We we talk about the people that, you know, you're the some of the five people that are around you. And quite often when I would meet people who wanted to make a health change, they'd start to like, look around and realize that the people that they're around are not making a health change, right.

The people that they're around are not that interested in improving and maybe are even holding them back from making that big leap or making that big decision.

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Hey, hey, welcome back to another episode of Real Integrative Medicine podcast. I want to do an update on a topic that I wrote about all this really long time ago, when I was trying to help prospective patients decide what kind of practitioner they should see, how to, you know, make decisions about what kind of evidence based practitioner they wanted to work less.

I'd written this great article for our practice, and it was basically, you know, five ways to decide if you're a practitioner is right for you. And I went into a discussion around how they make decisions and what's evidence really mean.

And it's like the same conversations that I've been having honest to goodness for, like 15 years in my work. But I want to update the list a little bit.

And today we're going to talk about how to choose a practitioner that you're working with that's going to help you actually reach the goals that you have, and also the kinds of like how to prioritize the things that mean the most to you in your pursuit of health, because everybody actually is looking for something slightly differently.

And the the like title that your practitioner has may not be the most important thing. The title that your practitioner has might be a very important thing based on scope of practice and what they're actually able to accomplish with you.

So I want to walk us through a bit of a framework for how to think about it and think about, you know, kind of those important pieces and how we typically make decisions when we're a consumer.

But then compare that to what you might actually need as you're a consumer in health care. Right. And if we think about how we make decisions right now, right.

If you, you know, wanted a new pair of jeans and, you know, you were trying to figure out how to buy the best pair of jeans, you might do a keyword based search, right?

Best pair of jeans for a 43 year old body. You might ask your friends who are kind of the same as you like, where did you get your jeans? I'm looking for a new pair of jeans.

You might, find an Instagram post with someone with great jeans, and then you're like, message them. And you're like, where did you get those jeans? Or, you know, kind of hope that maybe now you're suddenly target marketed those jeans because you followed that person.

We kind of make the same decisions. Or when we're making a health care decision, we kind of do the same thing. And I'm going to maybe argue that that's not the right way to make a decision about your health care provider.

However, that's kind of our default, right? We want social proof. So we want them to have reviews and we want to know that thousands of people are wearing these jeans.

We want someone that we know or that we're close to to have had an experience with that person. We're, less likely to just, you know, go off and try something that no one we know has ever tried before.

We're a little bit heard like, and that way that we want to just do what everybody else is doing and that the way that we're making those decisions is maybe not going to give you, the kind of information or feedback you're looking for, especially if the people that you're around are not pursuing health in the same way that you are trying to pursue health.

Right? We we talk about the people that, you know, you're the some of the five people that are around you. And quite often when I would meet people who wanted to make a health change, they'd start to like, look around and realize that the people that they're around are not making a health change, right.

The people that they're around are not that interested in improving and maybe are even holding them back from making that big leap or making that big decision.

Right. We have that image of like, you know, the partner eating Doritos on the couch. And the other partner is like, I want to start eating healthy. It's really hard for you to break free from those five people around you.

So different if you're talking about jeans, right? But when you're starting to talk about your health and something that requires your motivation and your, I'm going to use the word discipline.

And I'm using that in a very compassionate way. I don't mean that in like, a 75 hard kind of way. You know, it requires you to be invested. It's your personal health goal.

And my guess is if you have rheumatoid arthritis and you look around at the five people around you, they don't have rheumatoid arthritis. And so this actually is a very personal journey for you and your deep desire to change yourself and your health is actually being held back by the people around you then.

Yet we're going to make a decision about who we work with and how we pursue our new health goal based on those people that are around us. And so I think going to give us a bit of a new framework for how to think about it and, for how you can make a decision about it.

So first things first, not every practitioner has the same scope of practice. So just very high level. Not everybody can do all the same things. And so depending on what you are looking for, whether it's lab work and assessment, whether it's prescriptions, whether it is a diagnosis, right.

Not every level of clinician or every scope of every type of practitioner has the capability of delivering a diagnosis. Actually, that's a bit of a controlled act, meaning that you have to have a certain level of expertise to say, I now grant you as having a endometriosis, they may or may not have access to interprofessional relationships that you need to send for things like imaging or fillings.

They may not have the knowledge that you need in order to accomplish your health goals. It's different if you have a diagnosis or if you have a health goal, like getting stronger.

That's an accessible goal for every level of practitioner and every kind of practitioner. Whether you work with a health coach or whether you work with a personal trainer or physio, arguably they all have different levels of education, but that is a goal that they could all move you towards.

Whereas if your goal is to deeply diagnose your chronic anemia, there's going to be certain types of practitioners that are not actually capable of giving you what you need to understand and diagnose what's going on with you.

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You can subscribe to the stacks with the link in the show notes today, and get access immediately to all of our back issues that show you exactly how to be an evidence based practitioner.

I hope you sign up and you'll enjoy it. And I think that's one of the big challenges we have with the health and wellness, you know, environment online is that we'll talk about something like fatigue, like it's this wellness thing that we can cure with a green smoothie and a meditation when many people have an actual medical condition causing their chronic fatigue.

That requires assessment, diagnosis, maybe experience for the practitioner. And that's not accessible by your TikTok influencer. And so I think it's really important that you start by thinking about like, based on what's going on with me, what am I going to actually need?

What does this plan need to include in order for me to get where I want to be going? If you're looking for coaching and you're looking for accountability, you might not get that from the person who's writing your prescriptions and who is sending you for lab work.

And I think that's also where we can get quite frustrated in our health care experience, because we want to tell our doctor about our deepest, darkest fears and yet what their role is, is maybe to refill a prescription and send you for labs.

We may need to seek coaching and hand-holding again. I mean that in the most positive way. We need hand-holding actually to change. We might need to seek that in a different kind of practitioner who has a different skill set, different scope, and a different amount of time to be able to spend with us.

That's actually why I've always loved naturopathy medicine, because it's this, bridge between both worlds where, there's often prescribing rates and blood work ability and diagnosis and yet the luxury of time.

And so the coaching and the accountability and whatnot can also be achieved with that same practitioner. And I actually think that's incredibly valuable, to be able to do that.

So scope and, and I'm going to say licensed. Sure. And all of that is a very important first step to think about. Like what am I looking for here? And if you are not sure about your diagnosis, you probably need a type of practitioner that is going to be able to serve you in that way.

If you have your diagnosis and what you're looking for is a, cold care where you're looking for additional solutions that go along with your conventional health care experience, that's a different person.

So starting there is really important. Like what do I actually need to get out of my health care relationship here? Because very often people will sign up to work with someone and then realize there's like a limitation like, oh, they're treating my fatigue just the same way they treat everybody else's fatigue.

But I have sleep apnea. And unless someone sends me for a frickin sleep study, I'm never going to figure that out. So that's really important. But coming back to our jeans conversation, like, how do we go about making and selecting someone, based on what our goals are and our values are?

And I think that this is important, I want to talk about reviews and the way I would think about reviews and what I considered to be a positive review versus, what you're probably thinking now that I've said the word reviews, I want to talk about the difference between being evidence based and being cutting edge, and how research should actually make it into your practice and what you believe you want to consider.

There. And I also want to talk about sort of the coaching aspect of what clinicians do and offer, and how that is going to make a substantial difference to how you decide to work with somebody.

But let's talk about, reviews first, because like the jeans example, you want or referral, you want someone, you want to have known, someone who's about to do the thing that you've done.

It's interesting. Whenever I was working, in there was a time in my career when I worked with Cancer Care, and I was always really careful to book those patients at a time where I was, like, needed to be wearing two pairs of roller skates in order to see all the patients I had at one time.

And it took me a bit to realize how important it was for that patient to see that they weren't alone. Like I weirdly would get those patients to, want to work together, even if we were doing some really low key solutions like helping their cancer related weight loss or their fatigue like naughty.

We were even doing like, heroic, you know, maybe that, like cutting edge integrative care or like IV therapy, even if we were going to do something like just change their nutrition a little bit during chemotherapy, those patients and especially those patients spouses could barely say yes to the treatment plan.

If I was the only one in the office, me and my, receptionist at the time, it was just the two of us. And then the couple would come in, they'd sit down, they talk about, you know, their whole experience.

We had this extended intake for cancer care. I deliver them this incredible, treatment plan. And more often than not, if we booked them when we were alone and I, I'd be like, okay, they need my undivided time and attention.

And I would only book them during these certain times where I could just stare at them for an hour and a half and really, really, focus on them. Those patients actually didn't come back as often as patients when I was interrupted four times during the appointment.

So it's fascinating, right? If you think about like, people at that time and this was more than ten years ago, if you were pursuing some alternative or complementary cancer care at that time, like you were considered to be a bit of an odd doc, right?

You were doing things that were not standard care. You were talking about food. Like, why are you talking about food while you're having chemotherapy?

Like, this is how we approached it back home. But the people who felt like they were, you know, going off the beaten path, that they were doing things that nobody else was doing, they were getting care at this quiet office, and it was just me and them.

They didn't return. Meanwhile, if we booked those exact same appointments during a time when I had a full I. V. shift running, or I had people doing acupuncture at the same time, or I got interrupted for like, any reason.

Honestly, they felt like they were part of a group, and suddenly they felt like they were part of a field. And it was like, everyone here is talking about food while they have chemotherapy.

And suddenly their treatment acceptance went up, right? They didn't feel alone. They didn't feel weird. They didn't feel like they were going against their oncologists wishes to talk about protein while they had chemotherapy.

Those patients, Phil and I at the time, and I didn't realize it right away at the time, I was like, oh, God, I'm so sorry. I'm interrupting our appointment.

I'll be right back. Like, this never happens. And then I realized that they were like, so happy that they were not alone. They actually wanted me to be interrupted.

It, weirdly, was validating for them that they were not doing something that was so weird that nobody else was doing their. It's the same as a busy waiting room, right?

Like, and of course, when we go somewhere and it's a busy waiting room and we have to wait like two hours to see the doctor, that's really uncomfortable.

But when you go somewhere and there is a vibe, right, there's a vibe of like, all these people here are trying to pursue their health. It feels incredibly different.

And so just like when we want someone to have worn the jeans that we're about to buy, we actually want to know that the people that we're working with, or the thing that we're doing has a little bit of social proof to it.

The problem is, is that currently social proof comes in the form of like Google reviews, especially if you work with a regulated health practitioner and patients are always amazed that a I'm not allowed to ask for Google reviews as a regulated health professional, not allowed to say like, hey, can you?

I just really helped you have a baby, can you please write a Google review? The other thing that we're not allowed to do as a regulated health professional is respond to negative Google reviews.

So someone who's never been a patient ever could leave a horrific review. And we can't do anything about an that had a third point, but now I've forgotten it.

The thing is, is that as people that seek social proofs and we want to seek social proof in our health care experience, we might not be able to write.

It's different than like, you know, looking at a restaurant review and someone's had an amazing birthday there and someone who, like, absolutely loves their cheesecake.

Instead, we're looking at Google reviews that are, slanted towards the negatives. Our my Google reviews are almost 100% about the cancellation policy we have at our office, and it's never about the care.

Nobody ever got on there and said, Jordan's a horrible listener. Ray Jordan's bedside manner is just social. Never, right? Never. It's always about the cancellation policy.

Except these are like the very things that if you're as you're trying to embark on something, new, you're kind of going to look at this, right? Because you're deeply hoping that we can get a review just the same way as trying to get a review about these jeans.

You want to buy. So I'm going to suggest you think about your practitioner reviews a little bit more like Reddit and a little bit less like Google reviews or Amazon reviews, because most of your, health care practitioners actually can't get a positive, Google review.

We can't ask for them, and then we can't do anything about the negative ones. And so we just end up with a whole slew of negative ones. I want you to think a bit like Reddit folks, and I'm not a huge Reddit person, although I did have to, stop on the side of the road and refill the windshield washer fluid in my car recently, and I didn't know how to do it, and I used a combination of Reddit and YouTube to figure out how to do it, and that I was like, oh, this Reddit thing is actually really helpful.

So if you haven't been on Reddit, people can like upvote comments and upvote ideas and responses. So if someone says like, what are the best jeans? And there's 4 or 5 different options, people can like upvote options.

And so you can see it like move up the status ladder essentially if it's the very best answer for something, the practitioner that you seek out, the person that you want to see who is going to help you the most, probably has some Reddit upvote.

You just have to know what you're looking for. And they don't just mean social media following. Although I think that's really, can be quite powerful, right?

If they have a large social media following, it means that people connect with their content and that might really matter to you. Social media following you is a reflection of like how much people see themselves in that person, how relatable and shareable they feel like the content is.

We all want to be funny. Just admit it. We all want to be funny. And so if there is a page that has some relatable content or shareable content that you could share with your friends, you're a bit more likely to follow that person.

We might follow something that is like so hardcore educational that it gives us something really valuable to learn every single day, but we're more likely to follow something that feels like something we could reshare, and our friends would enjoy the people that we follow would we enjoy?

But social media following an engagement can be a great way to look for some, like Reddit thumbs up rate. It means that people are enjoying and engaging with this person and their content.

It means that they, perhaps are authentic, that they provide really great information online, that other people are attracted to. It might mean that they have a level of magnetism that can be really helpful for trying to move you forward, right?

If someone's got that like influence capability online, they probably can do the same thing with you and a one on one visit and influence you into changing.

And I mean that in actually the most positive way. I don't actually think the word influences as negative as I did, maybe even a year ago. There's lots written about how we need to support and coach patients through health change with positive elements of influence, and I think that you can actually seek that and look for that, like Reddit, vote, online and people that are sharing, but also they're they're having a magnetic experience online and people want to be around them.

I think that's actually why podcasts do so well at creating a movement and connection, because you actually feel like an intimate connection with the person who's having the conversation with you.

And that can actually be quite, quite helpful and quite powerful. So that's one way to look at those like sort of Reddit votes is looking online, but the other way that you're going to look for it and this you might not have thought of before, is you want to see organizations that are up voting that person you want to see opportunities that that person has had.

That's up for voting them. And what I mean by that is that, I mean, in my career, I've been invited to speak on many, many stages and how if you think about it like the work back on that is, how do you get asked to be an expert on a panel, or to write for a magazine, or to be a spokesperson for a particular, product or company?

You get asked that because you are knowledgeable, because you are personable, because you're agreeable, which hopefully like in a positive way. But I just mean that you're like, fun to work with.

Nobody who is a total jerk get asked to be a panelist at an event, right? The people who are getting upvoted by other organizations is someone that you probably would love to work less.

They're being invited to speak on behalf of organizations because they're knowledgeable, because they are pragmatic and logical, because they can distill difficult concepts down into very understandable and relatable terms.

And that's literally what you need them to do for you in your house. So if you see someone who's like, I was on this podcast, I wrote an article for this.

I was quoted in this magazine, those are all Reddit upvotes on that person. For them being someone that people like to work with and that someone who has value and is adding a body of work that you would benefit from in a one on one capacity, right?

If they have the ability to create podcasts and posts and articles and sharing, and they're on this stage and that stage and on this organization's website, and they're being this generous with their knowledge, imagine what it's like to pay for their time.

Right. Like, think about it. If you love their free content, you're going to really love their paid content, which when you're choosing someone as a practitioner, that's a really great sort of metric.

If you absolutely adore them, you would adore working with them. It's a really great way to think about it. So I want you to think about that. Like Reddit vote.

Like if you see other organizations that are voting that person up, up in the status ladder, that's a really great way to think about how to work with someone versus solely looking at Google reviews.

Right? If we only took the negative reviews about the jeans, we would never buy them. They're mixed in with positives, right? People feel like their but has never looked better. But when you look at reviews for health care practitioners, that review is missing.

Why do they come up with that example? Of course, the review about your good but is missing on your health care providers page. But you see what I mean?

That we actually can't counterbalance negative reviews with positive ones for health care providers. The other thing you have to remember is that you in order for you to take a recommendation from someone, you have to be like them in order to benefit from their thoughts and feelings about their health care experience.

When you're embarking on this new journey, you're motivated. You're excited. You want to get better. You you're probably willing to invest in yourself, right?

The person that that you get that referral from needs to be similar in those attribute and not be cranky, frustrated, impossible to please. Right? High maintenance if you don't identify with those, attributes, don't take referral like reviews from people that have those attributes, because it's not going to be a good reflection on what the kind of experience that you want to have.

Right? Like imagine. And this is a really silly example, but there it this is really prominent in our work. You know, if someone signed up with a personal trainer and got to the gym and then wrote a Google review that said, can you believe it?

He wanted me to lift the weights. Like that's why I hired him. I hired him to lift the weights, not me. And many negative health care experiences often has an, component to it where the patient actually needs to do something or be motivated to do something, or be coached to do something, and yet they are not ready or willing or maybe able to actually do the things that they signed up to do.

So remember, if you're going to take reviews, you got to take them sort of with a grain of salt and ask yourself, like, how close am I to this person?

And am I looking for the same experience that they were looking for? Other ways are really simple ways to look for those Reddit upvotes. I think that can be really valuable.

The next piece is around the evidence, and when I wrote that article all those years ago, this is almost the exclusive thing that I wrote about. I was like your Pete, your practitioner needs to be evidence based.

And now, you know, fast forward ten years and I think we've overused that term evidence based, and it's almost become meaningless because what we've not done a good job of is like critically evaluating what the term evidence based means.

I can see that as someone who has expertise in critical appraisal, that's meaningless for you. What do I mean? Not every study that's published belongs in medicine, right?

Like we have a whole body of work in medicine that's pointing us towards truth, that we're pretty darn sure we know what we're doing for lots of conditions.

We learn new things every year, but not every study that gets published should overhaul the way we practice medicine. So just because something was published doesn't mean your doctor should change.

Being evidence based means looking at all the available literature on a topic, being pragmatic, logical, unbiased, looking at things through a very critical lens, looking for practice.

Changing research not just any old research and action. Being able to action new research as it becomes available and is important, but not just changing our mind.

Every three months because there's a new study that was published in rats or nematodes or whatever. Sometimes we confuse being evidence based with being cutting edge, and cutting edge has two sides to it, and the first person to say that we don't update standards of care often enough to acknowledge new research, and that that usually is about like new populations or new small groups of people that would benefit from a unique approach.

You know, we sometimes find things about gender differences, like for heart disease or blood pressure, or maybe there's a big age difference between pre and post menopausal people and how they are going to respond to a treatment.

Maybe we find a big racial difference for how people will respond to a treatment, and the guidelines sometimes are not updated fast enough for us to acknowledge that new research. And that's a problem.

But being so cutting edge that we're actually adopting things into your medicine medical plan before we've really proven them, that's not evidence based.

And when you see a practitioner who's jumping on every single brand new study and trend, that's more problematic than it is to actually stick stick to our guns and like, stick to the thing we know about medicine in this current, current state.

Now, if your health is your hobby and you are a total health hacker and you want to wear whatever color lens of the walking glasses is, you know, popular right now, maybe you do want a practitioner who is so cutting edge that you're doing things that have not been proven in humans.

That is totally up to you. Most of us, if we got really down into it, we would want just the right answer. And the right answer isn't always the most recent paper.

Right? The right answer is a, complex web of decision making based on all the papers. So I would say that, like, you know, people who are evidence based, we've really almost have to question what we think that means now and make sure that we're talking the right language.

There's a big difference, like I said, between being evidence based and being cutting at. So that's that. Okay. And then the last part, as you're deciding who to see and who to work with, is that you actually need that person to be a pretty darn good coach.

So health I mean, there's parts of health care where your relationship with the person you're working with doesn't matter, right? Like your knee surgeon could be a total jerk, have the worst bedside manner, and you absolutely get better shoes with like, you come out of there and you're like, man, that guy was rough, but I'm better.

Many areas of health care require relationship based care for us to see an outcome, right? You actually have to get along with your doctor or for you to have an outcome.

You actually have to have provider time and work with the person for you to have an outcome. Nutrition is the best example. We need you to do a thing.

You need to take it home and then you do the thing and that doesn't work if you don't like your practitioner, right? If you leave your nutritionists or your naturopaths appointment, they like to actually think, I like the approach.

What did they say? I have now? Blah. I hate that part. It'd be art. It would be really hard to dislike your practitioner and follow through. Now every day you have to not snack.

You're going to be happy. Fun, right? How am I supposed to do this? I don't even like them. You can totally not like your surgeon. I bet your surgeon is maybe just having a bad day.

I bet they're awesome, but we could totally not like them and the treatment would still work. You have to have a relationship with everybody who's helping you do behavior change as part of your, treatment strategy, which is why I like that Reddit review kind of experience, where if other people are uploading them because they're lovely to work with, I think that's really important because that maybe is going to matter when you work with them, but you really need someone who is a good coach and they need to be able to, like, see you right and see your value.

They need to be able to inspire you and right find your strengths and strengthen them with you. They need you to overcome your weaknesses. They need you to figure out how to navigate turbulence.

Like I said, don't snack. And now your partner is eating Doritos on the couch. How are we going to navigate this? They need to be happy with that, but they also need to be able to give you tough love.

And so without that, I don't actually think we're able to make much progress, because otherwise we would just placate each other all the time. And I think that's where I had good success in practice, is that I actually really it's interesting.

Empathy is very low on my natural skill set. List. I've done my cliftonstrengths and empathy is my lowest. If you've ever worked with me as a patient, you've maybe find that surprising.

But I have very good tactical empathy. Meaning empathy when you need me to have it right. It's like tactical. It gets part of a strategy, and it doesn't mean that it's fake.

It just means that it's being turned on at a moment where it's really, really necessary for you to have empathy. But then I actually have this incredible ability to turn it off because that's my natural state and be like, well, you said you wanted to get better, so you need to actually change.

And having someone who's able to navigate that with you is really important, which is why it's so important that your clinician and you get out, right.

You need to get along, you need to trust each other, and you need to actually lean into that relationship with them so that they can help you change. So if we go back, you know, thinking about the reviews and thinking about what it's like to pick a practitioner, if you're going to listen to what your friends say, make sure that their friends that are like you right, and that you're surrounding yourself by with people who are motivated, willing to change, are willing to make mistakes, willing to try, try, try again.

Because that's actually what health change requires. None of you are going to hit it out of the park on your first at bat, and so you have to be willing to try it over and over and over again.

So the question of like, who do you work with? You need someone that you're going to be willing to show up with in your failures. You need to work with someone who you're going to show up, even if you did none of it. You even if you have to admit that you did 0% of a plan, knowing that they have the compassion and empathy to meet you there, but also the ability to try and help you move forward.

Because that's honestly what you're looking for. If you're asking for a behavior change. So how do you pick a practitioner? I think you need to consider a lot of things, but it's very different than buying a pair of jeans, right?

Because often the things that we're using to make those kinds of decisions are very external. You can look and see what their body type is like, kind of the same as mine.

But when you're making a health decision, your motivation, your self-limiting beliefs, your diagnosis, these are things that are probably hidden and the same when you're looking at your friend and going like, well, who did they see?

Those parts of them are probably hidden too. I mean, depending on your depth of relationship, you may not know those things about your friend or your coworker or your sister, or anyone who's giving you a rough feeling.

And so I think it's important that as you to make a decision about who you see, that you actually step back and think about, like, what do I need? What do I want?

Right? What what does support look like to me? If this is perfect for me and my health care provider, we're sailing into the sunset together and I was being super successful.

What do I actually imagine that looking like? And then use the strategies I've given you today, the reviews and your Reddit upvotes, making the decision between being evidence based and cutting edge, because that's those are very different things.

And then how to decide if someone is going to be the right kind of coach for you. And think about it from those three perspectives, versus just taking things at face value from a bunch of Google reviews, or maybe a referral from a friend who's not that much like you.

I hope you enjoyed this episode. And if you're an Ontario, spark plug for my, practice, which has amazing clinicians in it, if you're in Ontario, Clarity Health does serve people all over Ontario virtually.

And we are in the GTA, specifically in, in Burlington and support patients in person in that location. We have, lots of naturopathy doctors and an integrated, medical doctor who focuses on weight management and obesity medicine.

And in my opinion, this is my read it up, voting for them. There are some of the best of the best in their industry. And I would, absolutely trust them with my with my family members.

And so if you're looking for, a place to grow and a, group of practitioners that can support you, then they would certainly welcome you with open arms.

I hope you enjoyed the episode, and I will I will see you next week. Thank you for tuning in to Doctor Talks. We hope today's episode has enlightened and inspired you on your path to optimal health.

Each day is a new opportunity to make choices that empower your well-being. For more insights and strategies, subscribe to our podcast and visit our website w ww di doctor Talksport.com.

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Why Choosing a Healthcare Practitioner is Harder Than You Think (And How to Do It Right)

Jordan Robertson, ND

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