Interview with Dr Brad Rachman Transcript

Dr. Weatherby:
Well, welcome everybody. This is Dr. Dicken Weatherby and welcome to another of our success stories here. I’m joined today by Dr. Brad Rachman. Dr. Rachman is a functional medicine specialist, wholistic health, chiropractic physician. His background is that he’s studied biochemical engineering at the University of Michigan and completed his graduate studies with honors at Palmer University in Davenport, Iowa. In 1990, he completed clinical studies at the Institute for Functional Medicine in Gig Harbor, Washington which provides continuing clinical education to healthcare professionals.

In the mid-90’s, Dr. Rachman was named Vice President of Medical Sciences for Genova Diagnostics in Asheville, North Carolina. And while at Genova, he helped to develop Genovations, a pioneering medical tool that combines elements of genome science and preventative medicine to treat chronic diseases. Currently, Dr. Rachman is Medical Director of the Rachman Clinic in Black Mountain, North Carolina located in suburban Asheville in the Blue Ridge Mountains. The clinic offers functional medicine with an emphasis on chronic and challenging conditions.

And thank you, Dr. Rachman, again for taking time out of your busy practice to join us today.

Dr. Rachman:
Dr. Weatherby, it’s my pleasure. Thanks.

Dr. Weatherby:
So, I was wondering if you might just give us a short background on, on your clinic, and, and the type of patients that you see to sort of give us a sense of the type of work that you are doing in clinic?

Dr. Rachman:
I think from one perspective anybody sitting in the reception area of our clinic might see it as a primary care facility. And it does serve a few thousand families in that capacity, but they’re quite self-selective individuals and the majority of the patients that wind up here in the clinic, I call them the walking wounded. They’re, they’re individuals that have some form of chronic anomaly, and they’ve not been able to find a successful diagnosis that has proven to lead anybody to, you know, a treatment with any efficacy. I, I feel like these are individuals that don’t get better and they don’t die. They just continue to evolve in some element of, of chronicity and, and their overt expression of their symptoms can span across virtually every single organ system. So, they can span from everything from dermatologic to hematologic to hormonal and endocrine disregulation, and narrow endocrine disregulation. So, it’s really diverse. It’s very exciting. I wake up every morning excited to, you know, be an excellent sleuth and try to understand the essential cause of the issue.

Dr. Weatherby:
Great. Well, I, I think you’re really describing a lot of the functional medicine practices worldwide, and what, what practitioners are dealing with with patient populations. One of the things that sort of struck me was the, that a lot of these people are coming in maybe with a, with a previous diagnosis or maybe not even a diagnosis at all. So, and given your background at Genova Diagnostics, one of the premiere if not the premiere sort of advanced, how would we say, alternative medical labs in the world. I’m just wondering what role functional diagnostics plays in your practice?

Dr. Rachman:
It, it plays a fairly substantial role and, and I would, I would, you know, first preface that to say that every diagnostic test is potentially a functional test. Every test short of a psychology, you know, study or other specific marker for a genetic imbalance can give us really incredible insight about the function of the human body as opposed to trying to squeeze a patient into a taxonomy, you know, some **** that then, you know, leads us, you know, via some form of a formulary into, you know, the proper clinical application. I, I spent a fairly significant amount of time with routine laboratory testing, and I use it in a manner that’s anything but routine. But also I augment that with some specific test that help to discern with greater granularity what is really going on with the patient, but I’m, I’m quite appreciative of, of the role of routine chemistries and hematologies in, in helping me to kind of figure out what, what neighborhood am I in. Where, where am I going to spend this patient’s valuable time and healthcare resources to help them figure out what’s going on?

Dr. Weatherby:
Would you say that sort of blood testing is a fairly large part of your, of your diagnostic offerings?

Brad: I think it’s, I think it’s central to, to my practice. I try to envision how I would go about doing what I do. I feel like I do it well, and I get a lot of, you know, gratified patients as we discern really what’s going on with, with individuals and, you know, if I, if I try to think what would my life be like as a clinician without those, those tools, those like chemistry tools it would be very, very challenging.

Dr. Weatherby:
And I think one of the things that, you know, you and I have talked about in the past is the blood test results that come back from the lab, they’re the same results that a medical doctor, and allopathic physician is looking at. And I think one of the differences in the work that we do is we, and this is something that you sort of talked to me about is that one of the issues facing practitioners is that healthcare data like a blood test really lacks good meaning to us and particularly to our patients. I wonder if you could speak a little bit about that?

Dr. Rachman:
It’s, it’s quite common, in fact, it’s more, you know, the rule than the exception for a patient to actually come in already with some form of laboratory testing. Occasionally, I’ll be the first clinician to have done, done the testing, but more, more often, someone literally puts a laboratory printout, the, the reporting in front of me and it’s interesting because there’s all, there’s a very common theme to the way the information has been presented to the patient. And where, what, what they, you know, believe that they’ve gleaned from this. Most patients are sitting there looking at anywhere between a dozen to several dozen analytes, they have absolutely no clue what the names mean of, of each of these analytes. The piece of paper has some random scribbles on there clearly from, from the, either the referring physician or their primary care physician’s staff or, or from them directly that says this is good and do better here and this is, you know, bad. They’re looking at obviously individual analytes and I think they’re practicing what they need to do within, you know, those windows of 10, and the constraints of 10 minutes medicine where they are scanning down the laboratory report and looking for the h’s and the l’s, looking for the things that say high or low or, you know, god help us, a panic value. You know, they’re, they’re, they’re looking for that and if that doesn’t exist, if the liver enzymes are not, you know, outside of a laboratory’s “normal range” or reference range, there’s very little that’s written there. And patients more often than not describe that, you know, their blood values are negative and, you know, that’s why they’re here, they want to kind of figure out what really is going on.

Dr. Weatherby:
And then obviously, you know, where, where the role, the, the functional approach is how to extract more meaning from, from those numbers, in a, in a way that the patient can understand and can apply to their experience of their condition, I guess.

Dr. Rachman:
It’s the central, that’s the central theme which is, I, I find after doing this for 30 years and, you know, 6 to 7,000 patient visits that there is, there are acres and acres of diamonds locked, trapped inside of these medical reports that have escaped the, the, the, you know, prior clinical teams that have looked these, and I, I ascribed a lot of the value the patients get in working with me to what I’m able to uncover that, you know, that previously was overlooked.

Dr. Weatherby:
Exactly. And you’re using a functional health reporting tool in your office right now. Just wondering what life was like before that and maybe you could speak a little bit to what life has been like since you’ve had that tool available to you?

Dr. Rachman:
Before being able to have a tool that helped me to, to see the testing results with greater granularity and to be able to make the clinical correlations between values. I had to depend upon my brain. I have a great brain and I have an extraordinary memory, and yet, you know, there, there are certain limitations to the human brain’s capacity to remember everything especially when it needs to remember everything. To be able to draw statistical conclusions, the, the, the brain doesn’t, the human brain doesn’t typically look at things that way. It does some form of pattern recognition, but it’s somewhat limited. And more often than not, it’s, it’s not really capable of isolating a grouping of individual analytes, disparate analytes, analytes that may, some of them may wind up being, you know, of cell counts and some at the same time, may wind up being chemistry values. All of which may be within the laboratory’s normal reference range. And see the variation that exists and extrapolate the pattern to be able to determine if there is a clinical imbalance that, that makes sense to the presentation of the patient’s symptoms. And prior to having some software to help me to draw those unique patterns out, I missed a lot. I mean, I know, I missed a lot because with the presence of the software as a tool, I, I go back now. I, I re-enter previous values as we are about to move forward with the patient so that I can get a baseline of where they were, and, and I’m very honest with my patients and I often times, you know, will just say to them, wow look, you know, I didn’t have this tool, and look what we missed. I mean, this, this, was staring us, staring us in the face and I’m sorry but this, this was overlooked, but we’re not going to overlook it anymore. Dr. Weatherby, I just simply wasn’t able to see the patterns and wasn’t able to draw enough statistical significance just by wondering if the patient’s value is in or out of a laboratory’s reference range.

Dr. Weatherby:
Yeah, I think, you know, one of the things that you just alluded to there is one of the things that I really appreciate is the, sort of, the ability to look at the historical report. And see how values have changed over time. I’m wondering do you find that a value to your consultation?

Dr. Rachman:
I do, and, and, as, as each day goes by that, that I’m consulting with patients with the value of this, this software analysis tool, I find myself spending more and more time looking at the sequential trends in a patient’s physiology because we really now have three layers of, of information that helps me to make more sense of what’s actually going on with a patient. Number one, I get to see the patient’s value in a more sensitive and granular perspective than just looking at the reference range itself which we can delve into in a moment. Number two, I get to see patterns between analytes that I previously have overlooked. And four, I get to see the change over time. And to me, that’s function. To me, I’m able to actually be able to see a train wreck before it’s going to occur. Or to note when there is change occurring in a patient’s physiology ahead of where the symptoms are. Now, a very good pathology professor told me, you know, symptoms are the very last thing to show up, I mean the very last thing to show up, the first thing to show up in a pathologic process and one of the last things to go away. And it’s so true because how many times have we sat with a patient and known that we were really on to the right functional imbalance, the right diagnostics if you will, known that the treatment methodology was sound and making progress, but the patient is describing that their symptoms, you know, are still very much present. And by looking at the changes over time, I can look with integrity and a patient in the eye and say, I know this is moving in the correct direction. Or, you know, it’s not. If it’s moving in the right direction we need to hold steady with the treatment plan as follows, and I feel confident we’ll reach the conclusion where you feel better. Your physiology is already improving. You know, the other, the other speaks volumes also which is wow over time we’re not seeing the change we need to, there’s no need to pursue this clinical course anymore because we’re not getting the result, it’s not working. So, let’s go ahead, we’re going to make these changes and the level of confidence because of those three areas of analysis that I have in working with patients, it has elevated dramatically. I know it’s not everything. My clinical decision making hasn’t been usurped by a piece of software. There’s nothing that could ever match the combination of someone’s knowledge, their clinical experience, all the presentation of symptoms and cases they’ve seen, discussion with colleagues, nothing beats that as well as the training that we all have. As well as just good old gut instinct. But, you know, if we are busy flying a very complex jet aircraft where all the stakes matter, having the right instrumentation is critical to being able to fly that plane successfully and safely. Yes, if everything went out, you could, if you were a good pilot, you still need to be a good pilot, and you’re going to land the plane safely, but boy you can do so much of a better job and get to be more precise in being able to arrive at your goal destination if you have sophisticated instrumentation. And, and for me, the, the blood chemistry software is the centerpiece of my guidance system and helping people to understand what it is that’s really going on with their physiology and helping me to, to, to work my way through the decision making relative to that.

Dr. Weatherby:
Well, very, very eloquently put, I couldn’t agree with you more, and I love that analogy of a pilot having instrumentation. Obviously, they know how to fly an airplane but, yeah, I think you just put that very well. I was wondering if I could, just a final question, maybe just flip it around a little bit to the experience of, of your patients and whether you’ve had feedback from them in terms of what it means to them to have a report like that that they can take away, I mean, comparing it to the three pages of very obscure data that they would get from a lab or from their primary physicians to a report like that. I wonder if you could speak, if you have had any feedback from them, what, what it’s like for them on some level?

Dr. Rachman:
Yeah, I don’t, I certainly don’t want to, you know, over play the role that we all have as, as clinicians and treating physicians to be an educator. But for me, I see my role as a health educator to be equal to if not more important than my role as a great diagnostician and a great treating physician. If I can figure out what’s wrong with somebody, and I can know the right treatment but I can’t educate them, I can’t motivate them. I can’t convince them to make the necessary health changes and can’t communicate to them in a way that they understand what’s going on with them I’ve lost. I know I’ve lost because they won’t follow through. The, the study after study validates that a patient’s compliance with a required and recommended treatment schedule increases dramatically when they fully understand what’s going on with them. And the difference between having a, you know, piece of paper with a bunch of numbers and a bunch of written out fancy names of analytes with a couple of chicken scratches on it versus, you know, 20 plus pages of visually rich textured with very practical patient centered information about what’s going with them I routinely, it’s, it’s the exception, you know, to have, have patients not be impressed by this. They are often times jaw droppingly impressed to know that they’re going to leave the office with a full report that describes every single analyte, what is means to them relative to their clinical presentation. For me to sit down in the beginning of this and say you’re, you’re about to learn more about your body than you ever have before. And by the way, it’s all printed out for you and instead of the few pages that you typically have gotten from doctors in the past, I printed out these 23 pages, it explains everything to you. They all sit back in their chair, they kind of, there’s not only a sigh of relief but there’s this smile of appreciation where, like they, they know they’ve been, that, that somebody is getting them. Like what it really means to be a patient. And to receive that and to be able to use it as a tool, and for them to have an enduring copy of the information presented in the clinical case presentation. To me it makes the difference in successful treatment because I now have a patient that’s well educated, a patient that understands the need and the rationale between, behind the regime that I’m going to recommend for them. And moreover, they come back in with that report for follow up discussion because they see it as this kind of learning document. This enduring document and I know it’s important to them and, because they’re carrying it with them, it’s something they’ve saved, and it’s something that they’re using. So, I, I can’t, you know, overstate to me the value of, of having such a detailed report to be able to motivate and inspire patients relative to their health.

Dr. Weatherby:
Wow, that’s wonderful. Thanks for, for sharing that, and before we go, your practice is in just outside of Asheville, North Carolina is that correct?

Dr. Rachman:
It is.

Dr. Weatherby:
Do you, do you take patients for phone consults and things like that?

Dr. Rachman:
I do. I have a really diverse practice that extends into telemedicine and I enjoy every, every part of it.

Dr. Weatherby:
Wonderful. Well, that’s good to hear. Well, Dr. Rachman, again, thank you so much for, for taking time out of your very busy practice and your busy day for sharing your experiences with us and I really, really appreciate it.

Dr. Rachman:
My pleasure. Thanks, Dr. Weatherby.

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