Facilitated

17| Why We Do Things Differently: Six Years of Functional Medicine Lessons

• The Facility Denver • Episode 17

Share episode

We reflect on six years of practice at The Facility and examine why we approach functional medicine differently than many other clinics in the industry.

• The term "functional medicine" isn't protected, allowing anyone to claim expertise regardless of credentials
• Many practitioners order unnecessary tests before even meeting patients or understanding their health history
• "Big Wellness" has created a commercialized approach where marketing tactics often override patient needs
• Some clinics require substantial upfront commitments ($10,000+) before patients even speak with a practitioner
• Protocol-driven care lacks the nuance and personalization needed for effective treatment
• Over-reliance on supplements often replaces more effective lifestyle interventions
• Our approach emphasizes education, transparency, and strategic intervention based on individual needs
• Understanding "why" before determining "how" saves patients time, money and unnecessary restriction
• Continuous education and peer collaboration serve as crucial checks and balances


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

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

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

Mitchell:

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

Kate:

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

Mitchell:

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

Kate:

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

Mitchell:

Good morning it's two o'clock.

Kate:

It's one o'clock in the afternoon.

Mitchell:

You've been up for 10 hours already, so one of my favorite parts about recording this podcast is how you wear headphones the whole time and I don't, so on video we look like we're not doing the same thing.

Kate:

Someone has to listen to what it sounds like.

Mitchell:

Yeah, if you listen to the episode, when I recorded with our colleague, dr Weaver because I never, because you weren't here I didn't tell him the mic needed to be turned more toward his face. Well, I told him right away, and you had to. What'd you say? You had to raise his voice by 10 decibels 16 decibels. He had to go up and then because of that, you probably heard this 16 decibels. He had to go up.

Kate:

And then, because of that, you probably heard this, which we're trying to avoid today.

Mitchell:

Yeah, I didn't realize I was such a loud breather.

Kate:

We heard it, I heard it it was.

Mitchell:

I hated it because the content was so good. I was. It was a fun conversation, we got a lot out of it, but then it was distracting when I listened to it back. Yep. It's okay, we learn from mistakes, so I'm going to not breathe this entire episode. Okay, let's go.

Kate:

All right, and that's the end of the episode.

Mitchell:

So we got the 4th of July weekend this weekend 4th of July coming up and it's our birthday month.

Kate:

It's July. It is Mitchell's birthday on the 25th, my birthday on the 22nd and the facility birthday.

Mitchell:

Oh yeah.

Kate:

We have a birthday. Did you know? We have a birthday.

Mitchell:

We're six years old.

Kate:

We saw our very first patient on July 8th 2019.

Mitchell:

Yeah, we saw our very first patient on July 8th 2019. Wow, wow. We've been through a lot Seems like longer than six years. Yep, yeah, I am going home for the fourth. I wasn't going to the fourth. I wasn't going to, but my aunt, who's always so gracious, sweetened the deal by buying me a first class Delta flight home so that I would be there with everyone, which I thought was nice. And since I'm on first class, I get to check two bags. You better believe I'm bringing back 48 pounds of Northstar bison from Cameron, wisconsin. Shout out to North Star, one of my favorite meat suppliers. My mom went and picked it all up yesterday. I've got 24 pounds of beef, 12 pounds of elk, 12 pounds of bison and I'm flying home with two empty coolers that I'm checking. My only fear is because I'll do like curbside pickup in Minneapolis. Coming back here is walking from baggage claim in Denver to my car with a carry-on, a personal bag and then 48 pounds of meat in two coolers.

Kate:

Yeah, don't ever have a toddler. Well, this meat won't yeah, this meat won't talk back to me, but it's going to be heavy do you have any idea what it's like navigating denver airport without a stroller or a carrier and having a 33 pound child that, if you let her walk on her own, she will be 20 yards away?

Mitchell:

I can't say I have any experience with that.

Kate:

It's an Olympic sport yeah.

Mitchell:

Well, and last time you flew, you got stuck in the airport for like seven hours.

Kate:

Yep. I know every inch of that airport I would have gone home.

Mitchell:

I would have re-gone through security. I was shocked that you stayed.

Kate:

Oh, it's like an hour and a half ordeal and then the whole security ordeal with a toddler. It was just. I couldn't even consider doing it a second time in the same day.

Mitchell:

I'm assuming you found plenty of work to do.

Kate:

Are you kidding me? Yeah, my work was entertaining her.

Mitchell:

Man, sweet little Lucy. So anyway, don't blow your fingers off this weekend, anybody. I think there's. I don't know. I saw a stat once there's a good amount of people every year who wake up on July 4th with 10 fingers and they go to bed on July 4th with 10 fingers and they go to bed on July 5th with nine. Don't know how many, but it was alarming when I read it.

Kate:

Great, I love your stats.

Mitchell:

My empty stat. Yeah Well, what are we getting into today?

Kate:

Well, I thought it was fitting because it's our birthday anniversary and so thinking about mistakes and lessons learned and, essentially, why we do things the way we do, it's interesting.

Mitchell:

When we first started this we really thought it was going to be more patient cases and this and that and heavy science. But I guess the goal you know how many recorded 15 of these and we keep going back to philosophy. It's really and I don't mind it. Yeah, you know there's so much that I want to share, but I don't want to just be boring. I'd like to reach people where they're at and kind of give the groundwork of why we do what we do and what we think is helpful for you as a consumer to look at, for your health and for providers and this and that. But it's just interesting to reflect on.

Mitchell:

We haven't really got into a lot of the heavy science yet that I'm so excited to get into, because every time we sit down and we think what do we want to talk about in this next month? So much of it's around our frustrations with, like you said, mistakes. We've made mistakes. We see others making lack of understanding that consumers get around their health and we kind of keep coming back to this topic in different ways. I think today will be pretty relevant yeah, and it so.

Kate:

many of our episodes come from discussions with Shante, our mentor, and one of the questions we and you know we talked about business structure and systems and she said, well, how are other clinics doing it? And anytime a business coach or a mentor asks us that, we say, well, huge spectrum of how you can do things, what kind of care you receive, the cost from one clinic to another, and so really it has shaped our philosophy and given us confidence in the way we do things.

Mitchell:

Yeah.

Kate:

By not doing things.

Mitchell:

Yeah, and I mean there's good and bad with the openness of this field and I just I get frustrated sometimes because I know other providers that say they do this kind of thing and it's very protocol driven, it's very test heavy, it's not a lot of human connection and I think it's a lot of fear based.

Kate:

It is yeah.

Kate:

And most of what we want to do is subtract things from people's lives that might be detrimenting them if that's a word but let's even talk about the growth in, and it's really really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, really, not super early, but early, considering where we're going with functional medicine, with preventative wellness, with the wellness industry in general, and there's a lot of people that want a piece of the pie. So I saw the idea of the big effect, which, adding big in front of something, adds a vibe of nefarious corporate influence. So you know, big pharma, big food. Well, now in wellness circles, circles, we're seeing big wellness and it's the monetized, influencer fueled version of health care, and I want so badly to. That is not us and it's frustrating that.

Mitchell:

Now this is the battle we're fighting we I mean so much of, like you said, with the wellness influencers. It's kind of like identify a made-up problem and then you have the one solution that the world has not come to, and oftentimes stuff on the ends of things very extreme is what gets the most clicks. So often we find ourselves pulling people back to the basics. You probably don't need a $600 weighted vest that an unknown person is currently selling, that an unknown person is currently selling. You probably don't need an extreme diet change that a lot of people promote and it's frustrating because we kind of get lumped in with those people.

Kate:

Wellness is being commodified, but we're trying to practice responsibility and give you a heads up on these are the red flags we're seeing, but again, it just solidifies like this is why we do things the way we do. One of the biggest things is that functional medicine is not a protected term, so anyone can claim it, whether they have training and credentials to back it up. Or if they just watched a few YouTube videos, they can say, oh, now I'm a functional medicine gut health expert.

Mitchell:

I thought you were going to say a few voodoo videos.

Kate:

Sure, that too, it can be anything.

Mitchell:

We see trainers offering lab testing, we see podcast hosts offering lab testing and yeah, I mean, it scares me because that's not how we believe it should be run.

Kate:

You need a license to cut hair, but not to call yourself a functional medicine practitioner, so let that sink in.

Mitchell:

I cut my own hair.

Kate:

It shows yeah. Yeah. So this? How are other clinics doing it? What are the things that we don't like and don't agree with?

Mitchell:

I mean, the first thing that I don't like is over-testing. I once had a mentor tell me that a sign of a really unconfident, inexperienced clinician is somebody who orders everything under the sun as a lab test. And, like you always say, just because we can order it doesn't mean we should. Right, not everyone needs a stool test, not everyone needs mold testing. I mean, there's so many examples, right?

Kate:

Our typical philosophy is we will test if it changes what we do, but not just because it's available or exciting. So, yes, if a practitioner is telling you they need to order every test before even doing a basic intake, red flag.

Mitchell:

Yeah, that's something I don't like Run tests before you even meet the person and take a history. What also annoys me is overuse of supplements over lifestyle change. It's interesting because we just had a conversation before this. We've got a gal who's doing great, huge comeback but she's really conditioned to rely on supplements and you know she's got a big event coming up this fall and she's really trying to make a whirlwind of changes before then. But I've had to kind of we both kind of had to pull her back to. This is a lot that you're trying to get from supplements, and we see this from a lot of people. We should be taking things that support our goals and don't just have, like, a cool label on them.

Kate:

Yeah, goals and aren't, don't just have like a cool label on them. Yeah, it's the opposite of the conventional world. We're not just trying to give you a pill to fix your problems.

Mitchell:

We're trying to teach you the habits and the lifestyle and the eating strategy to not rely on a pill something also that annoys me, and I'm not sure if it's on your list, but long care plans yes, the commitment packages I mean, there's a place out in out east that makes you sign up as a member and I think it's like a ten thousand dollar sign up before you even talk to somebody from their clinic.

Kate:

Yep, ten thousand dollars to get started for a six month plan. Is it even a good fit? Do you need that level of support? Yeah, and this is the functional medicine business strategy. Everyone gets put into this funnel. They're on a set protocol, set plan, set number and we know it just doesn't work. That's one of the main, I would say, mistakes we made. Maybe learning experiences we've had is yeah, at one point we tried to do packages wasn't quite that extreme of before you even meet us, but not every patient needs that.

Mitchell:

And it was, and it came from a place of wanting to keep someone on a schedule where we have, hey, you pay for this all upfront and then you have this. But it became a very ambiguous process where not everyone does need that. So now we're kind of making this rule and we keep creating exceptions to it and it was just stressful from a bookkeeping, from an organization perspective, and I didn't like that. There were people that we could have helped that saw that number felt like it wasn't feasible and then we never got the chance to help them right and I think maybe we kind of contributed to that problem for a while. But I mean, we quickly got out of that because we realized it wasn't serving the people asking for our help it's similar to the protocol culture as well.

Kate:

So the clinics where you walk in and every patient it's like, okay, let's start our 5r gut reset for everyone, no matter what your history or goals are.

Mitchell:

That's what we do yeah, let's needlessly pull out shellfish and tree nuts when you already have a limited diet and you're afraid of foods. Let's create more fear around that. That's not really a solution, I do think. I mean there's like one if you say protocol when you mentioned that earlier today that I can think of that we reliably do, and it's for a specific condition known as Marcon's, which is an antibiotic resistant staph infection within the upper sinus passage, because there is a very easy protocol that we get 100% success with. But that's one small piece of someone's plan. But, yeah, when I see positive mark-ons, we know reliably, here's what we do for it retest, eradicate it.

Kate:

But even still, it's not a perfect protocol week by week. There's always exceptions.

Mitchell:

Yeah, I mean, think about the gentleman today. I asked him if you keloid or scar easily, because you know I'm not going to give him NAC if he keloids, which we're not going to get into today. That's an interesting thing. So I mean, you're right. Even within that, there's still room for exceptions.

Kate:

And it's a big red flag to me, because a lot of times these practitioners go to a oh, let's just keep going through it. It's that critical thinking piece that gets missed, and I think it comes with thinking, experience training, diversity of training, not the weekend seminar, how to 10X your practice.

Mitchell:

Yeah, I mean a prime example. We've got a fella who is struggling to get his initial labs done and he's got some pretty serious GI issues and he was begging for some sort of intervention and you gave him a, an elemental diet, and within a couple days it proved not for him. So we immediately stopped it, reinvigorated him to go get his labs done and then slowed everything down. And I thought that was great on your end to like arrest the process early. We even told him you know, reach out to the company you bought it from, get a refund. This clearly didn't work for you. It might look good on paper, but your response was not positive.

Mitchell:

Remember how you respond to interventions helps guide the next set of decisions we make. And if I just kind of put my head in the sand, keep going forward the same way with everyone. I'm going to miss out on the nuance that each person brings to their needs for interventions. And like especially with the gut, the 5r you keep saying that if you don't reduce your stress, no amount of enzyme replacement or probiotics is going to change your gut. Step one, one parasympathetic tone there's not a 5R plus P protocol.

Mitchell:

You know what we're going to make that.

Kate:

The other thing that drives me crazy is the functional funnel, and there's a lot. It's a, it's a marketing thing. There's a lot of different, uh, marketing tactics behind it. One of them is the low entry fee, hard upsell, yeah. So it's like $99 first consult, but you don't actually meet with a doctor and you don't have any labs included. And then now you have your first consult, there's no action steps other than sign up for our $10,000 program and it's going to solve everything for you year I get an amazing five hour lecture from him at a conference I go to.

Mitchell:

But I went to see him individually I mean, this was 12 years ago, 13 years ago for my ADHD and, yeah, I got a coupon for a half off a first visit and he sat down with me. He wouldn't tell me. I even asked him. Well, you're asking me for like $3,000 worth of tests. What do you think is going on right now? Thousand dollars worth of tests, what do you think is going on right now? And he said I can't tell you anything until we get your labs back. I actually cried because that was expensive for me and I thought I was going to be invigorated with hope or a few steps to take right away. And he literally wouldn't tell me anything unless I ran a bunch of tests and it was in that moment. This is not how I will do this if I have the chance to help people.

Kate:

I genuinely never want someone to feel that way after a first visit with us and we over deliver. I think both of us because of that.

Mitchell:

Yeah, I mean. It's personal experience that shaped me to realize that the first step is to connect and build hope. It's not to be a robot that looks at stool tests and then spits out a protocol. Connect with the person, slow things down, make it digestible and simple simple.

Kate:

Our marketing is completely patient referrals, provider collaboration and, essentially, just doing good work.

Mitchell:

That's pretty cool.

Mitchell:

You were a few weeks ago, you were feeling pretty under, like you were drowning, with some cases. We've gotten recently, and I remember I said stop, reflect. We are the safety net for all of these providers on the west coast, on the east coast, in colorado, down south, like we have become because of what we do. We have become wow, I don't know what's going on with this for, say, it's a physical therapist or a chiropractor or various providers. When they get overwhelmed, they send them to us and that is the greatest compliment that I could ever receive is that people view us as a safety net and a protector.

Kate:

And we don't take that lightly either.

Mitchell:

No, and I think it's because education is number one for us. We might not know everything that's going on with you, but we're going to teach you as much as we do know that's going on with you, and then you can become the expert right that you've talked about this before that gatekeeping of information we freely give of ourselves, and it makes a huge impact.

Kate:

Within the marketing sphere. Again, we really we hate marketing, we hate sales, we hate the sales tactics, but we do promise transparency, so we really don't do discounts. It's this is what it costs, that's it, and it feels good for us. Yeah, so it's not that sleazy like you talked about. Oh, half off your first visit. We just, we just don't do that yeah, we.

Mitchell:

We set prices up at a place that makes sense and we cut out the fluff, we cut out the sexy marketing strategies and we just get the work done. It's kind of fun stepping into that like no, there's no prepaid package discount, there's no. No, this is how it is and we will modify testing and treatment based on what you need.

Kate:

Implementing a lot of critical thinking. So why, before the how and I think about recently we had a patient with acne and skin is a common one. If I don't know the why, I'm not going to tell you to do a really in-depth elimination diet, if I can't tell you that it's the food as a trigger versus it's the hormones as a trigger versus it's the stress as a trigger versus it's the environment.

Mitchell:

Right, right.

Kate:

I want to know the why.

Mitchell:

first, I like how you dive in. With that I mean that person you're talking about, a woman with pretty high androgens but also has some gi symptoms have largely gotten better I mean stress hormones all over the place, blood sugar and made some huge progress. But now because I don't run a stool test on everybody we've made all these improvements weight loss, metabolic brain function across the board, having a period which was like the biggest awesome part of that but skin remains the final frontier. And so then we pulled some new hormones. We saw we got a little room to go there, but our feeling is that there probably is some sort of gut microbiome issue. So that's when we ran that test. We're multiple months into taking care of somebody, cleared out the static and now we can get down into this one piece. That seems to be still an issue. And you might be listening and say well, why don't you just run a stool test right away? Stuff is expensive.

Mitchell:

Right, I don't want to run everything right away. I want to dial in on the basics first.

Kate:

And we have to consider that when people are paying out of pocket because we have to consider not just the testing cost but the care cost as well and if we're going to run a test and it's going to deplete their budget, so they can't actually afford the care to do anything, we're definitely not going to recommend running the test.

Mitchell:

Exactly. So yeah, this is a marketing 101 class. Be sleazy, big packages, sexy ads.

Kate:

Fear tactics, yeah. Fear mongering, yep, no. This is why it's taken us six years to grow.

Mitchell:

Yep.

Kate:

It's okay we think differently. No protocols, don't upsell packages, use labs Strategically, educate the patient and then really know our scope and use partners and I think this is another thing within the, you know, functional, anybody can be a functional medicine practitioner. They have to recognize their lane and I think we're pretty humble in that and quick to refer out when they need to yeah, we can't be be everything for people.

Kate:

There's within, I would say, almost valid credentials MD, do, dc, cns, nprd, even health coaches. They all have a role in context, but each of them has to know their scope and what kind of training they're confident in absolutely so it's been six years. We've learned, we've changed. This is something that isn't set in stone. I think it's a big pro that we are willing to change, moving forward.

Mitchell:

Yeah, and I mean one of the ways you talk a lot about, like how are we doing our checks and balances and making sure that we're doing our due diligence to stay up on stuff and to be open to new information, right, constant education is a key and it's not just meeting our continuing education unit requirements every five years.

Kate:

Mine's every five years mine's every two years.

Mitchell:

Yeah, I need 30 hours every two years. Um, I don't know how many I've gotten this year so far, but typically I get about 100 a year. That count, yeah, but so much that doesn't so much. Yeah, that's the thing you know that three weeks I spent digging into iron physiology was not continuing ed, but I will say the last few weeks we've had some weird iron results, so I'm glad that I've been learning more. How do you check yourself?

Kate:

I think, yes, with education. I think also peer collaboration is important. So we're lucky that we get to interact with physical therapists, april and Ariana every week, um, but also just staying up on forums and also watching the industry. What are xyz people doing in the functional medicine world? Yeah, I, I mean.

Mitchell:

I've been fortunate to meet some over the last couple of years, some really amazing providers. I mean people like Dr Robert Silverman out east. You know he's kind of taken me under his wing in a lot of ways. You know I can call him. I mean he's coming out to teach around our birthdays and we're all going out to dinner with him.

Mitchell:

He's invited to our birthday dinner, and that's just crazy when I reflect like this is a such a well-known clinician and such an example in our industry and having someone like him, having someone like Dr Sam Yannick as a as an immunology teacher and I, you know, go to him directly for my own labs and collaborate with him, I mean it's huge that we've now started to find mentors that are doing it the way. That exemplifies willingness to learn and grow and change and be open to not protocol heavy. The problem is, if you do just go, there's like this effect where you start learning this and you go to a weekend seminar and it does seem very basic. Like this works every time and I could easily create a lecture using examples of the first shot. Everything went smoothly with a person and I could make the best talk about it, but so often it's so much more nuanced than that.

Kate:

I think we haven't quite gotten this reputation yet, but I'm worried sometimes when we go to seminars that the speakers hate to see us in the audience. Because we ask the questions. We ask the hard questions.

Mitchell:

We want to know what if yeah, and but also even thinking about dr silverman, last year, when we asked questions, he literally called me the next day to clarify a few questions I had, and I felt cool because he gave me some really nice compliments and said, like you guys are clearly doing this right. I could just tell by the the perspective you're taking, because the questions you ask are so foundational but nuanced. It's not like methylation, it's like, well, let's talk about sammy or glycine, you know what I mean. It's like much more specific. Um also, though, we went to oh, we're not gonna go there.

Mitchell:

Okay, I know where you're going, I'm gonna cut you off we walked up oh, okay, you can talk about that I, I can't wait to stop recording so I can hear from you what you thought I was going to say. I I mean, no, we got invited to a summit a while back and within about I don't know 10 minutes, we looked at each other, we closed the clinic, took a day off, missed out on a ton of patients and within about 15-20 minutes, we looked at each other and said how long do we have to sit here? Seriously, because it was what Sales and protocols and protocols and funnels and AI and how to leverage and how to scale the seven figure, all this stuff. That was like, oh, I thought I was learning about endocrinology today.

Kate:

Was it longevity I can't even remember the title of it, but it was not that.

Mitchell:

And what I hated was there was a lot of MDs in the crowd and I was just cringing that this is what if you're getting started, this is what you think this field is. I know. But we got out of there, we went and got lunch.

Kate:

Much better use of our time. Of there, we went and got lunch. Much better use of our time.

Mitchell:

So, uh, we could record this next year and I'm curious to see what changes. Yeah, I mean, somehow eight years ago I helped people, I'm not sure how, because I guess my heart was in the right place and I was really trying.

Kate:

I just thought, somehow I managed.

Mitchell:

Michael Scott reference always, but it's, it's crazy how much, if you put yourself in the right position, how much you learn year over year in this field, and I think that's what kind of keeps me going the thirst for knowledge, like you said, checking yourself to make sure that you're on the right path. It's humbling.

Kate:

If there's one thing to take away, it's this. Functional medicine isn't one thing, it's a wide range of providers, philosophies and, frankly, quality. We've seen the protocol mills. The supplement stacks, the pressure to commit thousands of dollars before anyone even looks at your health history, and that's just not how we do things. We believe in thinking critically, treating individuals, not symptoms, and using tools like lab testing when they actually make a difference. Just because someone calls themselves a functional medicine expert doesn't mean they're trained, licensed or working within a scope of practice. Ask questions, Stay curious.

Speaker 3:

For more about what we do at the facility check out our website, wwwthefacilitydenvercom.

Kate:

You can also follow us on Instagram at thefacilitydenver, for extra tips behind the scenes, fun and updates on new episodes. Thanks for listening. Now go facilitate your own health and we'll see you next time.