Chris Kresser: Helen says, “What’s the best way to deal with increased resistance to [the] cost of testing along with a case review? It’s very easy to lose patients when they’re told upfront the cost of basic testing in order to get to the root of their problem. I’m in a rural area that’s middle income and lower. These patients don’t have anywhere else to go for Functional Medicine except a further drive, but they’re unable to pay for Cyrex testing and other basic labs along with the consultation, so they don’t schedule. Any tips [for how] not to get frustrated regarding this and ways to go about it?”
Great question, Helen. We always have to meet patients where they are, and if you’re working with the population of people who are middle or lower income and can’t afford the testing, then it’s really not going to be practical to try to do all of that testing upfront. There are a few different options there. One is not to do any testing at all to begin with. We’ve talked about in the beginning of this Q&A how most chronic health problems like diabetes, overweight and obesity, and cardiovascular disease, which I imagine your patients are dealing with, are driven by diet, lifestyle, and behavior. Sometimes, the most effective way to start with patients, especially if they don’t have a high level of awareness in any of those areas, is to just start with that and get them some quick wins and allow them to see the benefits of this approach. You can make a ton of progress with diabetes, overweight, and GI problems and things just by helping people clean up their diet, getting them exercising a little bit, [and helping with] their sleep and their stress management. I would argue that that’s actually more important to do as a starting place if they’re not attending to those areas than doing any functional testing.
Now for me, in my practice, it’s really different because that’s not the population of people that I work with. I work with people who have complex, chronic, mysterious conditions. They are often practitioners themselves; they’re health coaches and nutritionists. They’re not only on a Paleo diet, they’re on AIP [autoimmune protocol], or low-histamine, or low FODMAP, or some combination. They’re doing all the right things. and yet they’re still sick. For me, starting with some testing right off the bat is a really good approach, but that doesn’t mean it’s always the best approach, especially in the situation that you’re in, Helen. Then, once you start to get some improvements from them, I would say blood[work]. You can do a lot with bloodwork, too, and that is often covered by their insurance even if you order it, so that’s another thing you can do. You can consider working with Genova, for example, for stool testing. Even though we don’t cover that test, [there are] a lot of the same markers that are on the test that we do cover and Genova ___ [40:23] with insurance coverage and some of the other labs. There are lots and lots of different ways to do this. If Cyrex and some of these other out-of-pocket labs are out of reach, you don’t necessarily need to do them very often.