IP Interview with Bethany Hays, MD, FACOG
IntegrativePractitioner.com interviewed Dr. Bethany Hays about the functional medicine approach, women's health and what's inspiring her in medicine today.IP: Dr. Hays, Congratulations on your recent recognition within the Functional Medicine community. You received The Institute for Functional Medicine’s 14th Annual Linus Pauling Award. This award is given to an individual whose research or clinical expertise has contributed substantially to the advancement of knowledge in functional medicine -- a well-deserved honor for your lifetime’s dedication to improve the nature of healthcare.You were noted as asking the following far-reaching questions that really encapsulate the vision of integrative medical thinking…“…how are we to use science for the benefit of that patient? How are we to live in the uncertainty that is truly the nature of our profession, and how are we to stand in that uncertainty and use every possible power within the practitioner, within the person, the whole human being to address that question?”These certainly inspire discussion… and we have a few more questions for you Dr. Hays:Functional Medicine ApproachIP: In what ways has the Functional Medicine framework impacted your personal approach to medicine?BH: Functional medicine has reignited my love of science and my confidence that each medical mystery has an answer if we can just find it. My confidence that there is an answer is sometimes the only thing between my patient and utter despair.IP: There are clear challenges to being a woman leader in any professional field, but does the medical industry offer its own set of hurdles that differ from, for example, the business industry?BH: Medicine is a profession designed by men for treating women. Because of this historical foundation, it has failed both men and women. It fails women because it objectifies and infantilizes them. It fails men because they can’t admit weakness (illness) and still feel strong and in control. I believe that the introduction of women in significant numbers may allow us to correct some of those failures. Women in medicine have had to be better in order to compete. They have to make higher scores on the tests, take extra call, work full time and then go home and care for their children. You hear women talk about working part time and then find out that what they are talking about is a 40-hour workweek. And still there are very few women in positions of power in medicine…of course that may be because women don’t value power in the traditional sense. A recent interviewer noted that I had sort of stayed “under the radar”. That is not entirely by accident. Sometimes you get more done when you don’t feel the need to take credit for it.IP: You state that one of your core professional goals is to find better ways to train physicians. Can you talk to us about ways in which you are doing this?BH: I am doing that by contributing a significant amount of my time and energy to the Institute for Functional Medicine. I think IFM has created a systematic way to train physicians that includes the relevant areas for a competent physician: an understanding of mind-body medicine, a belief in the importance of structural integrity, an understanding of the importance of the doctor-patient relationship, an understanding that you need to go upstream and treat causes rather than wait until illness is severe and treat with powerful and potentially dangerous drugs and surgery.IP: You have often stated that you do not believe in “cookie-cutter” treatment for patients. How do you ensure your patients are receiving individualized care?BH: I take the time to listen to them, hear the whole story and try to ferret out the genomics and individual environment within which that patient is struggling to find health and wellbeing. I am humbled by the infinite variety of presentation and the infinite pathways to healing that I am allowed to witness each day.Launching Your Own PracticeIP: You started your practice, True North, 6 years ago. Do you think the same challenges you faced, are the same faced by practitioners today who are trying to establish their own integrative practice?BH: Well, I don’t think it is as hard to sell complementary practices and I think you can find more physicians either trained in complementary areas or willing to work with them. And of course there are more examples of success and failure to learn from if you are just starting out.IP: What variables do you think have been responsible in changing the landscape?BH: I sometimes wonder if the success of complementary and alternative practitioners isn’t largely due to the unqualified success that they have had as healers. Sometimes I think we all just need to keep our patients engaged until their own bodies figure out how to heal. That would suggest that much of what we do in conventional medicine is simply to present the challenge “Do you want to live?...survive this!” And our patients either do or don’t survive, but they usually get very clear about where they stand on this question. Complementary and alternative therapists are successful because often their therapies are less dangerous and their therapeutic relationship leads the patient back to wanting to be healthy or survive.IP: If you were heading down that path again, what would you do differently?BH: Really…? Not much. Well, o.k. I would have made sure I got paid for what I did.IP: It seems you often operate at full-throttle, involved in Herculean projects, many simultaneously. What are the lessons you have learned about self-care during the various phases of your career? Especially while launching a new practice?Still learning…! In the long run: be sure you are having fun and spending time with your family. It is basically the ego at work to think you are the only person in the world that can get this (or any project) done! Also as someone once said, “It’s amazing what you can get done when you don’t have to take all the credit.” Circle process has been really great for me because I need to remember that in fact I am not doing it all and there are people to help me and support me.IP: What have you learned are the key success factors in developing a new practice? For instance, are you a believer in the “build it and they will come” philosophy or does a successful practice require a professional marketing strategy in order to attract patients?BH: It really helps to have a business professional in on the ground level. Someone who really knows how to look at how much things will cost and can translate that into words that practitioners understand like: “You will have to see thirty patients a day to make overhead if you build out that much space and want to have three complementary practitioners working with you.” I don’t know about other places but we have found Marketing to be a big drain on the organization and not really that helpful in getting people through the door. I would say early on it gave us some credibility…you know, if they have enough money to advertise maybe they are a legitimate operation...IP: If the latter is true – Do you have advice for how practitioners take time away from seeing patients to better market themselves and their services?My advice to practitioners is if you give good talk, get out there and do it. I always get patients when I go out into the community. But more important than that is giving good service, and good care. One miffed patient will lose you ten; one happy one will gain you two or three.Women’s medicine, Women’s CareIP: What do you feel are the most exciting developments in Women’s medicine today?BH: I think we are getting really close to some good strategies for preventing breast cancer with diet, lifestyle and supplements and that we have some good tests of intermediate markers that will tell us whether those strategies are working.IP: Could you discuss your opinions regarding the ongoing controversy surrounding bioidentical vs. synthetic hormones? And do you feel women should be taking hormones at all during menopause?BH: I don’t care about bio-identical or synthetic. I do care whether the hormone I give is recognized by the right receptors, metabolized by the available detoxification enzymes, suitable to a woman’s unique genetic makeup and given in physiologic doses. Since we are just touching on the tip of the iceberg in our understanding of what hormones do, I think the default position is to use bioidentical hormones and try to mimic Mother Nature. However, when you get “rabid” about that, you miss that there might be a synthetic hormone that would be safer in a given subpopulation. I don’t want to miss that. Then there is the whole issue of formulating pharmacies and how to protect patients from incorrectly formulated hormone treatments…No, the literature (from the WHI pretty clearly demonstrated that about 80% of women who go through normal menopause do better off hormones. But then 20% do need some hormonal support and some women need actual replacement of missing hormones due to oophorectomy or autoimmune destruction of the ovary.IP: Where do you see the role of integrative practitioners in supporting women’s health as they age?BH: Integrative practitioners are the best, absolute best, at engaging their patients in the project of taking care of themselves and taking responsibility for their health. It requires a good understanding of the therapeutic encounter and a toolkit that will keep the patient engaged until they learn enough about their bodies and their environment to stay healthy.What’s Hot & Where We’re Going in the World of MedicineIP: What research has really peaked your interest right now?BH: I am really interested in Eleanor Rogan’s work on estrogen metabolites. I am interested in the work on inflammation and cancer and that stem cells may actually be the cancerous cells. I am interested in the work of the Foresight project in England for preventing infertility and miscarriage. I am really interested in the work on methylation of DNA and it’s effect on the embryo and on cancer. I am interested in the information about iodine and breast disease. I am interested in pharmaceutical interactions and how little we know about them considering how many drugs the average patient is taking. I am interested in estrogen and the immune system. And, I love it when I find an article that supports a theory I have had for 10 or 20 years! (O.K. I admit it, I love my brain and I have to keep my ego in check constantly!)IP: Do you have a “required reading” list you could share with members?BH: No, anything in print is out of date…so get a computer and learn to use PubMed. Don’t accept the conclusions of the authors. Ask why more often…why does it work that way?…why doesn’t it work the same way for everyone?…why are we seeing unexpected consequences of our therapy?I am really horrified by the wrong conclusions I see all the time in the literature. I am constantly reminded of the story by Hans-Lukas Teuber who taught a course at MIT on brain physiology. (It helps here if you picture a wizened little man with a thick German accent.) He said, “There was once a scientist who trained a flea to jump when he blew a whistle. Then he pulled the legs off the flea one by one, each time blowing the whistle to see if the flea could still jump. Finally, he pulled off the last leg and blew the whistle. Of course, the flea did not jump. So the scientist came to the conclusion that the flea had gone deaf!That represents the kind of conclusions I see in the literature all the time. A good doctor needs to learn to think it through to the correct conclusion. A good medical school teaches that kind of critical thinking. That is what I am trying to teach at the Institute For Functional Medicine.IP: What would be your hope within the next 5-10 years for the future of medicine and patient care?I want the healthcare profession and the policy makers to start putting their emphasis on patients taking responsibility for their own health. We should not be asking does this policy provide healthcare to everyone, and does it support the doctors, hospitals, laboratories and pharmaceutical companies, but rather does this policy encourage everyone to make healthy decisions.I also hope that all practitioners learn the skills of the best complementary and alternative practitioners…to make eye contact, to listen carefully to the patient’s story, to be genuinely interested in the patient and their journey, to use the energy of their hands and their heart and to see their patients in the context of their whole life and all their relations.I would like to see medical schools teach the skills above.I would like to see people talking about death and dying, about how to die well, about what is important to them in the last days of their life. Let’s save some of those 60% of our healthcare dollars being spent in the last 10 days of life and spend it on prenatal nutrition.