podcasts

Podcast

Guest Bios:

Kara Parker, MD, IFMCP, is a board-certified family doctor who has been practicing functional, integrative, and lifestyle medicine at Hennepin Healthcare (HCMC) with a low-resource population for over 20 years. At the Whittier Clinic, Dr. Parker and other providers offer integrative primary care to help patients reach their health goals and obtain their best health outcomes. Dr. Parker is also an educator for IFM, has worked with programs teaching functional medicine to DOD and VA practitioners, and is the medical director of the Whittier Clinic Group Medical Visits program.

Transcript:

Kalea Wattles, ND:
Functional medicine recognizes the important connection between mental, emotional, spiritual health and overall physical health and well-being. Physiological disturbances in these areas are a vital part of a patient’s health story and are highlighted at the core of the functional medicine matrix. How do clinicians address the mental, emotional, spiritual connection to physiology when working within low resource communities and with patients who experience healthcare access issues?

Kara Parker, MD, IFMCP
In a one-on-one visit with patients in the room, I find it extremely helpful to bring up information that really shows diagrammatically what some of these relationships are. So for example, you know, if we’re gonna talk about in a context of stress, and we identify, okay, this is a person who might have some reactivity and maybe a history of trauma. And bringing up an image of, for example, the polyvagal theory. And here are the different stages of what you might be experiencing, and here’s physiologically what that feels like, and here is how we can do things to rebalance that. I think the more three dimensional or two dimensional that you can make things, the better.

Kalea Wattles
In this episode of Pathways to Well-Being, we welcome 2024 AIC speaker Dr. Kara Parker to discuss how social determinants of health impact a personalized approach to care. Welcome to the show, Dr. Parker.

Kara Parker
Thanks, Kalea. Nice to be here. Appreciate the opportunity.

Kalea Wattles
We have a long history of chatting with you about social determinants of health and how you incorporate this type of care into your practice. And I thought it would be important to give our listeners a little background and a little context and have you describe the community and the population that you’re currently serving.

Kara Parker
Yeah, I feel like a broken record. So I’m in the same community I’ve been in for 23 years, actually. I was a resident here in this community and then staff physician for over 20 years. So I’ve been practicing integrative functional lifestyle medicine through Hennepin Healthcare and in the Department of Family Medicine. So I’m embedded with a residency teaching program, and we’re in south Minneapolis. The community right here outside the window I’m looking at, I can look and see an encampment of unhoused people in our community. We have a large immigrant population just to this way. We often have Ecuadorian refugee immigrants outside every morning holding a drill in hand looking for work. So it’s…a Somali mall, I have a line of sight to a community of Somali American people that congregate in some buildings. We’ve got a mosque. And so it’s a really vibrant, very diverse, and low resource population that is the people right outside our walls that we primarily serve.

Kalea Wattles
We know, and I’ve heard you talk about this for years, that social determinants of health are so impactful to our health trajectory. And of course, the core of our functional medicine approach is to consider someone’s mental, emotional, spiritual health. The population that you’re working with, I’m wondering, are patients seeking care specifically for support in their mental health, in their spiritual health, or is it more common that they present for some other chronic condition, but then that gives you the opportunity to explore these areas?

Kara Parker
I don’t think people separate it as much as we do. So, especially when I’m dealing with people from other cultures, other communities, they’re coming for their suffering and their symptoms, and they’re generally not at all opposed to explore all aspects of that, including mental, emotional, and spiritual. And so sometimes people are definitely coming about their mood. Oftentimes it’s more about symptoms that they’re concerned about. And then as we explore, you know, the whole aspect of their being, mentally, emotional, spiritual becomes clearly an integrated part that it’s, we define a way, but people see it as the aspect of what they’re dealing with, you know, not so separated. So I find that it is very much a part of some of the most important aspects of getting to know a person is to ask those meaningful questions, you know, what is meaningful for you? And I think that patients are often really touched that that’s a part of the encounter. So it becomes the M-E-S aspect of the matrix, becomes part of the therapeutic encounter in that it gives you a window in to ask questions and make a connection with patients that is often not done in our healthcare system. So it becomes something really unique to distinguish this type of care from usual care, even though I would say this is good family medicine, we try, I’m on our behavioral health team, we teach our residents to do this, but in the reality of a quick visit, it often gets left out. So people don’t necessarily expect it as part of their care.

Kalea Wattles
I think you’ve touched on this important point about the practicality of it all. And as a primary care doc, I’m always thinking about, how do I realistically incorporate this into my therapeutic encounter? So I’m thinking of someone who might come into the office because they have hypertension or diabetes, and they have something that they want to talk about. It’s their goal to manage their hypertension, so they come into the office. How do you then access this mental, emotional, spiritual component? Is it you’re incorporating these thoughtful questions about their mental health into every visit, or it’s a certain type of person you’ll explore this with? What does that look like in the actual office visit?

Kara Parker
Hmm. That’s a good question. I think in the actual office visit, first of all, I find that, you know, we’re always taught in functional medicine to really center yourself. And so when I am clear about where I am mentally, emotionally, and spiritually and centered and then can let go of that but bring the capacity for asking about that into the room, like with any good encounter and interview, you’re going to be reading the person. And as you start to explore things, I really let the person I’m talking to share with me what’s most important to them. For some people, talking about how they’re thinking and what they need care about, about that thinking about their emotional life, about their spiritual life, is at the forefront and very important to them. But just starting out with some questions, you know, if we’re going to talk about high blood pressure, I’m sure that people listening to this practicing functional medicine resonate with the fact that patients very rarely come in saying, I can’t wait for meds for my blood pressure. They come in saying, what can I possibly do to lower this without taking medications? And it’s a very common thing, right? And people have a lot of thoughts about what it means to have high blood pressure, maybe a lot of emotions around it. And it’s meaningful to them that they’re experiencing this symptom that they know is important to their heart health and to their overall health. And they haven’t been able to regulate it yet on their own; hence, they’re in your office working with you on it. So there’s a lot to explore mentally, emotionally, and spiritually about that. And you just kind of send out some questions and see what arises. Certainly, with the example of hypertension, we’re going to talk about stress and, you know, how that is in people’s lives, how that plays out, how is their thinking? What types of supports do they have? And things like that. So it’s not, it actually doesn’t take much time at all to do a few probing questions on that. And then you just see what comes back at you and where people want to go, and we go from there.

Kalea Wattles
And do you find yourself then having these conversations where you’re linking our modifiable lifestyle factors, so stress or even a trauma history, linking that back to physiology and showing the patient how those things are connected? Is that something that you’re doing regularly?

Kara Parker
All the time, and thank goodness for the internet, you know, I do some virtual visits, mostly in person, and I think we can touch on group visits. That’s certainly a place where we do really in-depth teaching on that. But in a one-on-one visit with patients in the room, I find it extremely helpful to bring up information that really shows diagrammatically what some of these relationships are. So for example, you know, if we’re gonna talk about in a context of stress and we identify, okay, this is a person who might have some reactivity and maybe a history of trauma and bringing up an image of, for example, the polyvagal theory. And here are the different stages of what you might be experiencing, and here’s physiologically what that feels like, and here is how we can do things to rebalance that. I think the more three dimensional or two dimensional that you can make things, the better. And that’s how we maximize our group visits programs. So, you know, one-on-one visit, I have 30-minute visits, one-hour intakes, 30-minute follow ups. And so you can do a lot of education in that time, but when you pull people out into a shared medical appointment or group visit, and there’s two hours to really explore things in-depth, that’s where you can not only teach intellectually but also help people experience things. So, just to give an example. Right now, we’re running a mindfulness-based stress reduction group, or mind-body skills group visit, and it is people with chronic illness. And so every visit for me to bill as a provider, I am linking their pathway of learning these skills to their physical symptoms. And so we’re always pulling up things and people are talking about, for example, last week a participant who is hospitalized frequently, has blood pressure, diabetes, coronary artery disease, asthma that’s poorly treated, has had COVID, some long-COVID symptoms, really long list. She’s been experiencing some muscle twitches that are really scary to her. So been in the ER a number of times, been scanned, head scans are clear, but these tremors and twitches keep coming up. And so as she’s gone through our mindfulness program, she said, you know, I practiced the two feet, one breath, and then said, tremors, not right now. You know? And as she’s been going along and doing the various practices, she finds that walking meditation actually helps the most with reducing the tremors when they’re about to come on. And she was reflecting that she hasn’t been in the emergency department, and she doesn’t feel as scared about her symptoms now that she knows she has some capacity to regulate them. So really nice example of using a mind-body approach to help empower people to deal with their symptoms.

Kalea Wattles
Oh yes. Beautiful example. And I’m wondering, we’ll talk in a little bit about how you utilize group visits, but I’m just wondering, how do you select the type of patient that’s going to be a good candidate for a group? Are there some that really thrive more in a one-to-one setting? Or do you find that almost everyone is more successful in the group?

Kara Parker
Hmm, well, getting back to social determinants of health, I think first of all, you know, minus a person who’s really introverted or just doesn’t want to experience that type of a thing, what really is the selection for our group visits is whether people can get to them or have internet access. So we do both. We now do hybrid, so this is our group visit space here. People will come in, but in the mindfulness group, we have people in person and we have people online. And the barriers to that are literally, hey, I’ve got other medical appointments, or I can’t skip work, or it takes three bus lines to get into the group visit and I can do it once or twice, but I can’t do it for an eight series. So selection becomes about as much almost about privilege to access medical care. With that being said, we are bridging out into the community. We’ve set up some of our pain-based group visits through grants, have gone out to homeless shelters, some of our Native American community centers, and a bunch of our local community centers and gone to patients to do group visits. My colleague Dr. Haddow has been a big part of that. And then out of all of those different places, you invite people who are able to come in to come to our clinic and to continue the work. So that’s one way. You know, certainly if people, it is fairly common, actually, for someone to have an active mental health issue, to be under the influence of substances, for example, or to just not be in a capacity where being a member of a group and talking about health care and hearing about other people’s health issues is right for them at this time. And so they kind of self-select themselves. It’s very rare that we have to say, you know, I don’t think this is right for you at this time. Try again in the future. But really, anyone who resonates with coming to a group visit is really invited to a group visit. And, you know, we have over the past decade had such beautiful and diverse mixed groups. We’ve kind of seen it all. We’ve kind of seen it all, we’ve kind of covered it all. And as I advance through this practice and look at what’s the biggest bang for our buck with patients, we really keep coming back to adding as much mindfulness and mind-body practices for patients. And that really hits on the center of the mental, emotional, and spiritual aspect. When you think about what do we do in medical care, especially in a standard clinical system, that really impacts people’s capacity. It’s not unique to our clinic and our system that we have low access to psychologists, especially psychologists in the language and of the culture that people may need their mental health care. We don’t easily have access to, you know, health coaches and things like that. And so we do what we can to help empower people, give them agency, and work on their own self-regulation of understanding what their thoughts are, understanding what their emotions are, what they’re utilized for, and finding some ways to self-regulate that, to work with then, therefore, their physiological processes and symptoms, ultimately even down to labs and certainly behaviors.

Kalea Wattles
Wow. As a clinician, so many questions are coming up for me about how do you do what you do, because it does seem like these are hard, very rewarding, but challenging situations to navigate, to make sure that people are getting the care that they truly deserve. And a question has come up for me in my own practice, and I think it’s kind of similar to labs, how we were all trained, you know, only order labs that you are comfortable interpreting. And it’s similar to me thinking about these questions about social determinants. You know, do you feel safe in your neighborhood? And do you have access to the food that you need? Do you feel safe at home? I think, I imagine that there are other clinicians out there who are hesitant to ask these questions because we don’t know what to do with the answer. Maybe we haven’t cultivated those skills. And so from your perspective, I’m just interested, I’ll use this example of maybe I don’t feel safe in my neighborhood because I’ve thought about this one a lot. From your perspective, would it be the clinician’s role to help the patient find those self-regulating mechanisms so that when they feel something scary that they have the ability to kind of cope with that scenario? Or is it our role to help them get out of the neighborhood that they don’t feel safe in? I have so much uncertainty about how to act.

Kara Parker
Yeah, that’s such a great question. I’m gonna broaden it a bit because adding to that, along with social determinants of health and asking those questions when you don’t have resources to immediately fix them is, what do you do about trauma? And so we really, you know, we do trauma-informed, trauma-responsive care, and we teach it to our residents, we teach it to our clinicians. One of the things looking at the timeline of functional medicine that I feel like is really important to be aware of is allowing people to share that they have had a significant piece in their life without opening up the details of that, so using universal precautions for trauma. If you’re not a trauma therapist and aren’t really skilled, if you’re gonna open up someone’s trauma to help them close it and get back, then be cautious and allow them to choose what they share with you. I work with our military practitioners through IFM, and there is a lot of trauma in service members, there’s a lot of trauma in what they’ve seen. And so as you advise them on how to work with service members on a timeline, you know, being clear to say, hey, you can put down here in this box ‘stuff happened’ and just leave it as a box. If you don’t wanna write down the details of that or share those with me, fine. If you would like help on that, let me know, and we’ll get you to a professional who can work with you.

But just for listeners out there, dealing with anyone, trauma’s everywhere. It doesn’t have to be a low resource population, right? The stats on that are just heartbreaking. I deal with a population of people who have multiple stacked trauma, maybe more, you know, just on a number scale, types of trauma, perhaps, than a more privileged population. But given that trauma is so pervasive, be really careful about how you take a history and what you open up, what you do with that.

Your question, Kalea, about what do we do with social determinants of health questions? I feel like in my experiences that in caring and acknowledging that people are in a tough situation, even though you don’t have immediate resources to do something about it, it’s still worth understanding that. First of all, it really matters if someone is about to lose their housing or cannot sleep at night because there’s gunshots going on. That is this corridor right here, and it’s getting better. But for the past four years, it’s been really, really impactful to our patients’ sleeping lives and waking lives, and hearing that and understanding that I don’t have food access, yeah, great, I’d love to do this anti-inflammatory diet, but the gas station doesn’t have it. It is okay to ask those questions. You know, you are sitting with the patient, you’re sensing who they are and where they’re at, and caring and investigating and like, wow, this is a lot. I’m really sorry you’re going through this. Let me see if we can refer you to some resources. That is out of my league, but I really want to acknowledge what you’re experiencing here. That’s one thing. It happens all the time here.

You know, I’m at a clinic, our department is 90 clinicians. We are at a very full-service clinic, and we don’t have the resources. We’ve got Ecuadorian people walking in all the time who have nothing. And because they, you know, don’t have access to health insurance, they get incredibly large bills from us. We have to be thinking every day, what can we do for them? And so we bring together community resources and we go out in the community to churches and where they are, and we do our best, but there are huge gaps in what we’re offering them, but still, we ask, and we care, you know, we try. And then you know where the gaps are, too. So yeah. But it’s not easy. It’s not easy to have so many resources and so much opportunity and then to really not be able to connect that with people just because of the resources and capacity that they have. I see this every day. I also have resourced and privileged patients, so I see a real gamut. And when people have social determinants of health covered, they have financial stability, they can get food and choose it, and they will be able to follow instructions, you might say, they can buy a few supplements, they might even have some money for some, you know, little functional stool test, something like that. In general, people get better faster, and you can get to the mental, emotional, and spiritual work more fully generally when those other things are covered for, right? When people’s basic survival is not there… Working with long COVID, boy, was it apparent to me, as we applied, you know, I did this protocol development with Laurie Hofmann, Patrick Hanaway, Kristine Burke, and others, and my patients who had lower social determinants of health, they got the same information, they got the same resources, they even got free supplements. But to put the package together to reliably take them, to make it to the group visit to get things, and just with everything else they were dealing with in their lives, including lack of safety and lack of stable housing, same program implemented, it just doesn’t work as well. There’s too many other factors.

And when you think about mental, emotional, and spiritual factors and how they impact physiology, you know, the inflammation of chronic pervasive stress, so just adrenaline all the time leading to hyper cortisol release until you’re absolutely depleted is a common thing that we see coming into our office here. And that is a slow, steady burn, like just lights gasoline all along the matrix, you know? There are times where you get people into good control with their diabetes, with their blood pressure, with their long-COVID symptoms, and a major event happens that’s just a common, chronic, usual thing in people’s lives. And that is just absolutely destabilizing to the whole matrix, right? You can imagine. So working with a population of people that has just more data, more data on their social determinants of health, less capacity for lifestyle, more filling in their matrix, it’s a long-term relationship. And as I think back over the two decades I’ve been here, you know, we have a big clinic. I have common medical assistants I work with, but they rotate. And I am, just recently, a couple of them have come back to work with us in our integrative health functional medicine group. And we’re just delighting together as we’re like, oh, Dr. Parker, I remember this patient from like 8, 10 years ago, and they were doing so poorly, they were so worried about their health. I couldn’t believe it when I roomed them how stable they are, you know? So we really do see that. But it’s a long, long, long term, slow turn of the ship with a lot of ups and downs. And that’s more common than the functional medicine where you get a person who can really apply the whole program and they’re just miraculously better. You know, more commonly the story is, it’s a long-term, slow turn, and we just really hope that there’s more ups than downs and you can get people going in the right way. The mental, emotional, spiritual piece of that, if you can help people with their suffering, with what things mean to them, with how they think about it, sometimes that’s all you have with a low resource population. And that can be the most important medicine that you’re giving when, you know, other resources are lacking. So it becomes, in that way, a focus of the therapy itself. And as I look over people and think about stories, I think about just how important that is to be a person in someone’s life that they trust and that you can map their health journey with and watch ways in which they’ve suffered be released over time. So it’s very rewarding. Yeah.

Kalea Wattles
Thank you for that. It’s reassuring and comforting to hear you essentially leverage this therapeutic partnership that we value so much in functional medicine and just showing up and honoring the story and hearing it. And being a witness to one’s suffering, like you said, I think has its own healing capacity. And you kind of answered this, but as I was thinking about this topic and thinking about the work that you do, and then the work that I do with a different population, I was just thinking about, it’s clear how important our mental, emotional, spiritual health is. We’ve made a case for that. I think we can all agree that’s so important. But when someone is facing challenges to their basic needs of not knowing when their next meal is, where that will come from, or, you know, do they have housing insecurity? It was a little bit hard for me to understand how I make the case for dedicating the time to a meditative practice or prayer or mindfulness when there’s this sense of urgency. But maybe that’s my own urgency and not so much the patient’s. So I would love to hear, how do you hold those two occurrences?

Kara Parker
Yeah, well, I’ll tell you what happened today. I asked the patient, you know, a person with severe asthma and allergies who a colleague sent to me, and we go through the story and, you know, mold, mold, mold, mold, that he was unaware of. He’s now 48 and he’s like, oh my gosh, throughout my whole life and my current situation? Huh. You know? So I said, well, how’s your thinking? And he’s like, ugh. Muddled, unclear. I can’t think, my mood is so low. And now that you’re telling me about what mycotoxins can do, my mood cleared up quite a bit when I myself got out major allergens. But there’s still a long way to go. And I can see that, you know, what I need to do is get out of this apartment. I can’t afford to do that right now. This is gonna be a bit. I’m gonna be in this situation for a bit, and I know that it’s toxic for me, so let’s talk about how we can reduce that. But what he said when I said, well, what about your emotional health and your spiritual health? And he’s like, you know what? I don’t even know who I am. I don’t even know who I am. And I don’t know who I am because I think I’ve been under such a barrage of stress my entire life and so unstable in my basic needs and then in my health issues. He’s like, let’s come back to that question. You’re gonna know I’m better when I can answer that question. I thought that was really great, right? But he’s telling me this is a marker of my health that I want you to ask about again, when I can say who I am and what’s meaningful to me, I’m there to be able to even answer the question. So yeah, I think, you know another…another factor about mental, emotional, spiritual health and dealing with participants is I do our well-being work for our department. And so we have just recently done a moral injury study on actually all 7,000 employees at Hennepin Healthcare, and they got a percentage back, about half back. And our department stats show that 90% of our medical assistants, nurses, providers, and clerks, people who check in, who answered the survey, said that working with a low social determinants of health population, and especially the effects of racism and inequity, is a moral injury because we can’t do our best care for patients when we can’t adequately address those issues. So you are sitting with this, Kalea, and saying, I don’t know if I should ask this stuff. And how do I even start when I can’t address what’s real and important? We’re all dealing with that. And it is as important and disabling to the provider, as stressful to the provider, to not be adequately resourced to deal with the real upstream issues. We’re functional medicine, these are upstream issues that matter. So you’re not alone. And it’s a majority in primary care of what we deal with and what chronically distresses us working with people, not having adequate resources, and having these really tough things come in that we don’t have the cure for. You know, we have great options in functional medicine, wonderful tools, but if you can’t get to them, it’s distressing. And so just have to acknowledge that’s real. It takes all of society, our government, you know, our food, our industries, all of this to bring people up and address issues of adequate housing. It can’t be addressed right here with you and I and patients. But I think just acknowledging that it’s important and being, having self-compassion for that gap, because it is a trauma and doesn’t feel good to any of us to know that we can’t do our best work.

Kalea Wattles
Right. Well, I think this therapeutic partnership that we’ve talked about is such a vital component of this healing relationship, and it makes sense to me how this, a single provider can interact with their patient. But I’d love to talk about your group visits as well, because I imagine there is some therapeutic partnership between participants that enhances their healing. And will you tell us a little bit about your experience with that?

Kara Parker
Yeah, yeah. Oh my gosh. It’s really the village that does the work. And so 11 years ago when I gathered 22 of my most difficult patients, I did 11 and 11, and I got out of the first group visit and I was like, oh my gosh, I thought I was going to work so hard today. And I didn’t. They took care of each other, and that’s what really told me to keep going because there is such limitations as to what we can do. So when you gather that group around whatever you’re gathering them for, so we’ve done just lifestyle in general, diabetes, pre-diabetes, cancer, mindfulness, aging, pain, certainly, pregnancy, we have centering pregnancy here, and centering peds and parenting and all that. When you gather that group, the health changes, and the benefits are just leveraged so much. They amplify. And as a provider, watching people receive, and it’s not you doing the giving, it’s therapeutic. It is really therapeutic. So I love, as a functional medicine provider, being able to use that time to just boom, deliver information, to connect physiology like you’re talking about. How do you connect the mind, the emotions, with the physiology? Well, let’s talk about the microbiome. Let’s talk about the bugs that make oxytocin. Let’s talk about ways we can eat to increase these really important players that are going to do a ton of work for us. And I get to say that to 12 people instead of just a tiny bit of that to one person in a one-on-one visit. But then the real gold comes as people then share their ideas about that, their experience with that. Hey, here’s how I get these, you know, prebiotic things at the food shelf. I saw some, there’s some asparagus there. And did you guys know, da da da da da. And then also, when they support each other and hear each other’s stories and acknowledge each other’s pain. In my long-COVID group visits, this was essential to working with people who were so tired and so fogged and really disabled pretty quickly, taken out of their lives pretty quickly. To have a peer support group that understood what they were going through, acknowledged what they were saying, heard it and had helpful things to offer, you don’t get that out in society. You know, people in that type of a situation are shunned in their workplace and in their family where maybe there isn’t an understanding of a long-term chronic condition and support for that. So even for long COVID, even in their doctor’s office, unfortunately, right? Misunderstood, misdiagnosed, mistreated. So that peer support and gathering of a shared understanding and having time and space for that is therapeutic beyond words really to say. I think we do ear points group visits. So this room is just full of people in chronic pain who come in and we pop in the battlefield acupuncture points and then do a meditation with people. And we are very sure that people have a better response as a collective than they do one-on-one in the room. So, same needles, but the experience of doing it together, of hearing your neighbors say, oh my gosh, my pain went away last week for the first time in 10 years. And oh, hey, here’s what I did. And then also to work on some self-regulating, pain regulating techniques together? Absolutely leverages and maximizes it. They get really, really good reductions in pain in this group. And it’s full. It’s a walk-in, people don’t even have to sign up. They just show up. And they commonly call me to come help put needles in because there’s 22 people in the room, you know, which, it’s not an easy clinic to get to. People are really going out of their way to get here for that therapy. And the group is the gold for sure on that, so yeah.

Kalea Wattles
The group is the gold. Beautiful. And just thinking logistics, if there’s anyone else listening who is inspired to start utilizing group visits in their own clinical setting, just will you give us a primer of how you structure the majority of these? Is it some education in the beginning and then an opportunity for the group to share, or how do you set up the visit?

Kara Parker
Yeah, there’s lots of ways to set up the visit. You know, Jeff Geller with his integrated group medical visits would have very much a more loose structure, doesn’t bill for everybody. What we find works well if you are billing insurance and need to document chronic conditions and really satisfy the billing, we do a two-hour visit for most groups. And in the first, in the beginning, you’re going to be setting up expectations, talking about confidentiality, letting people introduce themselves and get into the space. Once you’re in a follow-up group, we would start with a mind-body practice, always with some brief mind-body practice. When you’re gathering people who are a little bit anxious, you know, it’s anxiety provoking to come to a clinic and to have a medical encounter, even if it’s someone you trust, a positive experience you’re looking forward to. So gathering people together, you help them co-regulate and get into as much of a kind of relaxation response as possible. So we’ll do a brief mind-body thing, maybe five minutes together as when we have a quorum of people gathered. And then we’ll have a question, some kind of a question that related to either how they did through the week, their chronic condition, their coping, just how they are. It’s really, really important for each person to get their voice into the space and their presence in the space with each other. So then we’ll dive into some teaching, you know, functional medicine–based physiological linkages for whatever the topic is. And people really appreciate that. So we give a lot of resources. We use a lot of the toolkit. When they’re virtual, well, we always send out MyChart messages with a ton of things. We record things, we record body practices that we do in the visit or that we’re teaching in the visit for people to review after. It’s always open for questions so people can interrupt. They discuss, we ask them questions as we’re doing the teaching, so that it’s everybody’s teaching each other as we’re learning together about how physiology and function work. And then we’ll do another long-form mind-body practice around the topic, whether it’s pain, if it’s mitochondria, if it’s, you know, we’re talking about nutrition, we might do mindful eating. If we’re doing something about mood, we might do love and kindness or self-compassion, or just a wide variety of things. And really, as a group together, get into entrainment, get into this shared space where you then come out of the practice and look around at each other and go, wow, you look different. You can really see it. You can see how people arrive, and you can see where they get to through this. And I think it’s another motivating factor for people to return. It also helps with bonding in the group. If you can get people in their ventral vagus, with their social and emotional engagement system online, it just helps, right? So we’ll do a long-form practice and then we’ll do reflections on how the group went, get some feedback, have some takeaways, and have people speak what they got out of the group that day. That’s kind of a general format for most of our groups built on different chronic conditions or, you know, yeah, so pretty simple. Once you build the structure, it’s very simple to drop in different topics. I don’t know if we have, we often have big things with sticky notes on our walls over here as we build different groups. I’m about to start one called Wholehearted, and it’s going to be a group on cardiovascular health, but of course include stress as that mentally, emotional, and spiritual health is absolutely important. And we’ll be aiming for a Department of Health grant to work with some of our people more impacted by health inequities. And so I’ll be working with a psychologist who’s mindfulness trained, who’s very involved in our different cultural communities and is more representative of that population. So going out into the community groups and bringing people here in a space where they feel safe. And easy to build, really making the bridges and the linkages and getting people recruited and engaged and just able to be here, that’s really the hardest part when you’re dealing with lots of barriers to access.

Kalea Wattles
Yeah, well, I really think that group visits are the future of medicine, of functional medicine, and I know all of our listeners, their interest is piqued. Well, I admire your commitment to leveraging community for your patients, for your colleagues. Thank you so much for spending time with us today and sharing all of your insights. It’s just a pleasure to talk with you.

Kara Parker
You too, Kalea. Thank you so much. Take care, everybody.

Kalea Wattles
Thanks everyone. To join the conversation on this topic, visit IFM’s pages on Facebook and Instagram. For more information about functional medicine, visit IFM.org.