could point more of the people I'm working with to you to at least get a baseline of what biologically might be going on that might be driving this condition, be driving this condition. I'll say this If you're diagnosed with PCOS and someone tells you the only solution is birth control because it will fix your hormones, find a new doctor. Oral birth control is never going to fix your hormones. It's not going to fix anything.

Mitchell:

Synthetic progesterone is not progesterone, it's progestin. It does not normalize cycles. It might clear up some symptoms for a while, but I am so frustrated with this idea that I know this wasn't the point of today, but it pisses me off, frankly, that people are just told that the only solution to fix your hormones is to take synthetic exogenous hormones that override brain signaling, so that now your brain is no longer in control, your body thinks you're pregnant at all times, you're never going to ovulate and, of course, you're bloated and you have mood issues. It's so ridiculous that that's what we're told. That'll fix it. That's the only thing we can do, really, is it? Because you've got a hammer, so you think this is a nail. I digress.

Kate:

And it wouldn't be a facilitated episode without a diatribe off topic from Mitchell.

Mitchell:

I'm sorry, I think a lot of people listening to this were probably told that kind of thing. So advocate for yourself.

Kate:

Synthetic birth control is not going to fix your hormones. For more about what we do at the Facility, check out our website, wwwthefacilitydenvercom. You can also follow us on Instagram, at thefacilitydenver, for extra tips behind the scenes, fun and updates on new episodes. Thanks for listening. Now go facilitate your own health and we'll see you next time.