Nurse's Role in Functional Medicine: Shaping Holistic Care Episode 1

This is episode 1 of the series: Nurse's Role in Functional Medicine: Shaping Holistic Care

Episode 1: In this episode, we dive into the world of functional medicine and its patient-centered approach. Our guest shares insights on the differences between functional and conventional medicine, the importance of addressing root causes of health issues, and the key elements of patient-centered care. We also explore how functional medicine has transformed patient outcomes, particularly in digestive health, and discuss the collaborative, empowering nature of this approach, along with the guest's training in holistic nursing and functional medicine.  

 Episode 2: In this episode, we explore the vital role of nurses in functional medicine and the importance of preventative care. The discussion highlights the value of case management, patient support, and accountability in functional care, as well as the need for collaboration among healthcare professionals to ensure comprehensive treatment. We also examine the benefits of functional medicine in preventing chronic conditions, such as hormone balancing for perimenopausal women. The episode concludes with practical advice for nurses and nurse practitioners interested in functional medicine and entrepreneurship.  

 
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Series: Nurse's Role in Functional Medicine: Shaping Holistic Care

Transcript

 Nurse's Role in Functional Medicine - Shaping Holistic Care

Guest: Leah Geoghegan, AGNP-C, IFMCP

Leah Geoghegan is a board-certified Nurse Practitioner and the founder of Emergence Health, a functional medicine private practice now in its fourth year of operation, primarily via telehealth. Over the years, Emergence Health has successfully treated hundreds of patients. Leah earned her undergraduate degree from the University of Pennsylvania and her master's degree from New York University, specializing in Adult Primary Care and Holistic Medicine. She is a certified functional medicine practitioner through the Institute for Functional Medicine and a certified medical marijuana prescriber in New York.  In 2020, Leah established Emergence Health to address the immediate need for medical care when physical offices in NYC were closed due to the pandemic. Emergence Health now operates in New York, Connecticut, and Pennsylvania, offering a personalized patient experience by integrating conventional and functional medicine. Leah's approach to healthcare is holistic, focusing on the body's natural healing processes and the importance of individualized patient care. She emphasizes listening to the body, valuing each patient's uniqueness, and building trusting relationships in a supportive environment. Beyond her clinical practice, Leah is committed to influencing the broader healthcare landscape. She is actively involved in rethinking traditional healthcare models and collaborating with industry peers to enhance patient-centered care experiences. Alongside her dedicated team, Leah guides emerging medical professionals and assists other healthcare practitioners in developing and scaling their practices.

Host: Candace Pierce DNP, MSN, RN, CNE 

Candace Pierce is a nurse leader committed to ensuring nurses are well prepared and offered abundant opportunities and resources to enhance their skills acquisition and confidence at the bedside. With 15 years in nursing, she has worked at the bedside, in management, and in nursing education. She has demonstrated expertise and scholarship in innovation and design thinking in healthcare and education, and collaborative efforts within and outside of healthcare. Scholarship endeavors include funded grants, publications, and presentations. As a leader, Dr. Pierce strives to empower others to create and deploy ideas and embrace their professional roles as leaders, change agents, and problem solvers. In her position as the Sr. Course Development Manager for Elite, she works as a project engineer with subject matter experts to develop evidence-based best practices in continuing education for nurses and other healthcare professionals. 

Episode 1: Nurse's Role in Functional Medicine - Shaping Holistic Care

Transcript

https://riverside.fm/shared/exported-clip/99e6832333c90b05bab2

Candace Pierce: This is Dr. Candice Pierce with Elite Learning by Colibri Healthcare. And you are listening to our Elite Learning podcast where we share the most up to date education for healthcare professionals. Welcome to the functional medicine shaping holistic care podcast. In this series, we are going to look at the latest trends and practices in functional medicine. And we know that functional medicine is becoming more popular because it really emphasizes treating the whole person rather than just the symptoms. Functional medicine is also opening the door for healthcare providers to deliver more comprehensive and personalized care, really addressing the root causes of health issues rather than just managing symptoms. Understanding functional medicine is going to enhance your ability to improve patient care outcomes, promote long -term health, and really collaborate more effectively with other healthcare professionals. Joining me for this discussion is Leah Gagan. Leah, thank you for joining me.

Leah Geoghegan: Thanks for having me, Candice.

PIERCE: Yes, absolutely. I'm really excited to learn how this approach differs from conventional medicine and those key elements that ensure patient -centered care and why it's important to focus on root causes. So hopefully we'll get to share some specific examples where these approaches have led to significant improvements in patient outcomes. Leah, how did you get into functional medicine? What really opened that door for you?

GEOGHEGAN: So, when I first graduated from nursing school, gosh, ten plus years ago at this stage, I started my career working in the emergency department. And I absolutely loved working in the ER. I can stay very calm under pressure. I loved working as a team. And I loved really understanding the full spectrum of disease, seeing people when they were acutely ill, understanding what those acute care interventions were. But unfortunately, in America, many people will also use the emergency department as primary care. And I just started to notice this pattern of people coming into the ER for basically managing chronic illness, which we weren't really equipped to do well. And we were prescribing a lot of medications to manage symptoms without a lot of education and follow up for these patients. And I became frustrated and burned out over time with this more reactive form of medicine because I really went into healthcare to help people heal. And when I first heard and learned about functional medicine, I just had this like light bulb go off in my head because I really saw that functional medicine was a pathway to help people truly heal at the root cause where they wouldn't need to take medications or even engage as much with the healthcare system over time because they understood how their bodies worked and were able to balance things at that source.

PIERCE: Absolutely. So, going into that, how does a patient centered approach in functional medicine differ from that conventional medicine that you're talking about?

GEOGHEGAN: Yes, good question. So, under the conventional model of care, we place a lot of emphasis on evidence-based care. There are a lot of protocols and studies that have been done to basically help us understand how the general population will respond to different treatments for certain conditions. And don't get me wrong, there's definitely a time and place for practicing medicine that way. As a former acute care nurse, I really do understand like there is a time and place for acute care interventions, but with functional medicine care, we basically use evidence -based practice just like conventional medicine, but we also include patient preference as well as provider expertise in our locus of designing a personalized treatment plan for our patients. So, it's a lot more individualized. It recognizes how someone's unique genetic profile, their environment, as well as their diet and lifestyle practices can actually influence their health and taking those things into account when caring for somebody. And it makes it actually really fun as a provider as well because you can see patients who have the same like root issue, but you actually treat them all slightly differently depending upon their preferences and depending upon what their testing is showing you.

PIERCE: Now, would you consider, I know we say conventional versus functional medicine, but would this be kind of considered more alternative or does it still fall in the realm of conventional medicine where insurance pays for the treatments?

GEOGHEGAN: Yes, good question. You know, unfortunately, right now with the way that our insurance model of care works, there's no way to directly bill insurance for functional medicine care. And the reason why is because with functional medicine care, we really value spending unhurried time during appointments, getting to know our patients, asking questions, basically weaving this timeline of somebody's history all the way back from when they were born through their present day where they're not feeling well, and the average primary care visits that insurance will cover is around 15 minutes long. So, it really just is not enough time to get deeper into somebody's history to really uncover these connections. And it's unfortunate because it does create a barrier to care, at least at this stage of the game for people to access functional care. And that is something that I'm really passionate about and something I'm trying to weave into my own private practice too is trying to get this knowledge and this wisdom to as many people as possible in a cost -effective way.

PIERCE: Absolutely, I love that you're trying to advocate because this really is a great approach to care and it should be covered. It should be part of healthcare options. So, I love that you're advocating for that. So, going back to functional medicine, what are those key elements that really make sure that it's a patient -centered care approach in functional medicine?

GEOGHEGAN: Yes, really good question. So, we value quality over quantity, first and foremost. So, in the insurance model of care, conventionally, you have to meet certain quotas of the number of patients you see in a day for reimbursement for your practice. In functional medicine care, we take care of a smaller subset of patients at any given time, which allows the providers to really give those patients their undivided attention and to allow more spaciousness for a relationship to develop between providers and patients. And that is really the core foundation of healing from what I've experienced in care is basically giving somebody your undivided attention, listening to them, reflecting back what they're sharing with you so that they really feel like they're being heard is really the foundation that healing can build from. And on the flip side, on the practitioner side, it's also really helpful because providers are burned out right now. You know, they're seeing 20, 25 people in a day. They're taking their notes home to try and finish in between shifts and things. with the functional model of care, at least that we've built here at Emergence Health, we really have a smaller subset of patients that people can care for so that they feel really well supported and the practitioners really feel like they're providing the type of care that they really want to, to their patients. So that's a big one. Another thing... sorry, go ahead.

PIERCE: I know I was going to ask you like on average, how much time do you get to spend with your patient?

GEOGHEGAN: So, the average initial appointment for a functional medicine patient is 60 minutes long. And typically, before that appointment, I'll request that patients fill out some detailed paperwork for me that goes over their history, their diet, stress levels, exercise routines, as well as sending me any of their medical records in advance. And I dedicate an hour before an initial appointment to actually review everything that patients give me before we enter into that first appointment because one of my pet peeves as a patient myself in the past has been providers not actually reading all of the forms and things that I took valuable time to pull out for them.

PIERCE: Yes, I filled it out. Why did I fill it out? 

GEOGHEGAN: Why are you asking me the same question that I already gave you? So just because I want patients to value my time, I also need to value their time. And I think that starting our relationship off on that foot really helps to build that rapport early.

PIERCE: Absolutely. Go back to the key elements. You look like you had some more you wanted to talk about when I interrupted you on time.

 So the other thing that I think is really valuable for delivering high quality functional care is valuing our practitioners and basically making sure that practitioners have the time to complete the administrative aspects of delivering care, that they have the ability to seek higher education and different training courses to stay on top of something that's so rapidly evolving like functional care because all of those things end up benefiting the patients too. And also pulling in practitioners even in the functional space, which is very holistic and wide scope. Having practitioners that have different specialties even within the subset of functional care also can really elevate and enhance the care that patients receive through that approach.

PIERCE: Absolutely. Are there other key elements that you wanted to hit on that are helping you ensure patient -centered approach?

GEOGHEGAN: No, I think those are the big ones really quality over quantity, valuing the practitioners and providing a nice container for healing, which includes those unhurried visits and providing people with resources and ensuring that you're meeting patients where they're at. I feel like sometimes, especially with the knowledge that we bring to the table, we sometimes feel like we know what the patient needs at any given time, but actually taking direction from the patients on how quickly they want to move, what they want to understand in more depth, what they want to be told what to do, really making the care delivery model very personalized also increases compliance with treatment plans as well as just outcomes for the patients, which is a win -win for everybody.

PIERCE: Absolutely. And my favorite part of functional medicine as a whole is the root causes, how you focus on root causes rather than just symptoms. So why is that such an important focus in healthcare or should be in healthcare?

GEOGHEGAN: Yes, absolutely. So currently in America, we have a sick care model of care. And we primarily use medications to manage chronic illnesses. And again, don't get me wrong, there's a subset of people and a time and place to use medications. But I believe it was actually the US Center for Disease Control and Prevention did a study recently that showed that over 80 % of people in their 60s and 70s took five or more medications on any given day. So, polypharmacy is a huge issue here in the US. And unfortunately, despite best intentions with treating with medications, they often have unwanted adverse outcomes or unwanted side effects and could be really cost prohibitive for people, especially dependent upon whether their insurance will cover them long term. I think just knowing our dependency on medications, giving people an alternative option for actually addressing the root cause of disease, rebalancing their body with the goal of not needing to take medications or even supplements long-term. My goal with my patients is ultimately to help teach them about their bodies so that in the long term, once we actually address what's going on, they're able to maintain their health with as little intervention as possible as well as that being a really empowering and positive thing for the patients, it also decompresses our healthcare system, improves healthcare costs, and just helps people stay healthy for longer.

PIERCE: How long do you typically follow a patient when you're looking at root causes and teaching them?

GEOGHEGAN: Yes, so it really depends upon the complexity of the illness that they're dealing with. And healing is not linear, especially in functional medicine care. You know, sometimes things get better quickly, which is wonderful. Other times there are setbacks that happen depending upon what's happening in someone's life. So on average, the way that I work with patients under my membership plan model, which is for more chronic health support, it's for at least a year long commitment to working with me, because I found that that's typically the minimum amount of time it takes to really peel away the layers, understand what's going on at that root cause and allow the spaciousness to layer on a treatment plan gradually so that it's not overwhelming for a patient, but it's something that they can sustain long -term.

PIERCE: You a lot of times you mentioned the ER when we first started talking about how you were in the ER, and you get patients, and they continue to come see you because you've taught them, but they don't actually do what you taught them to do. So, do you find that the patients that you're working with in the functional realm side of medicine, they're more willing to change?

GEOGHEGAN: Yes, absolutely. So those are the patients that I actually prefer to work with. And that's actually one of the advice that I would give to any nurses who are interested in engaging in functional medicine care. It requires a lot of your time and effort and who you invest that time and effort into makes a big difference in your work satisfaction as well as the outcomes for the patient. So, I bake into my treatment plan and flow with patients doing a 30-minute free consult where I really get to gauge where they are in that stages of change of whether or not they're really open to making some of these difficult lifestyle changes to really get better because the practitioner can only help a patient so much. Functional medicine care most especially relies very heavily on self -efficacy and the patient's willingness to change, to look at themselves in the mirror and to really understand how some of these behaviors that they have engaged in over the years, lifestyle wise, put in their body, people they've surrounded themselves with, where they've lived, how those different things could have actually led to some of the imbalance that they're dealing with. And that can be a really transformative and also painful process for a lot of people that in order to grow, need to kind of evolve and cut ties with some of these things you've become used to over time. And I really want to ensure that the patients that I'm working with are ready to make those commitments before we begin.

PIERCE: Those are hard commitments. Those are really hard. For a lot of patients, that's been the way they live their almost their whole life.

GEOGHEGAN: Absolutely. And I feel like many people really love the idea of holistic care. It sounds really appealing. You know, wow, focusing on my body and stress and diet and using herbs and supplements instead of medications. But ultimately when we get into the implementation, I found that if patients aren't ready for that, it can be very overwhelming for them. And of course if I'm already engaged in working with them, we take it step by step, we break it into chunks, we try and really make it as digestible as possible for them. Ultimately, many things in life, especially with care and healing, come down to the right timing.

PIERCE: And it's a lot of work. I think going into it, they have to know it's a lot of work. Holistic care.

GEOGHEGAN: It absolutely is. And being clear with those goals before somebody gets started on that journey is really what helps set people up for success.

PIERCE: That's really good. So, to help them with meeting those root causes and to set them up for success, what types of tools and methods do you commonly use?

GEOGHEGAN: Yes, absolutely. So, I often will use comprehensive testing after the initial appointment with patients where we go over their history in detail and we start connecting the dots between how they're feeling now and certain things that predated them feeling unwell. I'll have more of a clear roadmap of what testing we should do to confirm or deny some of our theories on why they're not feeling well, and I encourage people to almost have a toddler like mentality of just keeping asking me why You know, why is this happening? Like why are we doing this? Because I really feel like having people understand the why behind the testing the treatments also help to really improve compliance and in functional care in good news, even though my office is out of network with insurance I can leverage conventional labs to do more functionally minded tests. So, I look at things like vitamin and mineral levels, hormones, inflammation markers that can be run directly through patients' insurances and covered to the extent of their benefits. But I also have access to some of the other network tests that are also more specialized, and they go beyond what we can run through insurance, like comprehensive stool tests, genetic tests, hormone metabolism tests, that basically just give us different ways of looking at a problem than what conventional providers can often test and interpret.

PIERCE: Yes, I had, so I saw a functional med PA and she took ten tubes of blood on my first visit. So, I learned a lot about myself with those ten tubes of blood, but that was a lot. I've never had that much at one time, but I learned a lot about my health and things that were going on in my body. But I had asked my husband to please take me in case I passed out on the way to the car, have me a candy bar or something, but yes. Can you share some examples of where this patient centered approach or where you were addressing those root causes led to significant improvement in your patients?

GEOGHEGAN: So, one of the areas of functional care that I'm very passionate about is digestive health and most especially IBS, irritable bowel syndrome. There are some of these like broad blanket terms that we'll use conventionally that basically, don't really tell us why somebody is having symptoms, but it's a diagnosis of exclusion where this person has seen a GI specialist, they've had advanced testing like a colonoscopy or endoscopy to better understand why they have things like diarrhea, bloating, abdominal pain, food reactions, but all of those tests have come back normal. And conventionally, people are just told, okay, everything is technically normal. You don't have H. pylori, you don't have celiac disease, there's no inflammation, I think you're fine. And they're kind of left just having to manage some of these uncomfortable symptoms long term, or they're told to go on restrictive diets long term, like a low FODMAP diet to just manage symptoms. And people can get really down and out about that, you know, dealing with things like that every day. I feel like digestive health issues is really where functional medicine care shines because we do not just leave diagnoses at IBS. We try and understand why somebody has developed digestive issues. And some of the main reasons why I see people who have IBS through the testing that I do are things like bacterial overgrowth in the digestive tract that can lead to unwanted symptoms. Fungal overgrowth that can lead to things like sugar cravings and bloating. Maybe they're not digesting their food well. know, their stomach isn't producing enough stomach acid, or their pancreas doesn't have enough digestive enzymes to really break down that food and that's what's leading to symptoms. Or maybe they're having an issue with motility where food and stool are not going through their digestive tract at a healthy cadence and that can be leading to unwanted symptoms like pain, constipation or bowel frequency. So, taking that extra step, doing those additional tests, there are many different root causes for IBS. And that's part of what, again, makes functional care so fun because two or three patients can come to see you for the same blanket thing like IBS, but depending on their testing, you're going to treat each of those people differently.

PIERCE: love that you find that information, but if I go to the GI doctor, I don't normally find that type of information out.

GEOGHEGAN: Yes, unfortunately.

PIERCE: It just, you get the blanket diagnosis from them.

GEOGHEGAN: Yes, you do. And I think that can be also something challenging for providers to navigate when you're working with a newer patient to functional care because they've dealt with a lot of health care trauma oftentimes, or they've developed health care anxiety from being dismissed from other practitioners, or doing these workups and being told that everything is fine. It kind of scars them and puts them up hasn't put up these defensive walls or barriers, that it really takes a special practitioner who can take the time to help them understand how your approach is different and how you're going to help them really understand what's going on versus just, you know, even if things come back normal, leaving things at that.

PIERCE: Can you talk a little bit about your training? I know you are a nurse practitioner, and then did you have to have extra training in order to go into functional medicine?

GEOGHEGAN: Great question. So, I graduated from NYU with my master's in adult primary care. And at NYU, there was actually a subspecialty for holistic nursing that I was able to take. It's one of the only programs in the US that actually has a holistic component to it, which was wonderful. And it really opened my eyes to different modalities of healing, and I was actually able to do my clinicals at functional medicine practices in New York City as part of this program. So that's part of how I got some of my fundamental training. But once I graduated from my NP program and got my first primary care and functional medicine job, I did also get certified independently through the Institute for Functional Medicine in functional medicine care. And that entails going to different conferences and training courses. You have to have a certain number of clinical hours and complete a board exam as well as a case report on functional medicine care that you need to pass. And even though functional medicine care right now, you don't need to be certified in order to practice it. It was really important to me just valuing education and valuing just some of these more objective markers of what actually constitutes as an expert to be able to tell that to my patients and to show them how I have been able to really hone my craft. And I think it gives them a lot of confidence in the care that I deliver.

PIERCE: Absolutely. I am a proponent of certifications myself. So totally understand what you were thinking when you got your certification. But when you were going through your training, what did you see that was different between what you were learning outside of a holistic care model versus, you know, just probably what the rest of most nurse practitioner programs are. I didn't even know that there was a holistic nurse practitioner program available anywhere.

GEOGHEGAN: Yes, absolutely. And that's something that I'm also very passionate about. I have done a couple of speaking courses at different universities throughout the country to just basically provide nurses with awareness of this field of medicine early on in their careers, because I had not heard of this when I was in my undergraduate program by any means. And there really is a big discrepancy or different knowledge and skill set between the conventional training for nurses as well as the functional training. So, for example, in like my NP program, as well as undergraduate nursing, I think I had one nutrition course or one lifestyle course that really talked about, you know, which foods are healthy for people, how to manage diabetes using diet and lifestyle. And although that was a helpful course, it really was not as comprehensive as what's needed to practice lifestyle medicine. And that is a huge lion's share of the training for functional medicine. And for good reason, because 80 % of chronic health issues here in the United States are actually rooted in a lifestyle issue. So, if somebody is stressed, if someone's not sleeping, if they're not eating the right foods, if they're in a toxic environment, and again, you can use medications to help manage those symptoms, but ultimately, if you have the training to diagnose and implement a personalized treatment plan for these patients, you're actually able to help heal these chronic health issues without using medications.

PIERCE: It's so interesting you mentioned a toxic environment because it's not just a toxic like people think of mold or you know allergies, but it's also like your stress levels. If you live in an environment where you're always scared or stressed or you know, it also goes back to those mental aspects of your environment, which we don't really think about and I had a functional medicine PA tell me we can go through all these things, but if you don't remove yourself from whatever this toxic or this stress is, it's not going to, it's not going to help, we're not going to be successful. And I think that's eye opening and holistic here. Not just here, here's a medicine for you, but like, let's remove ourselves from that.

GEOGHEGAN:  I'm so glad that someone spoke to you about that, because you're absolutely right. Those, think, are some of the more challenging spaces to navigate functionally, because people might be more amiable to taking a supplement for something. But if you're telling them, maybe where you live is contributing to this, maybe your relationship or your job is part of the toxicity and what's making you ill, that's a harder thing to be introspective about and decide to change.

PIERCE: Absolutely. What do you find in your patients that like to let you know this person is ready to change? This person is ready to heal themselves.

GEOGHEGAN: Yes, great question. So, I really see myself more of a steward of this type of medicine, because I really do believe that patients know what's wrong with them. And they have great body awareness of articulating why they're not feeling well. But it's part of my job to help them better understand the underlying reason why they're feeling unwell, because they can tell you those things. Someone who's ready for functional medicine care has great body awareness. They've been tracking some of these symptoms themselves. They've been doing independent research. They're coming into my appointments being an active participant in their care, asking me really good questions, critically thinking. And they're some of my favorite people to work with because it's so collaborative. You know, it's not just me telling them what they should be doing. It's us engaging in this supportive relationship where we're both giving and taking. And it again makes it really rewarding for me because as much as I'm seen as the expert in this field, I learned so much about functional care from my patients and new supplements, new research, because they are also keeping their feelers out and actively engaging with this type of care, and they're also very good at communicating. So, I do have some form of unlimited messaging with my membership plans with the practice. And part of the reason for that is I want to be an active participant in their care, even in between appointments, because there are things that can pop up in someone's life that are significant to share with me as their care provider, but it might not make the most sense to utilize visit time to discuss those things, and when patients send me little updates on how they're doing or something that they noticed about their body once implementing a plan, it just gives me even more knowledge about how their body's responding, how they like to communicate with me so that I can support them in the best way possible.

PIERCE: And I bet you get to see so much success with your patients and that just like brings joy to what you're doing because you're seeing that what you're doing is making a difference.

GEOGHEGAN: my gosh, absolutely. It's one of the best, most fulfilling things. We call it graduating from the practice at Emergence Health, where ultimately people don't need to see me anymore. You know, they can take care of their own health and wellness. And of course, I'll still be here if they want to check in every once in a while, but they feel empowered and confident in taking it from the foundation that we've built together. And that can look like not having digestive symptoms anymore. That can look like having a healthy baby after having issues with fertility. I do a lot of things with women's health. That's being able to spend time with your grandkids and have good energy throughout the day for older adults. So, it really is a fulfilling profession in that respect.

PIERCE: I love it so much. Well, that concludes our first episode on the patient centered approach and holistic health and functional medicine. We hope you have a clear understanding of how focusing on the patient and really addressing those root causes can lead to improved health outcomes. If you've enjoyed this episode, be sure to stay tuned for episode two of the series where Leah and I will continue to delve into the role of nurses and functional medicine and the importance of collaboration and case management.

Episode 2: Nurse's Role in Functional Medicine - Shaping Holistic Care

Transcript

https://riverside.fm/shared/exported-clip/6c3aa6df0fad477488e6

PIERCE: Welcome back to the Functional Medicine Shaping Holistic Care Series. I'm your host, Dr. Candace Pierce, and back with me to continue this discussion is Leah Geoghehan. Leah, thank you for continuing this discussion with us.

GEOGHEGAN: Yes, you're welcome. This has been fun.

PIERCE: Yes, I've really enjoyed our conversation thus far. And to our listeners, if you missed episode one, I really encourage you to check it out because Leah really emphasized the importance of addressing root causes and how that leads to improved health outcomes. So, in this episode, we're going to focus a little bit more on the preventative care, some essential roles that nurses could play in functional medicine and integrative approaches that we've seen in functional medicine. Now, we already know how nurses play a crucial role in managing and coordinating care and that their collaboration with other healthcare professionals is vital for enhancing patient outcomes. So, Leah, I want to start with case management because that's a huge role for nurses in general.

GEOGHEGAN: Absolutely, and it's so essential for patient compliance, support, and basically just making sure that an entire healthcare team is really integrated and communicating with one another. And especially in functional care, think that has tremendous value because change is hard. know, you can feel so excited during an appointment to making change and motivated, but when you're home and you're in your environment trying to implement those changes, you can get stuck at times. So having an infrastructure where you have people to reach out to, whether that is a nurse, a social worker, your nurse practitioner, having a team of people that are helping you hold that space, be accountable, and to help you troubleshoot any issues and barriers that will get in your way of implementing a treatment plan can be very helpful.

PIERCE: So, what does that look like in functional medicine? How does that case management? How does it look to improve your patient adherence?

GEOGHEGAN: Yes, great question. So typically, the way that that looks for my current practice is I give people very detailed treatment plans, and I go over exactly what the next steps are. So, here's the testing you need to get done. Here are the supplements or medications you're taking and including in that note why they're taking it because even if they remember it in the moment for the visit, being able to re -reference those notes afterwards will be very helpful. I also will record oftentimes my initial follow -up with patients where we're really integrating the test results into a treatment plan for them so that if, again, they really want to re -listen to it and better understand what we discussed, they have the ability to do so. And then there's really close follow -up afterwards. So typically, a month after their initial appointment, somebody from my office will check in and see how they're doing, see if they need any support anywhere, if anything's unclear. And I think those touch points, making yourself more present in somebody's life as they're going through these interventions can be incredibly helpful. And that also is very different than I conventional care, because most people will often just go to their health care provider when they're sick, or maybe just once for their annual physical exam. And it's a retraining of how people engage in the health care system to teach them to be more proactive of, no, you should be touching base with your provider multiple times a year, even when you're not sick, to prevent yourself from being ill. So, changing that mindset through showing patients the model of how we want them to engage with us can be very helpful.

PIERCE: I love how you said you record one of your visits and it really took me back to when I met with the functional medicine and they were looking at all of those labs that they drew and she's circling and like drawing lines and saying this goes into that. And I know what each lab means by itself, but you you're not really taught that functional medicine looks at this goes into this and goes into that. And so I was very confused when I got home. couldn't regurgitate what she just told me about how all the labs affect, you know, this did this, this did that. And I was like, I don't know. So having that recording, I think, is so beneficial. I love that you do that.

GEOGHEGAN: Thank you. Yes, and you're a doctor, a prepared nurse, you know, and it was hard for you to digest. Imagine what it's like for some patients who don't have that experience in healthcare. I'm constantly reminding myself of that, of how can we make this information as easy to understand as possible and not overwhelming to somebody, because most people's initial inclination when they don't understand something is to kind of shut down or to look inward at themselves and be like, why aren't I getting this? She's making it sound easy, but I don't understand. And that is not a good foundation to empower somebody to care for themselves. And a lot of that also is just trying to figure out what tools and what way somebody learns best. And part of my initial evaluation with patients on top of going over their health care is to actually ask them, okay, on the spectrum of wanting to know absolutely everything on your test to just telling you what to do, where do you fall? Like what is the best way for you to learn information? Are you visual? Do I give you YouTube videos? Do I give you podcasts? Do you like handouts? Do I color coordinate, you know, my notes for you? So, there's a lot of that intake too, just to again, make sure that patients are able to follow the complex treatment plans that we're enacting, and as a provider too, taking that extra time upfront often saves us a lot of time on the back end with clarifying questions and confusion or follow -up appointments to revisit a treatment plan because we took that time to really make sure that everything is organized upfront.

PIERCE: So, you don't know what you don't know until you sit down, and you analyze all the tests and know, that's the assessments of the patient. becoming overwhelmed as a patient, how often do your patients look at you with the huge eyes and in that initial where you're breaking everything down.

GEOGHEGAN: You know, it does happen sometimes for sure. But I think also checking in with patients throughout the appointment, allowing that space to be like, how are you feeling? Is the pace that we're going through this, okay? Do you have any questions? Just allowing that space for a patient can be really helpful. Instead of just waiting to the end to have them ask questions or to just summarize everything, I noticed breaking things up into chunks can be a lot helpful. Especially knowing that an appointment's an hour long, know, sitting down and talking to somebody for that amount of time requires a lot of attention. So, I think breaking it up in that way can also help people stay engaged.

PIERCE:What does collaboration in functional medicine look like?

GEOGHEGAN: Collaboration is so important for functional medicine care and healthcare in general. And that's something that I think nurses really can play an integral role in. Nurses just in general are so well suited for functional medicine care because beyond just understanding the pathophysiology of disease and critical thinking, we really learn about family dynamics and emotional and spiritual needs of patients, and for many patients, nurses who have come from bedside nursing to transition to an NP role or outpatient care, we're used to spending a lot of time with patients and their care providers. And through just being present during those things, having emotional intelligence, think nurses are able to really understand the whole person in a very intimate way beyond what other healthcare providers are able to deliver, and in that way, it can be really special to have them transition into functional medicine care because it's almost just an extension of the way that we've already been trained under the nursing model of care. And that's really essential to having those communication skills because too often, think conventionally, specialists, primary care providers, social workers, therapists, we all kind of operate in our own separate silos. And people don't often communicate, you know, treatment plans that you're doing with a patient to their other practitioners. And I've witnessed personally how that can be incredibly confounding and stressful for patients to have to be that translator of treatment plans from one provider to the next, or how do they navigate conflicting information if their GI specialist is telling them to take a medication and I'm telling them why they shouldn't. Where does that leave them with these two providers that they trust? How do they move forward with that? having that interdisciplinary team, having people with different skill sets and training that have mutual respect for each other, communicating in the betterment of patients and allowing their egos also to take a step back and just realize, you know, I'm not going to be the expert of everything and It is not a weakness for me to reach out to other people to better understand areas of medicine that I am not an expert in, in the betterment of my patients' outcomes. And I think nurses do a really great job at that, being humble and reaching out for help when we need it, because we have always functioned in a team dynamic in a really empowering way.

PIERCE: So, when you're talking about interdisciplinary practice, do you find that as being specialized in functional medicine that you're accepted in mainstream medicine when you reach out or that they're willing to collaborate or what does that look like right now?

GEOGHEGAN: You know, it really depends. It depends upon the practitioner. And I always pride myself on being a forever student and being open and curious to new information. And that's part of what makes health care so dynamic and exciting to be a part of. Because even five years ago, we were practicing and we have different policies than, you know, at that time, even just screenings to be proactive with things like mammograms for breast cancer, those interventions have changed. And unfortunately, I found that not all providers are as open and curious to alternative forms of healing. Even if they're not able to offer anything more to their patients, that they've reached a standstill, that they're kind of stuck, it can be hard for them to be open to different testing or different thought processes than what they've been trained in. It again can be a little tricky being in a more like new age form of medicine to engage with some of those more traditionally minded practitioners. But I found over time that there is a law of positive attraction. And if you bring out an energy of curiosity and respect, then you will actually attract other like-minded and hearted professionals to collaborate with. And that's part of how you build your professional network, you know, over time and through building relationships. You have your go -to therapist, your go -to GI specialist, your go -to rheumatologist that you have good rapport with and that respects your opinions and is willing to take calls with you because again, ultimately that just benefits your patients better and makes them feel really cared for and held.

PIERCE: Absolutely. And I'm starting to see more and more that functional medicine is becoming a choice where people are actually looking into it going there. But I also I see what you see that bias of I'm not into that. I wasn't taught that way. So, I'm not interested. So hopefully as this continues to grow and we see successes, patient outcome stories that can be shared, this will bring about more curiosity.

GEOGHEGAN: That's exactly it, Candice, absolutely. And although the pandemic brought a lot of tension and discomfort and stress to healthcare practitioners that many are still recovering from, I think there's also been a really beautiful silver lining of some of the flaws in the healthcare system that were illuminated through the pandemic. Both for nurses realizing, wow, I really wasn't very supported in that environment and I wasn't really cared for as much as I want to be as a valued member of this team, where they're looking elsewhere for positions that really make them feel empowered and supported. But then also as patients, know, wow. So maybe taking a medication for something is not always the solution. Maybe there is another way to care for my health or be more proactive at supporting my immune system so that I'm not vulnerable to some of these scary side effects of something like COVID. So, I have noticed that there's a renewed sense of interest both from patients as well as practitioners in this field of medicine, most acutely over the past four years. And I had already been in the field prior to the pandemic. So, it was really special for me to witness and be a part of catching that wave and seeing that shift. And I'm a huge believer in the fact that there's more patients than providers that need this type of medicine and I want to get more people into this field who are good -hearted and supportive and want to deliver this type of care. I want to really be somebody that can help support other nurses on this path if that's what they choose.

PIERCE: Absolutely, and we have to find a way to have alternative choices that are covered by insurances because they should be. If we know that they work, we have the evidence to show that they work, then that should be an option. It shouldn't always just be medications and surgeries, you know. If there's an alternate means that actually works and we have evidence to show it, why is it not covered? So that other patients can benefit from it.

GEOGHEGAN: Absolutely, Candice. And it's exciting if anybody listening to this is really interested in the research behind functional medicine and care outcomes. Cleveland Clinic is one of the forefront research institutes that are doing a lot of studies on functional medicine care. And they've actually released two papers to date, one that's showing how functional medicine care can help improve patient outcomes long -term and improve cost-effectiveness of care specifically for insurance companies, which again, ultimately it does come down to money in our care system, unfortunately, having that type of data to support functional care is incredible. And then they also have a new study too that shows the power of community and how we have a loneliness epidemic here in the United States. And by having shared medical appointments where people who have similar health conditions can talk and feel supported by other people who are dealing with that same issue, how that also can drive positive outcomes and cost effectiveness, especially under this umbrella of functional care. So definitely something to keep an eye on as studies continue to come out.

PIERCE: Absolutely. Can you give an example of how this integrative approach has successfully prevented chronic conditions?

GEOGHEGAN: Absolutely. So, in addition to digestive health, one of the main areas that I help patients supportively with are hormone balancing throughout the lifespan. So, women who are cycling and having issues with fertility, PCOS, uncomfortable periods. But I feel like one subset of ladies who often do not get proper education and care are perimenopausal women which are women within the five to seven years prior to them not getting their period anymore, who start to go through hormonal shifts and changes. We've all heard of them, right? Hot flashes, night sweats, mood swings. And of course, even though those symptoms are uncomfortable, there are also a lot of diseases that women are more vulnerable to as they enter into perimenopause and menopause. When women stop getting their period and estrogen is no longer at higher levels in the body, we're more at risk for cardiovascular disease. We're more at risk for osteoporosis. We're more at risk for dementia and issues with memory. And typically, the way that I work with patients is trying to understand and address hormone fluctuations during perimenopause using natural treatments as well as maybe bioidentical hormones to help keep hormones balanced as they transition into menopause. Not only helps them with symptom management, but actually will help prevent some of those illnesses from developing.

PIERCE: That is so interesting. So, do you work with other physicians, other care providers in that care with the perimenopause menopause women?

GEOGHEGAN: So, it really depends. I do have the training and expertise to manage those patients on my own, but oftentimes, especially if somebody already is on the spectrum of disease where they maybe have some osteopenia or osteoporosis, I will work in conjunction with endocrinologists or OBGYNs to continue to monitor people. And interestingly too, there's been a lot of new data out on actually using hormone replacement therapy in very specific subsets of women who have had breast cancer previously and are in remission and how giving them hormone replacement therapy can actually help prevent cancer reoccurrence, which goes against some of the early studies on hormone replacement therapy. And in those cases, just knowing their history and everything, I feel more comfortable working within the team dynamic to make sure that. We are giving them the minimum amount of hormones that they need to optimize their health and that they're being screened properly to ensure that things are safe.

PIERCE: Yes, that's really interesting. When I was in nursing school, I worked at a pharmacy, and we actually compounded hormones. Like the, you know, the, the provider would communicate with the pharmacist, and he would compound whatever hormones he was asking for the strength. So, he could like rub it on or it was even pills. We compounded pills. So, I remember a lot of, of back and forth trying to figure out dosages.

GEOGHEGAN: So great that you had that experience. Yes, functional medicine, we do use a lot of compounding pharmacies to again just deliver that personalized approach to care. I'll even use it for things like thyroid imbalances for patients if they're in between two doses of levothyroxine or NP thyroid, you can actually create custom doses for people and ensure that those medications don't have fillers or any additives in them. So, it really is a useful tool.

PIERCE: Absolutely, I know sometimes they'll even compound some of the GLP -1 meds.

GEOGHEGAN: Yes, yes, I have seen that as well. And there is a little bit of controversy around that too, of whether or not they actually function as well as some of the prescription strength ones. I think we're still kind of in the wild west on how to navigate, you know, some of those things now. But again, it's a learning curve. It's something that instead of moving away from those things, I feel very attracted to working with practitioners who instead of being dismissive of new things like that, or really curious and lean in and go to extra talks, speak to pharmacists about it so that we just get more clarity.

PIERCE: Absolutely, and it really lends to that patient -centered approach, personalized care. Not only personalizing what you're doing with them and assessing them and really looking at the big picture, but also then bringing in pharmacists and other providers who can lean in and learn from each other and really personalize the care that that patient receives. That's huge. I love that opportunity that functional medicine brings.

GEOGHEGAN:  Me too. I get so excited just talking about it.

PIERCE: What are the main benefits of preventative care within functional medicine?

GEOGHEGAN: Absolutely. So, there are multiple ones, but essentially early detection of disease risk and of imbalance can help prevent disease, can help prevent adverse outcomes. And it's always easier to treat things in their early stage versus when they're in a more advanced stage. So that is one of their cornerstones also helping to teach people how their bodies work and using lifestyle as medicine when they're feeling well helps to prevent disease. One of the like adages I'll share with patients a lot of the times, especially when they're interested in functional care present preventatively is if you make time for your wellness, you will not be forced to make time for your illness down the line. And I think that resonates with a lot of people of wow, like this is an investment in myself and in my family and in my community and by doing this now I'm actually saving myself time, money, stress and issues as I age or as I live life.

PIERCE: Right? This is part of self-care. And I know a lot of people think self-care is selfish, but if you take care of yourself now, you're going to be a better mom, a better parent. You're going to be a better nurse. You're going to be a better practitioner. You're going to be a better friend because you're going to have the energy and the time to invest in others because you took the time to invest in your health. That's not selfish. It's really, it's not.

GEOGHEGAN: And I think both from the provider and patient perspective, being really clear on your why, why you're choosing to do something, will help you stay rooted and aligned with your North Star as you go through these treatment plans, as you invest this time. And on the patient side, that can look like something, I have a 45 -year -old patient right now who lives in the city and is North Star is I want to be with my kids and active with my children throughout their entire lives. I want to be a present parent. I want to be able to go outside and play with them. I want to be able to move them into college without pain. I want to be the healthiest version of myself for them. And when things get tricky for him, when he keeps coming back to see me for the preventative approach to care, that is what helps him stay aligned and motivated. And for practitioners too, mean, just really understanding the type of care you want to deliver, how you want to come across, what really matters to you in your life. These are things that I never thought I would be building my career around, but having flexibility, like working with people that really make me excited, that I enjoy seeing. There are career opportunities out there that will allow you to show up and do those things that you enjoy every day. Andbeing really clear about what you want in any given moment will help you build that future and build that career around what you are setting your sights on.

PIERCE: Yes. And I was just thinking about how we are role models to our children. know, our children, they watch me have quiet time. They watch me work out. They watch you do these things and they're going to role model that when they get older. They're learning from you what we do. Don't I grow up and I would hear the phrase don't do what I do. Do what I say. But no, it's our role model is what we do. It's not what we say.

GEOGHEGAN: Absolutely, that's such a great point. And something else that I'll share about that as well is one of the main ways that I attract new patients to my practice are through word of mouth and through my current patients. And part of the reason why is because these patients that I'm working with go to family gatherings, they talk to their girlfriends and people look at them and they go, wow. You look amazing. You've lost weight, your hair is shiny, like you seem really happy and present. And it's through all of those like external cues and just communicating with people that they realize something has changed in someone they care about. And that is probably the best form of marketing because people can actually see these outcomes and they actually want a piece of that too. And they're already curious and open when they see people that they care about getting tremendous benefit from functional care. So, I feel like it's this beautiful grassroots movement that has just slowly been evolving. And it's wonderful for the practitioners too, because if you're really clear on what type of patient you're calling in, and the people that you enjoy, typically, like a friend of a friend is someone that you would get along with well, just in general with like, social dynamics and it's very similar with patients. If you really love your patient population and they're referring to friends and family that they're also very aligned with, you're creating this community of people that you really enjoy being a part of.

PIERCE: Yes. So, what role do you see nurses playing in functional medicine?

GEOGHEGAN: Just as nurses are the backbone of the healthcare, truly our healthcare system here in the United States, we are the number one trusted profession. I can see us becoming the backbone of functional medicine care as well. But just based on the type of people who are attracted to being a nurse, the training that we get, and not just the skills and the intelligence we have on the clinical side, but the emotional intelligence that we bring to the table too which is so foundational in working with people, in building rapport, communicating with that interdisciplinary team as we spoke about, I feel that nurses can play a really central role in this. And that can be anywhere from a nurse that's working as a case manager at a functional medicine practice, or administering IVs, or going over diet and lifestyle interventions with patients, to nurse practitioners that are doing these advanced tests and creating customized plans with their patients. And it really is one of my missions through my practice to attract other nurse practitioners who are core aligned with these values into this field, because there are more than enough patients for all of us. And I want people to feel like they're able to transition into this field of medicine. And even going further into entrepreneurship as well, that wasn't something that was really brought up to me when I was going through my training and education, but it's something that has been really fulfilling to my life and building the career that I want. And I want to show people that there is a pathway to do that for themselves too, if that's something that they want to explore.

PIERCE: So, speaking of entrepreneurship, what advice do you have any advice you would give to other nurses and nurse practitioners who are interested not just in functional care but also maybe entrepreneurship?

GEOGHEGAN: Yes, absolutely. So, one of the main things that I would recommend is finding the right patient fit. I know we spoke about that a little bit before, but you only have a limited amount of time and bandwidth and energy in any given day. And who you invest that time in makes a big difference in both your health as well as the outcomes for your patients. So being really clear about your locus of control, your expertise, what type of people you enjoy working with I think is one of the most foundational things for setting yourself up for success in the field of functional medicine care. So that would be one big thing. And also, just knowing your limits as a provider. know, like knowing what is within your control to do, knowing when something is getting too complex or when something is serious and requires a referral. I think that's one of the things I really appreciate from my emergency room experience is still having my spidey sense on when something is becoming more acute and knowing what to do in those scenarios, walking patients through that. And that I think is the most self -aware and appealing provider for me is somebody who knows their limits and knows how to work within a team for the betterment of their patients, and last but not least, this is a bit more of like a personal development recommendation, but getting really clear on your goals, your why, your North Star that we were talking about, really understanding what you want to get out of your career, what you want your mark to be on this profession so that you can start taking those steps towards building that career for yourself and attracting those patients that are going to help you further your skills would be my advice. Also, finally, I would recommend having a mentor. And I know that's easier said than done, but essentially somebody who has been through and somebody that you look up to, who is in this field, who has training and expertise that's willing to take you under their wing and to show you, you know, the field. And I think nurses, more than any profession really understand that because part of our training is clinical hours. spending time with practitioners that are trained, just being a fly on the wall at times and seeing how they approach difficult topics, how they explain certain things, just so that when you're new, you have those experiences so that you can integrate that information and then make it your own over time.

PIERCE: Absolutely. And I love what you said about a mentor because the knowledge, the wisdom, the experience that you get with a really good mentor is priceless. I mean, they can really help you grow tremendously.

GEOGHEGAN: Completely agree. We all stand on the shoulders of giants, and I would not be here today if it weren't for my family, my partner, the people who believed in me in those early stages, the practitioners that took the time to train me and to be available for questions. All of that is not unseen and really has shaped my career to this stage and it's something that I want to continue to give back to most especially the nursing community because of how valuable it's been to my personal growth.

PIERCE: Yes. Well, that brings us to the end of our series, Leah. Thank you for spending this hour with me with sharing your experience and your expertise with our learners.

GEOGHEGAN: Thanks so much, Candace. This was fun.

PIERCE: Yes, to our listeners, thank you for joining us on this podcast series. Nurses we know are crucial in ensuring the health and well -being of patients and that directly affects the patient's overall health outcomes and their quality of life. We hope that you have gained insights into the essential role of nurses and the benefits of integrative and preventative approaches in functional medicine. Functional medicine is definitely becoming more popular as more people really are looking for a personalized and holistic approach to healthcare and focusing on root causes of illness rather than just treating symptoms. I know I started seeing a functional medicine provider for my own health for the same reasons. It's also something I found that was particularly appealing and that is that it emphasized patient-centered care. Lifestyle modifications and preventative measures, which for me and I know many others can lead to a more sustainable health outcome. For those who are looking to learn more about functional medicine, some valuable resources you could look into would include the Institute for Functional Medicine and the American Holistic Nurses Association. If you found this series helpful, please subscribe and leave us a review. And if you have not already, I encourage you to explore many of the courses that we have available on EliteLearning.com to help you grow in your careers and earn CEs.