Making the case for functional medicine in pharmacy
By Kimberley Kallio, BSc.Phm.
Setting the scene
Talk to any young pharmacist, and they’ll tell you that working as a pharmacist is nothing like studying pharmacy. In pharmacy school we had clinical thinking drilled into our heads every day. We followed a specific pharmacist’s thought process to assess medication therapy systematically. In school, we wouldn’t dare leave an inappropriate PPI prescription unaddressed.
In the real world, at least in community pharmacy, things are very different.
We work in prescription mills.
A typical pharmacist will see hundreds of prescriptions per day. That means only the most pressing clinical concerns are able to be addressed.
Patients are sick of waiting.
By the time a patient sees us at the pickup window, they are burnt out. They’ve waited to get an appointment. They’ve waited for the doctor. They’ve waited for the prescription to be filled. They just want to go home. The last thing they want is for us to tell them their prescription is not appropriate.
Doctors are sick of our faxes.
Rarely is it the case that a pharmacist who discovers a problem with a prescription has the power to solve said problem. Sure, we can adapt prescriptions in very specific circumstances, but more often than not, we need to get hold of the doctor. And doctors are not a simple phone call away. They are hidden away behind secretaries and lunch hour closures and weekends away from the office. The best-case scenario is a fax query marked urgent that we may get a response to by the end of the day.
Meanwhile, patients show up day in and day out with prescriptions and medication regimens that are a nightmare. Unnecessary medications. New prescriptions to treat the side effects of current prescriptions. Therapeutic duplications. Dosing too low. Dosing too high. Drugs that interact with existing therapy. And don’t get me started on drug shortages and drug coverage issues.
It’s enough to drive a pharmacist crazy. And it is. We went into pharmacy school to learn how to help people. And now that we know how, we are unable to help. The more we learn about our craft, the more we recognize issues that we are hard pressed to solve! It’s why more and more pharmacists are ditching the profession, going back to medical school, entering dentistry. Anything to leave the pharmacy counter behind.
Enter functional medicine.
But I’m here to tell you that you don’t need to leave pharmacy to help patients. Discovering functional medicine has changed my entire outlook on being a pharmacist.
In a career where so often, you are stuck between a rock (the doctor) and a hard place (the patient), functional medicine felt like being given some chalk and climbing shoes and scrambling up the crack to new horizons.
What is functional medicine?
It’s root cause medicine:
Functional medicine is a systems biology approach to patient care that addresses the root cause of disease. Instead of providing Bandaid solutions to patients in the form of medications, functional medicine practitioners go upstream to find the root cause of the disease and address the issue there. There is a huge emphasis on modifiable lifestyle factors including sleep and relaxation, stress and relationships, exercise and movement, and nutrition.
It’s not alternative medicine:
It is common to think of anything but standard western medicine as “alternative.” But functional medicine is meant as an add-on to standard medical practice. Our standard medical system is incredibly effective at treating acute conditions like heart attacks and cancer. But the care model that works so well for acute conditions is poorly suited to the chronic disease crisis we find ourselves in currently. That’s where functional medicine shines. Many of the chronic diseases that burden our citizens and societies are lifestyle driven. By addressing lifestyle first and foremost, functional medicine is the key to solving our chronic disease crisis.
It’s medicine ideally suited to 2022.
There has been a paradigm shift in the way we consider many things. In the past few years, we’ve seen a trend away from binary concepts and towards a spectrum view. We no longer put people or concepts in neat and tidy boxes, but hold space for nuance and complexity. Functional medicine does the same. Functional medicine practitioners don’t consider a patient as with or without disease. We consider a patient’s health to be on a spectrum, understanding that for years prior to a diagnosis of disease, there is a period of declining function. We aim to identify this declining function and correct it before disease manifests. We don’t look at neat and tidy body systems, but rather at the whole person. Instead of treating only the patient’s cardiovascular disease in a one-problem, one-medical visit process, we look at the whole person understanding that many diseases have the same root cause and that by addressing the root cause we can bring healing to many conditions. For example: we understand that by addressing insulin resistance we can reverse Type 2 diabetes, but we can also help bring relief to women suffering from hormonal imbalance issues like uterine fibroids and PCOS.
Why is functional medicine perfect for pharmacists?
We are the original health coaches.
The lifestyle changes required to see benefits in functional medicine require a health-coach approach. As the most accessible healthcare professionals, pharmacists have historically acted as health coaches. Patients come to us to get new prescriptions, but they also call us when they have questions about diets. They see us when they have a new ache or pain, or when they need some cough medicine. Like health coaches, we are gifted at putting things into patient- friendly language and guiding patients through different options to arrive at an informed decision.
We can do more with our licence.
At a time when more and more pharmacists are fed up and ditching the profession in search of more fulfilling days, functional medicine offers a beacon of hope. We may not be able to diagnose disease or prescribe medications, but pharmacists are well within their scope of practice to suggest many of the therapeutic tools that functional medicine uses. We are able to suggest exercise, dietary interventions and stress management. There are also many over the counter products that we have access to like probiotics, vitamins and minerals.
How can you get started?
The certification program I am working towards is through the Institute for Functional Medicine, But IFM is not the only provider of functional medicine education. There are many other options. If you want to get the opinions of other pharmacists on the functional medicine journey, you can join the Canadian Association of Functional Medicine Professionals Facebook group and ask the group questions.