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REPLAY: The Power of Community Medicine with Dr. Michelle Woolhouse and James Maskell

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Replay James Maskell

We revisit our podcast with James Maskell and our ambassador Dr. Michelle Woolhouse on the power of collaborative, group or community medicine and the role connection plays in healing. 

James shares with us the benefits group programs offer to both the patient and practitioner and how the connecting of individuals experiencing chronic health conditions can allow them to feel heard, engage further and experience sustained benefits from treatment. With loneliness playing a huge role in the incidence of cardiovascular disease and all-cause mortality, James shows us how connection brings people together on their journey for health. 

Following on from our series on Endometriosis, this podcast reminds us of the different ways we as practitioners can support our patients with chronic conditions, particularly those that can increase social isolation. 

Covered in this episode

[00:39] Welcoming James Maskell
[01:05] What is the “community cure?”
[06:02] The  success of the Daniel Plan
[07:55] Salutogenesis in healthcare
[10:03] Using community medicine to combat the loneliness epidemic
[13:58] Attention and listening within a group setting
[17:23] How to get started in a community care based practice
[23:01] Using technology and virtual groups 
[27:56] Group work helps practitioners 
[31:02] Group dynamics lead to better outcomes for all
[35:30] Relieving some of the financial burned of healthcare
[36:38] Thanking James and final remarks

Key takeaways 

  • Chronic disease, chronic mental health issues, access to affordable care, loneliness, social isolation, and emotional health are some of the biggest challenges to the healthcare system. 
  • Fifty per cent of Australians have at least one chronic health disease. 
  • Collaborative care aims to empower the patient towards participating in their health and wellness. 
  • Patients who are not well-supported in the community are at greater risk of non-compliance or a reduction in compliance after the acute phase of a condition with lifestyle change recommendations. 
  • Group functional medicine offers efficiency and can be delivered to a wider audience, supporting more at a time. 
  • The Daniel Plan involved a church congregation seeking to lose weight. Two practitioners delivered a program to the congregation and the congregation formed an accountability group supporting a huge improvement in the body composition of the congregation and the reversal of chronic illness. 
  • Salutogenesis is health-creation to reverse chronic illness 
  • Beyond Blue identified that 1 in 5 people aged 18-25 years old felt lonely in 2019. 
  • Loneliness is a risk factor for cardiovascular disease and all-cause mortality. Community-care or shared-medical appointments can reduce the impact of loneliness. 
  • Connecting people with similar health conditions allows them to create healthy behaviours and friendships to support a return to health for each other. 
  • Mentorship or health coaching provided by someone who has improved their health through lifestyle changes can offer leadership to a collaborative care environment and connect the practitioner to the group. 
  • Nancy Kline’s 10 points in her book Time to Think support the development and facilitation of a group including: 
    • Attention and listening – having a group listen to you can be very powerful and therapeutic 
    • Equality – equal time within the group to support equality 
    • Sense of place – the group creates a feeling of worth 
  • As soon as people within the group realise that there are others in the same place as them, that they can be heard, they become more comfortable with group meetings, even after initial resistance. 
  • Group coaching can be done online and through social media if managed effectively, with opportunity to meet in person. 
  • Dr Joel Kahn cardiologist, had great success in starting a Plant-based Nutrition Support Group online, resulting in a group of 7,000+ men connecting both online and in person. These men benefitted from the connection as many were experiencing loneliness and learnt how to cook plant-based meals from each other. 
  • The COVID-19 pandemic has promoted adaptability to technology and has resulted in an increase in participation in online group meetings, removing the barrier of accessibility for many. 
  • Online groups may promote more engagement as the material can be accessed 24/7, allowing continuous engagement. 
  • Online groups allow the facilitator to get an insight into the environment of the participants, allowing for further environmental support. 
  • Online groups can be used to complement integrative and functional medicine and have been associated with an increase in practitioner job satisfaction, lowering burn out. 
  • Practitioner benefits of online collaborative group care include the ability to see patients transform over time and feel as though they are benefiting the community. 
  • There are two types of patients who can benefit from collaborative care models, and ultimately both types inspire each other: 
    • The patient who adapts to recommendations immediately and sees fast results. These people benefit from the second group as they may burn out easily and are motivated by the second group to continue with the compliance. 
    • The patient who may not be as fast to adapt to recommendations and needs to see the proof before complying with their prescription. These people can really benefit from exposure to the first group who model the treatment and may have longer sustainability than the first group. 
  • People are wired for connection and protection. 
  • Groups with different ethnic backgrounds, socioeconomic statuses, can be united by their chronic illness and desire to overcome it. 
  • Group care can be offered to the patient at a reduced price as the cost can be shared amongst the group. Not only can the group share the cost, but they can also share stories and connection. 
  • Research has found that 97% of people would choose group care over individual care after they had experienced group care. 

Resources related to this episode

James Maskell
The Community Cure Audiobook Free Copy
The Functional Forum
FX Medicine Podcast | Functional Medicine 2.0 with James Maskell 
The Daniel Plan | Dr Mark Hyman & Saddleback Church
Nancy Kline's 10 Components | Time To Think
Plant Based Nutrition Support Group
Dr. Joel Kahn
Research: Does digital health technology improve physicians’ job satisfaction and work–life balance? A cross-sectional national survey and regression analysis using an instrumental variable (Zaresani & Scott, 2020)
Article: Shared Medical Appointments: Cleveland Clinic
Article: Learn About the Collaborative Care Model
Research: Collaborative care compared to enhanced standard treatment of depression with co-morbid medical conditions among patients from rural South India: a cluster randomized controlled trial (HOPE Study) (Srinivasan, et al., 2022)
Article: Collaborative care model significantly improves patient outcomes, Mayo Clinic
Research: Collaborative Care for Patients with Depression and Chronic Illnesses (Katon, et al., 2010)
The Meanings of Salutogenesis (Mittelmark & Bauer, 2016)
Webinar: Digitising your practice: How to pivot your business by going online (Tammy Guest - 2020)

July Clinical Mastery information


Michelle: Hi, and welcome to FX Medicine, where we bring you the latest in evidence-based, integrative, functional, and complementary medicine. I'm Dr Michelle Woolhouse, an integrative GP and joining us on the line today all the way from California is James Maskell, author, community builder, and healthcare entrepreneur. James, how are you?

James: Yeah, I'm doing great, thanks. Yeah, thanks for having me back on the show all the way from California.

Michelle: So James, you have long championed a blend of functional medicine and community-based health care model to help solve some of the biggest challenges facing medicine today, such as chronic disease and chronic mental health issues, access to affordable care, the challenge of loneliness, social isolation, and emotional health.

And indeed, we are without a doubt in a chronic disease crisis. So never before in human history has our statistics for lifestyle-related chronic disease ever been so bad. In Australia, we have 50% of people living with at least one chronic disease. And our primary health care system is really on the verge of collapse with workplace burnout at the highest level ever seen. 

But James, you feel like you've got a solution that you call “community care”...or “community cure”, actually, sorry. Tell us about community medicine and community cure, what does it mean?

James: Yeah, I appreciate it. So I guess the last time I was on this podcast a few years ago, we had been making efforts for about a decade, but particularly the last few years to try and make it more palatable and easier for doctors to learn to practice this new operating system of medicine. I like functional medicine because there's a specific system where you could have practitioner teams, but ultimately, it's a lifestyle first root-cause approach.

And I think the reason why that's so valuable is because the elegance of the solution...I don’t need to tell everyone who's on here that the elegance of the solutions provided creating long-term self-efficacy in patients, and empowering them towards participating in their health, that is a worthy goal. But ultimately, I came to a conclusion in 2018, that the delivery of that medicine is so inefficient, long appointments with doctors, that ultimately could never become the new standard of care. It was always too inefficient.

And the biggest thing that I realised is that if we're going to build a whole new health system based on people making lifestyle behaviour changes, we're not delivering it in a way that sets patients up for success. Because I think we can all understand that a patient could come in, you could spend an hour and a half of them giving them a great workup, really giving them new understanding about the root cause of their health conditions.

And they would go back into their community where they don't feel supported, where they're the only person they know who has the same kind of chronic illness and they just can't execute the protocol. And even if they do execute the protocol for a month or two, while the symptoms are severe, and while they're still an acuteness of the issue, that fades away over time, and they go back to the old habits.

Michelle: Yeah.

James: And ultimately I just realised, the question I want everyone to ask themselves who's listening to this is, "if someone engages with you for an episode of care, 3 months, 6 months, 9 months, 12 months, whatever it is, what is the health outcomes of that patient 5 years down the road?” Have we created a real change in direction of health for this person that is permanent? Or have they just tried some supplements and lifestyle for a bit to get their chronic issues to go away and sort of gone back to their usual habits?

Now, that question really was on my mind two years ago. And ultimately, the combination of really being fiercely committed to answering that question, and also trying to create or come to a structure that could really become the standard of care. I came to see that group delivered functional medicine, group delivered integrative medicine, really solved both of those problems simultaneous in that...

Michelle: I think I...

James: ...it was efficient enough to be delivered at scale. And also, it was the right structure for patients to actually do the changes.

Michelle: I don't think that you would have many functional or lifestyle medicine practitioners, naturopaths, GPs, exercise physiologists, that would disagree with you. I think a lot of the frustration that we all feel is that deficiency in helping someone achieve a long-term goal and getting them to sign up for a 6-month program, 3-month program, 12-month program, or whatever a person kind of designs. Which is really how lifestyle behaviour change needs a time on a system that takes them through the micro changes, the societal changes, etc., to achieve that goal.

But what I loved about your book, there was a small community in California that almost started on a whim. And it became an incredibly effective program which now has a book dedicated to the program called The Daniel Plan. Tell us about The Daniel Plan and why was that so effective?

James: The Daniel Plan started when the pastor of a huge church, a megachurch as they have over here in America, was ridiculously overweight and came to Dr Hyman and Dr Amen wanting help. And he got help seeing them each individually because he's very wealthy and he could see them individually. And he was like, "Look, my congregation have the same issues."

So what they recognised when they looked to come up with a plan was that the whole congregation came to church on a Sunday, I think 15,000 people, but also they met on Wednesday nights. On Wednesday nights they had Bible study. And they met in groups of five, small groups in each other's homes and in other locations.

And so what they decided to do is to create a healthy curriculum that went into those groups that was Christian-based because everyone there was Christian. But that also introduced people to the fundamentals of health creation. And then use that structure as sort of an accountability group. And the results were tremendous. And it wasn't inside the health care system, it was just in a social structure. So there you get healthy curriculum delivered in a group structure and you have incredible outcomes. I think they lost 250,000 pounds between...

Michelle: Oh, my god.

James: ...15,000 people. So it's an average of 16 or 17 pounds, like 10 kilos each, on average. And there was obviously reversal of chronic illness, which was a tremendous success.

Michelle: Yeah, well, I mean, this is what you speak of. I loved also that term “salutogenesis” that you spoke about a sociologist professor talking about health from a cultural perspective. And I think we often miss that. 

We acknowledge as practitioners that we need to take in people's beliefs and their culture. But really, fundamentally how we look at social health and cultural health, as opposed to just individual care. Talk us through salutogenesis in healthcare, what in your ideal eyes would that look like?

James: I think one of the things that any practitioner who's been in the space for any real amount of time realises is that the chiropractor, the acupuncturist, and the clinical nutritionist, and the lifestyle-focused MD, are all doing something that's fundamentally different than a drug-first approach in health care, there's a different goal.

And ultimately, medicine in the way that is practiced in Western medicine is disease-focused. It's focused on the disease, we start with a disease. We have a way of determining what the disease is, and then there's a protocol for that disease. And that's disease-centric medicine pathogenesis. Salutogenesis is health creation built around health. So if you look at all of those professions and all of the ancient medicine, it was really salutogenesis. It was inspiring people to participate in their health doing the fundamentals of health creation.

And I just kind of recognised that that idea which is popular in the naturopathic circles, Joe Pizzorno talks a lot about salutogenesis really regularly. But that was sort of like a binding factor that brought together all of the practitioners in the space. And ultimately, the group visits are really all in alignment with salutogenesis because it's inspiring people to participate and do the fundamentals of health creation in order to reverse chronic illness.

Michelle: And I think too, it's just congruent. So how we live our life, how we socialise, how we shop, how we exercise, becomes like a cultural normality. So we then normalise good health, rather than it being a fad that you go through, or, "This person's fanatically healthy,” or “I'm not." Or we tend to fragment and compartmentalise what we think healthy is.

But I loved the story about Dr Geller, which you wrote in your book. And I thought this was really beautiful because I've been fascinated by this epidemic of loneliness. Beyond Blue in 2019 which is our federal charity to help support mental health released statistics that found 1 in 5 18 to 25-year-olds felt lonely. And this was before the pandemic even occurred.

So we know that loneliness is a bigger risk factor for heart disease than smoking is. So it's an incredibly powerful, negative influence on health even in young people. And so community care is often touted as this innovative and creative solution to loneliness but obviously, we can't really promote a loneliness cure because not really very many people will sign up for it. But tell us about the role that community medicine or shared medical appointments have in trying to combat the epidemic of loneliness?

James: Absolutely. As I mentioned earlier, I feel like the most chronic illness, even if we send people home with a protocol, they're not meeting other people who are like them, where they can recreate friendships around healthy behaviours. And when I first heard of Dr Geller's story, the first time I interviewed him, I spoke to him, I was like, "Man, I got to write this book," because this guy just oozes credibility. And he's run groups some of which have lasted for 20 years.

They start off as a diabetes reversal group but even after they finish billing insurance, this group continues because the community really values what they get out of the sessions. So he identified that, yeah, loneliness was the biggest driver of all-cause mortality. 

Michelle: Wow.

James: And that you could...if you started a group, you could not only solve for loneliness, but then also the group could be this sort of adherence solution for everyone to do the healthy behaviour. So you sort of had a synergistic delivery system.

And that's really the power of the groups, you're solving the biggest driver of all-cause mortality, more than nutrition, more than smoking, more than alcohol, it's shown that social stress is a driver. But also when you get people in groups, and when that groups last a long time, like if the groups can last 3 months, 6 months, 9 months, 12 months, there's enough time to create new friendships, and build structures for accountability, mentorship.

I think mentorship is a huge thing. There's a rise in the U.S. of health coaches. And what is a health coach, right? It's not quite...it's definitely not a health professional. But it's not really just a regular person. It's sort of like a halfway house. And we found in the last year and a half that health coaches are almost like the equivalent of the mentor in Alcoholics Anonymous. They're someone who has typically reversed their own chronic illness and now wants to help other people.

The health coach is the perfect person to lead the group because groups create...they're able to be a lot more vulnerable when they feel they're in a room of people just like them. 

Michelle: That's right.

James: And that coach can sometimes be the missing link where maybe a doctor or even a clinical nutritionist can be a little bit of an expert, and you need a peer to really build that trust.

Michelle: Definitely. Because you go through Nancy Kline's 10 points, a book called Time To Think. And you go through her 10 points on developing and facilitating a powerful group. And I just looked at them again yesterday, just to refresh my memory of them but they were just profound, her way of actually collecting that top 10. Let's go through a few of them.

So the first one was attention and listening. So she has a beautiful exercise that she teaches people about listening. But often we think that we're listening to others, but creating this sacred space within a group that when you talk, no one else can actually speak at the same time. There's no, "Aha," there's no, "Yes, that's the same that happened with me." It's just this space of pure listening that can be such a profound healing mechanism for people.

James: Absolutely. And I've interviewed a few people who have said things along the lines of like if really listening to a patient can kick in the placebo response - and that's one of the things that we know is that one of the reasons why doing an hour initial appointment for patients with a regular naturopathic doctor or functional medicine can be so profound for the patient is they've never been listened to, right? The doctor normally cuts in after 14 seconds to tell them what's going on.

And so imagine what it's like now to have 16 people really listen to you, or 20 people really listen to you. The compound effect of just being heard and validated through that process is super powerful. So we're looking to deliver the maximum effects of that…

Michelle: That's right.

James: …and I think there's nothing more stronger and more elegant than a group.

Michelle: It'd be amazing to actually do the biology, almost neurobiology or pathophysiology of that in terms of seeing people's cortisol levels go down or inflammation markers. I mean, it'd be an amazing study.

But the other one that I loved was equality. So she talks about everybody having this sense of equal time because there is this unspoken inequality within our community. And I love the fact that she weaved in that sense of equality within the group. So everybody has the same time, the same resources, the same opportunities to speak, to listen, etc. I thought that was a really beautiful part that would probably have a very profound effect on the healing essence, as well.

James: Yeah, even if you don't use that time, to just know that you have it can be healthy as well.

Michelle: That's right. And I think...I loved also her sense of...she has this towards the end of her top 10, the number 9 was developing a sense of place. And she spoke about how a lot of patients or a lot of clients feel out of place within the system. So they just feel so overwhelmed by the system, they don't feel like they belong.

And she had this terminology that the group creates the feeling of “you matter.” And again, it's that same sort of sense of equality and listening, this profound ability to be seen and to be listened to, to be heard. But to also just hold space for yourself while your community also does that, too.

One of the things that I found when I started using shared group appointments was trying to get people over the line. And a lot of people are like, "Okay, that's good for some, but I'm not really a group person, I don't like to share." How does one...if some of the practitioners out there are thinking like I was, "This is such a great idea. How do we start?” what would your recommendations be?

James: That's a great point. And I think one of the things that certainly in the U.S. most functional medicine practitioners were paid cash, they kind of opted out of insurance or the system. And particularly, those patients are reticent to pay for a group now because they've been so used to paying for someone's expertise. So, we've found in the last year and a half that we started to create structures to go after all the people who have never had access to functional and lifestyle medicine and find that those people are really ready and excited to be part of it. That's one thing.

But for those practitioners who want to do it, here's what I found. So I interviewed this nurse practitioner here in the U.S., and she used to make sure that every single patient who came into her practice had to go through an orientation. That was her...what she did was super efficient for her practice.

So once a week, any new patient that called would have to come to this orientation. And when she started doing her orientation, it was basically her talking for an hour. And then she handed it over to her front desk and it was just sort of all the details of this kind of medicine and what's expected.

And then over time, what she found was that, what if, instead of taking the whole hour, what if we just do 15 or 20 minutes of like, "Hey, this is what happens in the practice." But then actually just start to ask the people in the room, "Hey, what's going on for you," and almost do a bit of a micro group visit right there in the orientation.

What they found is that, and probably what you found, as well, that as soon as people get over the hump, and they realise that other patients are just like them, and they have an opportunity to voice what's going on for them, and an opportunity to hear from other people who are just like them, then they're hooked. But there is that initial resistance. And so that orientation, I thought was a great way to overcome that resistance and give people a little taste of what it’s like to be in that kind of container.

Michelle: Yeah, I think that's such a fantastic idea because it's almost like the doorway in and you're introducing them to a whole different way of conducting healthcare. 

So this doesn't just apply to the medical system. What I loved also in your book talking about all healthcare practitioners can really adhere to these kind of shared group style appointments like naturopaths, and nutritionists, chiropractors, psychologists, exercise physiologists. This does apply to all of us. Have you got some examples of people in the U.S. that are using this that are not in that mainstream category?

James: Yeah, absolutely. Yeah, it's really interesting to see, I mean, even in the UK and the U.S., definitely examples of people starting groups. Group coaching has been done online by all kinds of coach entrepreneurs. Ultimately connecting it to the medical system is really valuable.
But, yeah, I just want to give everyone an example of something that was really...I spoke about in my book that I think it's the most transformational concept because it actually takes it beyond the health system, and into the world.

I mentioned there, Dr Joel Kahn who is a cardiologist, and he had a patient who was telling him it was hard for him to make the lifestyle changes. So they started together this thing called the plant-based nutrition support group. So it was really like, how do you get men to eat vegetables, which I'm sure many people who are listening to this have struggled with.

And ultimately, they started a Facebook group, and they thought they could get a few dozen men who might be interested. At least it started from Dr Kahn's practice. But within 6 months, they had 7,000 men who had signed up. And ultimately...

Michelle: Really? Wow.

James: ...they turned that into lots of small meetup groups, and then they had like an annual event where they would get some cardiologist or some big name to come in. But ultimately, that was completely free, not part of the medical system, and had a huge impact on the men who are part of it. Because by and large, they were lonely, by and large, they didn't cook for themselves, or they weren't married, and they had a hard time cooking for themselves. So it was providing this sort of full-spectrum bio-psycho-social solution. So zero costs that was valuable to everyone.

And just imagine the impact on your medical practice or your clinic if you were to just engage and try something like that in your community. We have all of the resources, the technology to be able to bring people together, even virtually, but all we need to do is really take that path. And sometimes your patients might be willing to do the legwork to make it happen. But there's certainly a need out there, there's certainly desire. And if you can fulfil that desire, you can become the centre of your community, an indisposable resource for help.

Michelle: It's fantastic, isn't it? I mean, that's the one positive thing that came out of this COVID-19 pandemic was this adaptability to technology, and groups, and people just signing up. There's just this incredible wealth of knowledge out there. But finding that central core, just choosing either one or two groups to kind of be a part of. Tell us about embracing technology for this kind of group visits?

James: Well, the book came out January 2020, and I was all gung-ho about convincing the world that they should do functional medicine groups, only to find that groups were no longer possible two months later. And not just the functional medicine group movement that was on its very earliest days. But also what about Alcoholics Anonymous, Narcotics Anonymous, addiction groups, all just destroyed overnight, essentially.
And so we started to think straight away, "We want to learn how to do this virtually." Because I had some ideas that virtual groups could work, but I didn't really know whether there'd be any advantage to doing it virtually. And so we started in the summer of 2020 over here, or very soon afterwards, putting together some groups to learn, "Okay, could we take a multi-stage, a multi-week group, teach people about anti-inflammatory diets, and then, ultimately, to see if we could actually create healthy behaviours in a short period of time." And that worked really well.

And we actually discovered a few interesting things that I think your listeners would like to know. So when you do an in-person group, let's say you do a group every week for five weeks, and they come into your office and they meet at your office. First of all, there's definitely some lift to having to come to your office and drive across town to get to the group, right? There's some inaccessibility...

Michelle: Motivation.

James: ...that happens. Certainly a lot of practitioners that I've spoken to have resisted doing groups because they're like, "Well, there's not even 20 spots in my car park. I don't even know where people would park." Just things like that. If that's holding back the development of this group processes, why not do it online? Especially now people are used to doing telemedicine, they like it, they feel like it respects their time, so let's try it.

So one thing we learned is that if you do a virtual group, you don't just get the attention of the patient when they're in your office, you get their attention actually 24/7. If you have a group every week and in the middle of the week, you send them a video to watch and comment on, they watch it because they're engaged into the group. And you're actually getting a lot more sort of engagement from them.
And ultimately, it's that engagement that really makes the impact, that really changes behaviour. So that was a big thing. Like a digital-first experience means that you sort of have more attention from the patients in between sessions.

Also, what are we really doing here? What we're really doing is environmental medicine. And the number one environment that people live in, especially during COVID, is their home. And one of the things that's been really amazing is been doing a group visit in a home where you can actually now see what is in someone's home. If they tell you, "Look, I've mainly been eating salads," and you say, "Well, let's just go and look at the fridge," you can see what's actually going on, right? And if it's only beer in the fridge, you know that maybe…

Michelle: You might have some people turning off their video at that particular time and claiming electricity's out.

James: I'm not saying doing that on the first session. You may have to build credibility and build trust first.

Michelle: That's true. For sure.

James: In reality, be able to see a little bit of what people's life is like, it gives you a window into that. And I think telemedicine does allow us that, it allows us to see people in their environment, and to give us a lot of clues to really understanding people's lives and coming up with solutions that can help them. But in that group environment, it can be really valuable as well.

So what we learnt over the last few years is that virtual groups do work, that people like the virtual groups. And that ultimately, it reduces many, many points of friction to people actually engaging in groups. And not just patients engaging in groups, but practitioners to actually start to want to run groups. And so I'm very bullish about virtual groups as a way to sort of complement...

Michelle: To start.

James: ...the delivery of integrative and functional medicine.

Michelle: That's right. And I think...I mean, one of the things that I found really interesting in the research, so there was an article in the Medical Journal of Australia, I think published around two years ago that basically on the pilot program that was done in Northern New South Wales. And what they found was that there was, of the practitioners that did it, something like 95% of the practitioners felt that their job satisfaction had increased dramatically. And they brought that back into their one-on-one practice.

So the fact that they had these groups maybe once or twice a week, they found they were looking forward to it, they found that it was such an inspiring addition to their practice that they felt less stressed, less burnt out, more enthusiastic, more effective. 

Did some of the research in the States mirror that for you, as well? So it's not just about the patients getting the result, it's also about the practitioners feeling better about what they're delivering, how they're helping the community.

James: Yeah, absolutely. I mean, first of all, you get to see patients transform over a period of time, which is amazing. But yeah, there's research out of Mayo Clinic that says that if you just spend 20% of your working time doing something that you really enjoy, that can reduce your chances of burnout significantly.

And so what we found actually is that for practitioners who take some of this on and actually go into it, that they really enjoy it. They're able to do something different. And that ultimately, by spending time doing that, they're able to feel a lot stronger about their life and their work. And it kind of breaks up the monotony of the one-on-one appointments which is kind of a grind. And so I think many practitioners have enjoyed doing it, or enjoyed knowing that their patients are getting it.

Michelle: That's right. I love the fact that when I started looking into this, I mean, this concept isn't new. The Mayo Clinic and the Cleveland Clinic, the two most arguably famous clinics in the world have been doing group-shared appointments for how long, 30, 40 years?

James: Yeah, exactly. Well, Dr Geller started, I think, in the late '90s when he just came out into work. But there had been different groups being delivered since the early '90s. But yeah, Alcoholics Anonymous goes back to the 1920s and '30s. So one way or another, people have recognised the power of this. 

But I would imagine if I had to guess and we go 20 years into the future, or even 10 years, my hope is that we would look back at the sort of first iteration of professionally driven natural medicine, like naturopathy, functional medicine, integrative medicine, and realise that we were not really setting patients up for success by not giving them the right container and support for transformation.

And I guess there's one thing that I've learned about this that I want to share is that I think what we've done is we've made it easy for certain personality types to get healthy, right. Those patients that for whatever reason, personality type, or just desperation are in such bad shape that they just do everything that you tell them. But there's a certain other group in the population that need a little bit more proof and that want to see other people have success before they jump in. They're just sort of not an early adopter of anything.

When you put those two types of people in a group together, the people who are the quickstarts who just run the beginning, they inspire the other people to participate, because the other people see the early people starting, just going with it and getting great results. And then maybe when those first early people kind of burn out because they go start quick but they can't sustain, they get...

Michelle: That's right.

James: …the sustaining energy from the other people who were slower to start but can sustain. And that's the power of these multi-month groups where they last for six months or longer, in that you actually start to feel this whole container happen where the different personality types become a benefit to everyone.

And that's why in the project that I've been working on to deliver virtual groups, the outcomes are so tremendous. And part of the reason I feel is that everyone is participating because everyone is inspired by either someone else in the group, or the coach, or more than likely everyone in the group.

Michelle: I think that's such a good point, James, because I think for those people that are resistant to join up, we have no idea of the power that is within that group. I mean, there's a lot of research on group dynamics and how a group can build in its energy. It's almost like 1 + 1 equals 10 within a group. And the fact that we've got so much diversity within our society, whether it's educational levels, or intellect, or sporting prowess, or the early adopters, all of these different kind of facets of our personalities, and our strengths, and our weaknesses, come together to create this incredible sense of connection.

And I think we don't look at relationship health enough, the relationship between each of us within our society. We talk about the health of an intimate relationship, sure, or a family relationship, but the health of the society seems to...we just haven't really made that connection between our individual health and our society's health. 

And we're wired for connection, and we're wired for protection. And I just love the fact that you mentioned some of those people that can bring someone forward. And then that person that has been brought forward, if the stronger one then has a little dip, then they can be the inspiring one. That's such a beautiful image of how we can all get better together.

James: Yeah, the name of my book was...the subtitle was Transforming Health Outcomes Together. And as we've really jumped into this, I've seen that not only is this a great health intervention, but this is actually a great societal intervention too. To have groups with different ethnic backgrounds and different socioeconomic statuses united around their chronic illness and wanting to overcome their chronic illness and working together to overcome the chronic illness, that's real, that has been really profound.

And these groups have created...especially in the groups that we've seen that focus around chronic illness, we've seen real relationships develop that never would have developed without this kind of connection.
And for those doctors and practitioners and naturopathic doctors who are listening, you know that those patients are in your mind. If you think about your patient population, you probably know that you have these different kind of patients from different groups. Imagine if they were together, once a month, once a week, and starting to build friendships and starting to support each other and implementing the protocol that you gave them. That's powerful medicine, it doesn't need to cost a lot and it can really exponentially increase your practice outcomes.

Michelle: Absolutely. And I think the cost is really important as well. I mean, as you mentioned in the introduction that integrative medicine can be an expensive way to impart lifestyle medicine, functional medicine. That one-on-one care is much more expensive than this group work. And so we're basically sharing costs, sharing stories, sharing human connection. And so it's a sense of financial burden that is shared as well. But the outcomes are even better.

I think that's the thing when I read the research from the Medical Journal of Australia is that 97% of people felt that they would choose a group over one on one after they had joined one, which I thought was incredible. But also, the effectiveness of the healthcare was much better than that one-on-one care. So it's not just better for the practitioner and a better feeling. It's not just a feel-good medicine, it's actually much more effective in terms of sustaining that, but also just all of the other intangibles, or immeasurable that come with it.

James: Yeah, absolutely. Yeah, there are immeasurable benefits, for sure. And I think that's really well said.

Michelle: Thanks, James, for spending time with us today and exploring this, what we can call visionary model of care. I know when I first came across it, I was like, "This is absolutely inspiring." And I'm sure all of the practitioners listening can think of at least several of our patients or even fifties to hundreds of our patients that would benefit from this style of care. And I hope that this conversation is really the impetus that can make some of us really take that leap into this shared group format.

So you've just done the most wonderful job putting a book out there that can...I highly recommend it, because there's just so much in it in order to inspire you. Because I love the fact that lots of different practitioners did it in their own particular way. And so there's no one format or one size that fits all.

James: Yeah, that's right. It was great to pull on all of the different examples from so many different sort of niches of medicine. And I would say, one of the most exciting things is that the book...the implementation is still going on and there's more innovation that's happened in the last two years. And I would say, yeah, this movement really sits on the shoulders of those people, those doctors, those practitioners, that went about it when the coast wasn't clear, right? They didn't really understand what they were doing but they just felt sort of compelled to try it.

And so much of their success is built on their shoulders. I've tried to hold them up as the heroes of the book for doing that work. And there's many, many heroes to celebrate. But I think people listening to this could be the next generation hero because ultimately, bringing it to your community, bringing it to your country, your state is still up for grabs because it's reached 0% of its potential, this movement, at this point.

Michelle: That's right.

James: So it's up to all of us to take it forward.

Michelle: So we're all pioneers, it's just fantastic. Thanks so much for your time today, James.

James: Thank you.

Michelle: And for anyone that's interested, you can download for free a copy of an audiobook The Community Cure at thecommunitycure.com/audiobook

Thanks, everyone, for listening today. Don't forget that you can find all the show notes, the transcript, and other resources from today's episode on the FX Medicine website. I'm Dr Michelle Woolhouse and thanks for joining us. See you next time.

About James Maskell

With the soul of an advocate and the mind of an entrepreneur, James Maskell has spent the past decade sparking debate and encouraging a shift away from conventional western medicine and toward a wellness-centered, functional medicine model—starting with the doctors themselves. To that end, he created Functional Forum, the world’s largest integrative medicine conference with record-setting participation online and growing physician communities around the world. He’s also the founder of the Evolution of Medicine, a community e-commerce platform which provides highly curated and customized resources, tools, products, and services, making it easier and more affordable for conventional doctors to embark on a new way of managing healthcare. An in-demand speaker and lively impresario, with a broad and thriving network in the functional medicine space, James lectures internationally, and has been featured on TEDMED, Huffpost Live, TEDx and more, and contributor to Huffington Post, KevinMD, thedoctorblog and MindBodyGreen. He serves on the faculty of George Washington University’s Metabolic Medicine Institute, and speaks regularly on the integrative medicine conference circuit. He graduated with honors from University of Nottingham with a degree in health economics. He lives in Venice Beach, California with his wife and daughter.


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