[INTERVIEW]
Ronda Nelson: Well, your patient comes in and they have fatigue and constipation, bloating, brain fog, all this laundry list of symptoms, and you put together a beautiful protocol: 15 supplements, a new diet, and about 27 different changes. Six weeks later, they’ve barely touched it, and you think, “Well, they’re just not compliant.”
I hate to break it to you, my friend, but the patient probably is not the problem. I think your plan is…
Well, welcome back to the podcast. Here we are. We are, oh gosh, we’re into November now. I can’t even believe it. How did this year fly by so fast? And the older I get, the faster it goes. My mom and dad used to always say it, and I thought, “How can that be?” But it really is true. It goes so fast. Today, we are gonna talk about you and your problematic protocols.
Everybody does it, myself included, and we’re gonna talk about it. I think that when we start making these big old fat protocols, it ends up being a problem. We are trained to recognize patterns, things that are wrong, connect the dots, look at their complaints, you know, their chief complaints, the symptoms that are really bothering them, and then we tie it to an underlying physiological process.
And it’s a strength. It’s a superpower. It’s what we all do really well. It becomes a liability when we find one thing and then that turns into something else, and then we find another thing and we’re like, “Oh, well, yeah, I need to fix that.” And then, you know, fatigue gets adrenal support, and constipation gets a bowel formula, and bloating gets probiotics or bile support, and then brain fog gets the cognitive support, and then poor sleep, we got valerian, and so on and so on and so on.
Pretty soon, we’ve just chased all the symptoms, which is, you know, sadly, it’s really what the patients are used to as well, is we’ve chased all the symptoms and now what we’re left with is a long list of supplements. And they will say — how many times have you heard them say, “It’s too many things. It’s too many pills”?
And it’s true. I don’t, I don’t like it either. If the pill count gets too high, I’m out. I don’t, I don’t wanna do that anymore. I need to know, I need the most efficient way that I can take the supplements and get the outcome that I want, and the patients are no different. So I don’t know, for those of you that have been around for a while, earlier this year, I talked about a patient that was a long-haul type patient.
She had restless legs, and she came in to me and she called me back. I wasn’t able to fix her before. And, uh, for those of you that remember this podcast from earlier, it was in the first six weeks of the year, I did like five clinical cases. That’s how we kicked the year off. And they’re all good. If you wanna go back, you can listen to them.
But she came back to me and she said, you know, “No one’s been able to help me,” and I went to a functional medicine doctor in her state. She’d moved away from where I lived. And she said, “I just wanted to send you my test results and what they recommended.” All of the supplements, I don’t remember the exact number, but it was like 23 supplements or something like that.
It was some crazy number. And every single one of them was a supplement tied to a symptom or a blood marker. Every one of them. There was no, “Okay, let’s start with this, then let’s do this, then let’s do this.” They literally sent her a list. She didn’t buy all of them, thankfully. And then to make it even worse, they were all synthetic.
They were all just crappy supplements. And I said, “You don’t, you just don’t need all that. Here’s what we have to do. Here’s what we have to do to get you fixed.” So, a lot of times in functional medicine, I always say — you know, I don’t like functional medicine. I don’t like it. I am in the camp, but I believe that there’s a better, different way to do it.
It’s not all $5,000 worth of testing and 23 supplements. It’s just — we don’t have to do that. There’s a better way to do it. What I want you to think about is that the patient that comes in and they have a laundry list of symptoms, they did not get that way overnight. This was a process, right? It’s a process.
We forget about that. Most of these chronic complex presentations, they’ve developed over time through, you know, interacting factors like stress first, and then there’s some metabolic changes, and then, you know, the diet was in there somehow. Then the digestive system gets all messed up because of the stress, and then that disrupts their sleep.
And then sleep causes the need for a medication, and then the medication causes a side effect, and then we get another medication, and then pretty soon they’ve got a disease state that’s happening, and they’ve got a diagnosis. And all of that starts to happen, you know, over time. And as that begins to… it’s like a ball of tangled yarn that just kind of keeps unwrapping and unwrapping and unwrapping. And as that happens, the patients end up coming to us, and they’ve got a ton of symptoms, a whole bunch of complaints, and no one’s really looking at what the underlying cause is.
So we pride ourselves on looking and investigating that underlying cause. But so many times what we do is we do the same thing. I’m like, “Oh yeah, I’m gonna address the underlying cause, and give you something for constipation, and give you something for sleep, and give you something for bloating, and give you something for, you know, itchy skin.” We’re kind of no different. We just put a little… it’s like putting lipstick on it, you know? We just do it a little differently and call it this, call it different, but it’s not really any different.
Some of the symptoms have the same underlying contributing factors. You know, you have thyroid symptoms that could be stress symptoms, thyroid symptoms that could be poor iron symptoms, thyroid symptoms that could actually be infectious symptoms. They could indicate that there’s something else going on with the immune system. So there’s always more than one road that leads to Rome, so to speak. So it developed over time, so why in the world would we think that we can fix it overnight? We can’t.
And it is — I don’t even know how to just say it. Breaking that mindset is hard. It’s so hard. I’ve been doing this for a long time, and a lot of you listening have the same clinical experience, clinical background. It still happens, even though I’m like, “No, we are gonna start slow. We’re gonna rebuild Rome from the ground up. We are not gonna go in and try and fix that window and fix that wall and fix that leak and repair that roof. We’re not doing that.”
But then we end up doing it ’cause the patient’s like, “Well, you know, I do have hair loss. My hair’s falling out, so can you give me something for that?” And then off, off we go. And now before we know it, it’s like 23 supplements and a 23-car pileup, and it’s just a big old pile of wreckage, and no one’s getting any better.
We have to stop chasing the symptoms and start identifying the priorities. So first, I want you to think about what are the priorities? Everyone has different ones. I have mine that I like, and those are kind of the… those are my priorities, what I look at.
If you are a mold person or you live in the Pacific Northwest — not Pacific, Northeast. If you live in the Northeast, then ticks might be your thing. Everybody has Lyme. Maybe, I don’t know what your priorities are, but I would encourage you, make a list of your priorities, the foundational things that you believe have to be in place before the patient can get better.
I would argue that upper digestion has to be on that list, because how can you repair a body if we don’t have enough hydrochloric acid, bile, pancreatic enzymes? We’re not chewing well. We don’t have good saliva. That whole upper through the duodenum, that little nest of chemical activity that happens in there has to be working.
Second, I would argue that stress management has to be in there as well, because we know that if there’s high stress, then we are in a sympathetic state and we’re gonna have poor digestion. So I think those two could arguably be pretty important and kind of at the top of the list.
I would also say bile is really important. Let’s say you have someone — I don’t know how this could be, but let’s just say you have someone who has really high stress and their upper digestion is all messed up, but they say, “Oh no, I have no problems with bile.” That’s like — can’t be. It can’t be. It’s not how the digestive process works. They’re all playing the same melody. They’re all playing the same thing. They just play different instruments, but it’s the same song. So you can’t have one that’s broken and not the other one. So I always say bile gets my specific attention. I’m looking at bile. What’s happening with bile?
Another one that’s important to me is what is happening within the lymphatic system, because the lymph is moving toxins. The lymph is how we’re clearing toxins, and if that lymph is stagnant, if they’re not breathing well, they’re not moving well, those muscles aren’t contracting, then those toxins are gonna build up.
And I think having a good phase one, phase two is also important, right? I can work on lymph, but if I don’t have a way to get it out, then that’s not gonna help me, and I think that the bowel or elimination is also a foundational thing. So in my mind, and drainage — drainage, that would include lymph, but there’s other drains. Bowel is a drainer. Gallbladder’s a drainer. But those kind of — I think about all those things as foundational.
So you pick yours. I don’t know what yours are, but those are mine, and if I can keep my eyes on that, especially with a new patient, I’m gonna get a lot further, a lot faster. It’s also going to put guardrails around the temptation — that’s the word I want — of saying, “Oh, well, there’s a probiotic for this, and let’s give you something for poop, and let’s give you something here and something here,” and then we end up back with our 23 list, or list of 23 supplements.
If I have those foundational things and I’m focused on only those, then now I can stay right there, and I know that the patient’s gonna get better when I can fix the diet and start working my way through these foundational issues. The problem is it becomes boring. Do you guys get bored with this? Sometimes I get bored. Sometimes I just get bored of talking about diet or talking about bowel or talking about the liver or talking — sometimes I’m just bored. Oh, blood sugar in there too. You can’t not address any kind of metabolic dysfunction.
So notice I did not say sex hormones. Notice I did not say thyroid. Notice I did not say HPA axis. I mean, that might be with stress. But I’m thinking like, what are the — what’s the plumbing, the electrical foundation, the walls? Just the basic kind of stuff. That’s what I have to make sure is working, and if those things aren’t working, then I’m going to be tempted to — I’m not gonna be as effective. The patient’s not gonna get better like we want them to, but I also am gonna end up ping-ponging around and just giving them a whole bunch of supplements, ’cause you know how it happens.
They come back and they say, you say, “Well, how you feeling? How are things going? How are you feeling?” They’re like, “Well, you know, I don’t know. Not really too much better.” When they say that, that is your clue that you skipped over some foundations.
You have to build — there is an order of priority here, and it’s not overwhelming them with a whole bunch of supplements to chase the symptoms. So I’m gonna give you the priority. You ready? Here it is. Here is your protocol priority in kind of phases. I want you to think about it in phases.
Phase number one is you’re gonna stabilize and establish a good, solid foundation. That’s number one. You’re gonna — you know, if there’s any urgent medical things, if you need imaging, you’re gonna deal with all of that. You’re gonna improve diet and daily habits. Are they staying up late at night? Are they sleeping in in the morning? Are they skipping breakfast entirely and then complaining about being fatigued later in the day? You’re going to just start with a few basics. That’s like phase one. I think phase one and two kinda go together, but phase one is just the kind of the emergent basics, the things that you gotta have that they have to fix, like, right away.
If you have someone who has, uh, high crazy spicy thyroid antibodies and they’re eating bread three times a day — to me, that would be a phase one target. I would say, “Okay, I just need you to not do that for about six weeks. Just six or eight weeks, just get off the bread. You’ll live. Let’s find another bread that you can use. There’s a couple of good ones at Whole Foods. Let’s find those for you. Let’s try those. We’re just gonna go six weeks.” Okay? So those are — that’s like a phase one. It’s kind of the, the screaming 911, like siren kind of priorities, okay? That’s phase one.
Phase two is to not only look at their response, but also then say, “All right. Of your list of foundational things, which one is the one that’s under the most stress? Which is the one that’s speaking the loudest? Which is the one that’s waving the white flag saying, ‘I’m not okay. I am not okay.'” And you’ll know that by the symptoms. So if there’s bloating, heartburn, you know, they have to sleep inclined at night. If they’re about to blow their lid, they’re just like yelling at their kids, or they’ve got migraine — whatever it is, you gotta like look at what are the things that are screaming. What are the things that you’ve got to address right away? Usually, it’s gonna be in the realm of stress management, digestion, sleep, and elimination.
Because we’re dealing with some of the metabolic stuff by just managing their diet. But that’s the trap, right? We go, “Oh, well, let’s give you something for digestion. I’m gonna give you something for sleep. I’m gonna give you something for your blood sugar, something for your gallbladder because you have like light-colored stools, and then how about something for your bowels?” And now here we are right back where we started. Right back where we started. We say we’re gonna do it differently, but we’ve just put lipstick on a pig. And it is no different because we’re still dealing with the symptoms.
So hard. You have to step back and say, “What are my priorities?” Okay? “What are — Ronda, what are your priorities?” I say, “Okay, my number one priority is going to be upper digestion. I do not pass go, do not collect $200, go straight to jail, do not come out of jail. You get no tokens, you get no money, you get no moves on the board. Nothing happens.” If you’ve never played Monopoly, you’ll know what I’m talking about.
Nothing happens until we get the upper digestion fixed, and then probably stress. I would put those two together ’cause you can’t fix upper digestion if they’re in a chronic stress response. Agreed? We all on the same page there? So I have to keep going back to the foundations. Stop, stop. I know there’s, I know there’s a 23-car pileup. If I’m the emergency responder to a 23-car pileup on the freeway, in real life, am I gonna be able to fix everyone at one time? No. What do they do? They triage them, and the most urgent get treated first.
That’s what your priority list is. It’s what it will help you kind of formulate. Like, those are your foundational priorities, and once you fix those, once you have those, it might take you three months. Is the patient going to feel better? Yes, they will. When you address those foundational components, they’ll start to feel better. But your brain is gonna say, “Yeah, but don’t they need a probiotic? Yeah, but maybe I need to give them, like, mushrooms,” or, “Yeah, but maybe we need, like, a cell core drainage product or something like that. Yeah, but…” No, no, no, no, no. Just go right back to your list of basics. Deal with the emergent stuff, like the stuff that said literally 911 siren. And then you’re gonna say, “All right, what’s changing? What else do we need to address?” That’s kind of the phase two.
In phase three, now we’re kind of at the — and you might not get to phase three for four or five months. It might just take that long, maybe less if you’re really good at what you do or the problem isn’t too big. But in four or five months, you’re gonna go to phase three. You see how slow this is? But it needs to be this way because people are sick. No more of this, “Take some Catalyn and you’ll feel better,” business. I mean, that was what it was in the 1930s. It’s not like that now.
So phase three is address the persistent dysfunctions. So your initial evaluation, the emergent things have kind of cleared up. Now you’ve got metabolism, you’ve got all your foundational stuff, the metabolic, upper digestion, stress, liver, gallbladder, elimination, whatever your priorities are. Those are done. Now we go, “Okay, what’s left? What’s left? What do we need? What else do we need to do in order to get this patient better?” And then phase four is just to maintain.
So it’s not hard, right? Priorities, get your foundations. What are your priorities? What are your clinical foundations? Number one. Then we’re gonna do address the emergent things. So think of the foundation. There are five things. They’re down here at the bottom of the house. First wall, what’s emergency? What do we need to address right away? Number two, how are we gonna start building the rest of the walls? How are we gonna get this infrastructure created? And then phase three is anything that’s left over, like we just have that dang leaky roof or that car that just won’t quit leaking oil. We’ve got to figure it out. That’s the persistent stuff, and then we’re just gonna maintain with them.
It’s not that hard. So working with people and having supplements that go into what I call the supplement graveyard — in other words, more isn’t better. And if you are recommending supplements and then they come in and you’re muscle testing two weeks later, “Nope, don’t take any of those. You need six more new ones.” No, no. I’m not… I can’t. I just, I can’t do that. I don’t understand. How is it that someone’s gonna, A, be able to afford that, and B, you do end up with a supplement graveyard.
Your protocol should be effective and efficient enough that you can have them finish the bottle, because how many times do they bring you in a bag full of supplements, or they’ll bring you in a list of what they’re taking? Some are from you, some are from the previous practitioner, some of them are from Whole Foods. They can’t even remember, and every bottle has a different dosing instruction, and there might be three bottles of one thing, and they all kind of do the same thing, and the ingredients are about the same, but they’re all half-finished, or one of them they haven’t taken, and one was from a neighbor. I mean, the poor patient just needs a full-time administrative assistant to figure all this stuff out just so they can take their supplements.
But all those products are probably not needed because the foundational piece and the strategic plan was missing. And practitioners, these functional medicine practitioners just get in a hurry — like, “Oh, here’s your lab test, your complaints. Okay, take all of these things. Bye. See you in two months. See you in a month. See you in six weeks.” If every single new symptom required another supplement bottle, you’re not doing functional medicine well. You’re not. You’re just building a more expensive collection of supplements. You’re adding to their graveyard.
So is the patient, if we come all the way back full circle, is the patient really non-compliant if they don’t want to take your 23 supplements, in my example? Or have you just made success kind of impossible for them? I would argue it’s probably the latter. Because when patients don’t follow the recommended plan, most of the time we take it as, “Well, we’re gonna blame them. Yeah, they’re not compliant,” or, you know, “They just didn’t come back because they just can’t afford it.”
Well, how about you make it affordable for them? How about you just fix one foundational thing? What if you gave them one thing for stress and two things for digestion, and that’s all you did? And you said, “Okay, we’re gonna do this for one month, and then you’re gonna come back, and then we’re gonna look at it.” It’s the slow road, but it allows you to have a longer term, and I would argue a faster, more efficient return to normal physiology when you start slow to go fast later.
And you also don’t know what are these patients dealing with in their life. You’ve given them 23 supplements. I mean, just hang with my example here. You give them all these supplements, but you don’t know what’s going on in their life. They’ve got kids, pets, maybe financial pressure, relational stress, work stress, life stress, a mother who’s in memory care, whatever it is. And you think, “Well, why can’t you just hang with me?” Well, because they can’t. You just made it too hard for them.
The instructions are confusing, supplement costs are high, or it’s inconvenient for them, or there’s too many changes. “Okay, stop that and do this one.” All of that stuff reduces their follow-through and their commitment to be consistent with you. I think that this is the problem, is that we give them too many things. We’re focused on too many targets. It’s like trying to shoot a flying bird. We just point the gun, and we just start shooting, and we’re missing most of the time.
Instead, think about what are the foundational priorities. What are your foundational priorities, and then how can you get them implemented? Because it might be your ego. You know, you might think, “Oh, well, I’m really good at what I do, and this is just what you have to take, and I’m gonna beat my chest and say that I’m great.” I’ve met practitioners like that, and that doesn’t serve anyone well. We come with humility to say, “I really wanna help you, and this is how we’re gonna do it.”
And write it out for them. Explain to them, “This is why you have to go slow.” There’s a belief that just because a complicated patient deserves — or that a complicated patient deserves a complicated protocol. “Oh, they’re complicated, so we need to do a lot.” I do not agree. I do not agree. In fact, I say the more complicated they are, the more simple it needs to be. The more the symptoms, the fewer the supplements.
I have a lady coming in. I counted in her recap that she sent to me, she has 38 different medical diagnoses. 38. I don’t even know if I can help her. I’m wondering if it’s spiritual at this point. I don’t even know if I’m gonna be able to help her. I’m gonna talk to her, but I don’t know. But everybody’s put her on these, every kind of protocol. I think she’s probably been on 200, 300 different supplements, and she’s just got bags and bags and bags of them. And it broke my heart because no one’s paying attention to what’s underneath all of it, and it’s like a big — this is a 73-car pileup. I mean, I don’t know if I’m gonna be able to help her, but I’m gonna try.
But clinical confidence requires the willingness to prioritize, to simplify, and then monitor what’s happening, and then admit when you missed it, and then make a change, rather than just reflexively adding more supplements. That’s never gonna help anyone. It doesn’t help anyone.
So on the business side, to land the plane here, an overwhelmed patient doesn’t stay. So what happens, you end up having to do more and more and more marketing. You’re like, “I need more new people. I need more people.” I would challenge you this week — gosh, I am kind of in the homework model. I’m like, so sorry, three weeks in a row now I’ve given you homework.
This week, I would challenge you to figure out what your — it’s called a churn rate or patient retention rate. What percentage of new patients in the last six months — just do a six-month look back. What percentage of new patients in the last six months are still with you, and what percent of them have dropped off within six months? And I think you’d probably be surprised what you find. Maybe, maybe not. Maybe you’re gonna say, “Hey, you know, I only have a 20% drop. I have an 80% retention, like 80% of people stay.” But most people, it’s around 50% drop. It’s about half over a six-month period of time.
That’s not a fun conversation to have because you gotta look in the mirror and say, “What did I do? What’s my contribution in this, and what did I miss, and how could I have made this simpler for them?” Because an overwhelmed patient does not stay. But when you have a protocol that’s written out and it’s clear, it’s concise, they know exactly what they’re supposed to be doing, they know what they’re supposed to be taking, and it’s not overwhelming.
Here’s the challenge. I’m gonna put this out for you as something to take on. You remember, some of you guys aren’t old enough to know this, but there used to be an old show on TV, it was called “Name That Tune.” And “Name That Tune” was always fun because they would play, like — somebody would say, “I can name that tune in three notes,” and then the person at the piano would play three notes, and the person would have to guess what the song is. You gotta be a real music buff to do that.
What if we said name that tune, but we did it with supplements? My challenge is, what if you could just start — you made a rule for yourself that you cannot give any more than four supplements. No more than four. How would that change how you think about the patient? How would that change? I would bet it would change. All of a sudden, you’re gonna be real efficient with what you’re recommending. Real efficient. You’re gonna make those first 30 days so ridiculously simple. You’re gonna boil it down to the very basic foundational thing, and maybe it’s just stress and digestion and gallbladder. Maybe that’s it. Maybe it’s three things. I mean, bonus points if you can get three, and you’re gonna do that for one month. You know, dietary changes, but don’t tell them, “Start doing exercise and walk this and do this and hang upside down and do push-ups.” Don’t do that. Just make it easy. The goal is to make it easy for them.
What if you could name that tune, name that supplement protocol in four supplements or less? You might try it. Just see. See what happens. The patients are gonna be happier. You’re gonna be happier. They’re gonna get better results, and you don’t get confused because you don’t have this treatment doing this thing and this one doing the other thing, and it starts getting crazy, and then, “Well, which one should I take? Okay, well, yeah, which one was I doing for what?” It starts getting confusing, and it’s hard to explain to them. “Well, we’re doing all of these things for this,” they just get overwhelmed. So how about we don’t do that?
Let’s just try a little experiment, shall we? Together, collectively, our little community here in our corner of the world, let’s just try. For the next month, I want you to try with all of your new patients — do four supplements or less and work on the foundation.
So you have two homeworks this week. One, write down your priorities. What are your foundational priorities for you? I gave you mine. What are yours? Write them down. Put them on a sticky note. Put them on a list. Put them as a screensaver on your computer. Put them as the wallpaper on your phone. Put them where you can see them so that they’re constantly in your face reminding you, “This is my priority. This right here is my priority. Period. Full stop. My priority. This is what I’m gonna do.” And don’t change. Do not deviate.
And then let’s see if we can do Name That Tune in four supplements. Let’s see if we can do it. I think you can. And when you do, leave me a comment here. Leave me a comment and say, “I did it. Four.” Like, yes, I will celebrate with you. You can always send me an email too if you want to. But I really wanna know. We’re gonna do this, so I wanna know how this turns out. We’re gonna try a little experiment here. We’re gonna make it not complicated so we can retain the patient and finally get them better.
[CLOSING]
Ronda Nelson: If you want more clinical help, if you’re confused about what to do with your patients, come join me in Clinical Academy. Super easy, $99 a month. You can come in, stay as long as you want, stay forever. Lots of people do. But it is the best clinical, super simple, easy training you’ll ever have, and it’s my clinical brain, how I do it in a very street smart, easy way. It turns what you know into what you need to do next. It takes all the clinical heady knowledge and makes it real practical, what’s the next step? What’s the very next step I need to take?
So come join me in Clinical Academy. You can go to rondanelson.com/clinicalacademy. Otherwise, I’ll see you guys next week.
[END]