“Telemedicine is going to be the way of the future”
: [00:00:01] Welcome to the Outcomes Rocket podcast where we inspire collaborative thinking, improved outcomes and business success with today’s most successful and inspiring healthcare leaders and influencers. And now your host, Saul Marquez
Saul Marquez: [00:00:18] Welcome back once again to the outcomes rocket podcast where we chat with today’s most successful and inspiring health care leaders. I want to invite you to go to outcomesrocket.health/reviews where you could rate and review today’s podcast because today I have an outstanding guest. His name is Dr. Sunjya Schweig. He is an amazing individual who I had the privilege to meet when I was at the Health Care 2.0 meeting. We had just a wonderful discussion. He is the co-founder and co director at the California Center for Functional Medicine. He’s an expert in complex chronic illnesses which require rigorous investigation and management. Think of them like that Dr. House. He’s been studying teaching and practicing integrative and functional medicine for over 20 years. He’s built a phenomenal practice with some great partners and an amazing team in California. And what I want to do is just open up the microphone to Sunjya to fill in any of the gaps of that intro and welcome to the podcast welcome to the podcast my friend.
Sunjya Schweig: [00:01:24] Thanks so much, Saul. That was great. I really want to add that I’m grateful to be here. I really appreciate the work that you’re doing to give us all insights into that process and mindset of being a health innovator and thinking outside the box. So many great lives together in what’s just incredibly exciting and dynamic time and health care. Yeah. Thank you.
Saul Marquez: [00:01:44] Thank you Sunjya. I will accept those words. And so I wanted to ask you you know go back to the beginning. What got you into health.
Sunjya Schweig: [00:01:53] Yes so for me it was really a calling. And you know I have not and my parents are not physicians like my grandpa was the doctor that used pediatrician. I didn’t know him super well so it kind of was there and in the back of my head. But you know really kind of came to me in high school and I really just knew that I want to go into medicine. And they also knew that I wanted to practice integrative and holistic medicine. That’s how I was raised as a kid. And so when I went to college at UC Berkeley and studied medical anthropology and Religious Studies which is an offshoot.
Saul Marquez: [00:02:25] That is cool by the way medical anthropology. That’s fascinating.
Sunjya Schweig: [00:02:31] Yeah. So I was always very very interested and open to the explanatory motto of what people come with. How do you understand they don’t know what other modalities are they using. So big picture yes as opposed to Western medicine which can be kind of reductionist production of science so it’s complicated when you try to bring in a big picture. But yeah that’s always my my framework. And in fact I did some research in college on alternative medical systems and then work. After college you can go straight to med school. I took some time in between and went and lived in Ecuador for a year.
Saul Marquez: [00:03:03] Wow very cool.
Sunjya Schweig: [00:03:05] I worked with a mobile surgical program there. So literally an operating room in a truck that was designed and built here in California and offering surgical care to the underserved in the super remote places of the Ecuadorian country in the jungle et cetera. And so that was also a incredibly fascinating time on the side that was doing research trying to understand you know how do these rural indigenous people who probably rarely go to the doctor understand what’s happening to them when this modern operating room comes and parks in their town for Iran run and does 50 or 60 different surgeries. Very interesting.
Saul Marquez: [00:03:42] And that is very interesting. And what was the reaction when the truck came and how did the people react.
Sunjya Schweig: [00:03:48] So the operating has so he was performing procedures which were not an emergency. So they all plan to have things like gallbladder surgery or understand testicle surgery for her his or tubal ligation in some cases like coma removal et cetera. So elective things that could be scheduled in advance of a pipeline that people kind of knew what was gacha but still it was fascinating you know talking with some of the people you know men and women and mothers and fathers about their kids and there was definitely that sort of you know level of mystical magical thinking around what was happening and it was gratifying to be able to speak with them and reassure them also to tell them what we looking at and what they could expect in terms of going into the truck and coming out the other side on a gurney.
Saul Marquez: [00:04:34] So yeah that is super interesting Sunjya. And so what did that experience do for you and the way that you serve your patients and the community where you’re in now.
Sunjya Schweig: [00:04:46] Yeah. So it’s really I think we can draw a trajectory from my childhood up through studying medical anthropology and religious studies digging into people’s explanatory models working in Ecuador. You know all the way up to now which is in our practice and the more dive into this little bit. But our practice really serves the mystery patients the patients who have seen 10 or 15 doctors and are still there and haven’t gotten cancer and chronic illness like you mentioned kind of detective work like Dr. House. Yes so it really is in that setting. The relationship between the doctor and the patient is really frequently one of collaboration and communication listening and interest being present for anything that will give you clues and you’re really letting the patient tell their story.
Saul Marquez: [00:05:33] That’s really interesting. You work with patients remotely to or do you just work with them in your office.
Sunjya Schweig: [00:05:39] No we do know a lot of virtual care.
Saul Marquez: [00:05:41] Do you.
Sunjya Schweig: [00:05:42] Yeah. So I would say on average my week is probably about one third of in person visits and then two thirds virtual either phone or video and we use a secure telemedicine platform for the video visits. We do require that our patients come and see us in person or visit and then annually after that for you know so that were covered under our California license and we’re working out the kinks a little bit. You know telemedicine is you know I mean it’s incredibly hot area and it’s going to be the way of the future. But there’s still some kinks in terms of regulation. Regulatory issues to figure out. So it’s the ongoing Volney experience. Again even our local California patients you know living in the Bay Area with the traffic as it is people picking stuff up for the virtual visit. And as many of us know you know there’s something you and I need to do an exam and obviously I want them in person in the office. But yes they care and they provided phone video. We have a secure portable messaging system where almost all of our patients communication flows through. And so we do a lot of management in that manner.
Saul Marquez: [00:06:48] Very interesting. So maybe an area that we could start with as Sunjya is talking about the different models of care and where your model and what you and your team do and how it’s different.
Sunjya Schweig: [00:07:02] Yeah absolutely. So you know I think the place to really focus is to understand how much trouble we’re in in this country with regards to our medical system and particularly with regards to chronic illness management. You know Western medicine is incredible. And if I need a surgery or if I get into a car accident I will go to a hospital. I will seek care. It is basically magical in terms of what we can do at this point in time with the level of technology we have for saving people’s lives in that setting. However on the flip side of it are patients who have chronic illnesses. Chronic illness is basically the greatest health care crisis of our time in my opinion. We’re seeing for the first time that we have a shorter lifespan expectation you know people’s quality of life is completely disrupted and it really we really see it as threatening the fabric of our society as well as the health of future generations. And it’s largely the problem is that there’s a mismatch going on. There’s a mismatch between our genetics is a mismatch between our biology and what we’re doing how we’re eating what we’re doing in terms of activity what we’re doing in terms of technology exposure screen exposure and how the health care system is really built. I think of the from functioning as the more we think of this model of a tree and came up with the outer leaves and branches where all of our specialists reside and most of what we do from a chronic illness management point of view is try to prune back the final manifestation and professional help bring down somebody’s blood pressure try to control their blood sugar try to control information try to Camperdown the immune system in a variety of immune impotence that actually are auto you know with this and that symptoms symptoms symptom management. And again trying to prune back that final manifestation. What we do in functional medicine contrast to that is we try to look as far down that tree as we can. Right. So Dr. route’s we’re talking about the basic basic inputs what are people eating with the exercise and movement patterns like with their stress and resilience like sleep relationships trauma microorganism more clinic infection exposure toxins environmental pollution cetera that’s filtered up through the trunk which we can think of as their genetics and genetic predisposition. There is that attitude. Police spiritual constructs and then from there it flows into starts to become this sort of core clinical imbalances which then results into symptoms. Right. If we’re working way down that tree in the roots of the trunk the really fun thing from our point of view is that it almost doesn’t matter sometimes what the actual diagnosis is because you’re starting to look instead for common pathways and things like inflammation are immune to tribulation or mitochondrial dysregulation or Audo and the inactivation chronic infections are those things become core a unifying principle that we start to target and you can get to those from many different angles. So from a functional medicine or integrative medicine point of view you have this much broader toolkit and offers you a huge number of different modalities to the so.
Saul Marquez: [00:10:13] Dr. Schweig give us an example of one of those channel you could access.
Sunjya Schweig: [00:10:19] Sure. So patient comes in and the humorous way of putting it would be that the folks who come to the pope to come see the whole of the doctor the people who have a whole list of medical problems.
Saul Marquez: [00:10:30] Ha ha ha ha.
Sunjya Schweig: [00:10:31] Know. Yeah. So they might have a bunch of different Gushin has no issues cognitive impairments sleep disruption body pain chronic fatigue. Picture loading etc.. So we basically cast this really wide net and looking at a bunch of different lab studies and that can be costly up front. However what’s really amazing is that if you invest that cost money upfront is that you get answers that again can reverse and hold people back from these chronic illnesses. So again we can see as wide that we start immediately with dietary intervention putting them on elimination diet. Coming down the information and on of the inactivation get them meditating. Get them all plugged in with our health coaches start working on lifestyles or working on barriers to change. And then by the time they come back to the second visit they’ve already started to see improvement. Before we’ve really given them anything to take giving them any quote unquote magic bullet etc.. I didn’t change their mindset of wow now I do have ownership on this. I do have potential to shift the course of that. And then from that point we start to address the findings that we’ve seen on the left studies and almost always we start with the gastrointestinal system and adrenal system. They’re trying to fix these regulations in those areas gastrointestinal system as Corbett has over 70 percent of our immune system reside there. And you know it’s huge huge 70 percent anti you know if you think about the amount of information that our Musa’s and that’s the process in a given day the massive overwhelming majority of that is coming through our mouth Mios our skin experiences some our lungs experience some but you know in terms of just quantity almost most that’s coming through our gut and our gut is really the interface you know the tube from our mouth all the way down to our anus is the outside world. Right. And so the gut is the interface of what does our body count and which is our body allowed to come in. That’s working well in imbalance and we have good microbial diversity of our micro biota and the biome is half all body systems are functioning in a much better way. Howard says I just disrupted the downstream effect take effect over almost anybody. So again that pipeline you know get them working on themselves providing support. Start working on their start working on imbalances of various nutrients and vitamins et cetera and then tackle triggers tackle things that are keeping them in that regulates. And a lot of time we see chronic infections are at the root of that. So it gets complicated but again so so gratifying. On my end as the doctors do this work. It’s wonderful to be able to give people hope and just yesterday actions. And then of course it’s the outcome.
Saul Marquez: [00:13:18] That’s so fascinating that dishrag and just thinking about it from the standpoint of you know we all know somebody or are that somebody that is struggling with an illness or chronic illness that you just can’t find answers to. And so it’s awesome to know that there’s alternatives and holistic ways too. I laughed at your whole list but the reality is you know there are whole lists of things that people go through and what can we do to address those. So if you’re listening to this and you know somebody I might you to go visit Doctor shakes eyesight’s ccfmed.com that’s Charlie Charlie. Frank Medd Mediacom and he does a really good job of walking through what they do over there but what a great introduction to a different way. And so if the normal way has not worked for you or your loved ones check out what he and his team are up to. Okay maybe I would just love to hear Sunjya story a patient story confidential. No no names but the success that you have.
Sunjya Schweig: [00:14:26] Yeah absolutely. When that comes to mind is a 36 year old woman who came to see me and she had done a huge amount of international travel and across a wide variety of developing countries and had been mostly healthy had some exposures including a few frantic fights abroad even. But her main symptoms that she was experiencing was what her rheumatologist thought was rheumatoid arthritis. So knee swelling knee pain inflammation fluid build up to the point where you know she was having trouble walking she is having trouble walking from her home to the subway and getting herself to work and back and so we again did this really comprehensive workshop and we found a variety of different possible triggers. Again focusing on the. We found some despite all the organism some imbalance in her gastrointestinal system she had low IGDA in the globulin a on her gut. Signifying sort of an ongoing process that was causing harm to immune dysregulation over time she had a test that was positive for both intestinal bacterial overgrowth even though she didn’t have a large amount of direct gastrointestinal symptoms. So some of these conditions can affect the gut and cause a ton of different GI symptoms from bloating gas IBS concentration diarrhea alternating pain NAHJ etc. cetera. How did some of that those leap of faith for me to tell are OK. No we have to focus here in the treatise. Interestingly she also had some exposure to some foreign pathogens including Borrelia Bergdorf rye for a causative agent for Lyme disease. And so our first steps for her was again to focus on her gut and to focus on balancing some other nutrients abnormalities vitamin D etc. And over time over the next six months it took time. It was a work in progress. She gradually got better. Her knees improved. She got to the point where she could walk without a problem. She knows Labutta. Yeah she knows the pain by the end of the week of no commuting. She was able to get off of methotrexate and her rheumatologists had prescribed so very compelling and we put her also on to some herbal protocols to cover some of the suspected tick point infections in the body is so complex it’s not always clear what’s the trigger. But with this really comprehensive protocol again she proved just a little bit up and down. Way I kind of look at it the patients a common practice is an improvement and then some drops kind of like two steps forward one step back. But over time and covering ourselves through those interventions retesting Zebo we naturally treat her two different times. Now she’s at the point where she’s been squeezed into great and awesome yeah. So here’s this young woman. Had she stayed with the standard care she would have escalated up the career ladder she would have gone on to use more and more extremely expensive in the knowledge that Horrie drugs with potential side effects to her with definite side effects to the health care system. As you know she would have used more specialty care she would have probably gone on to develop additional auto immune diseases. Now we don’t understand auto immune disease superwealthy in Western medicine but we do know that if you have one your chances of getting a second or third or more is much much higher. You know so her trajectory both in terms of her personal health as well as her cost to the medical system was very concerning. So with this sort of comprehensive approach again we were able to reverse that with benefit for her and the society at large and very exciting medicine.
Saul Marquez: [00:17:59] Congratulations to you and to her as well in her family for just this recovery. It’s a really awesome story. Thank you for sharing that.
Sunjya Schweig: [00:18:07] Yeah you’re welcome.
Saul Marquez: [00:18:08] And you know there’s a question I’m sure in the back of the listeners minds right now. How do I pay for this. insurance is one thing. Is this something that you guys take. You don’t take I know that it’s a burden. I know it’s burning in the back of their minds is burning in the back of mine.
Sunjya Schweig: [00:18:23] Absolutely. Yeah we are a direct to consumer practice. So we are a cash practice and the patients do pay the time a visit and unfortunately I think that’s the way of the future for many different types of medicine not just ours. Now you hear a lot of different providers going that way because of how broken the system is and it’s going to take some kind of major disruption to figure out how we’re going to help people pay for their care. But the fact is that you don’t really know anymore what you’re getting with health insurance. Senator it’s not until you go try to access that care order a blood test or order an MRI or see a doctor that you actually understand what you’re going to pay. So my take on that is well it’s probably a smarter move at this point to have an HSA type plan where a smaller premium you have a deductible but you can do that pretax HSA account and then you have a choice with your dollars with you with him and you’re covered in case of a catastrophic emergency. But again you have that ability to think you’re probably going to be paying for some of that care anyway. Right. So that’s one system side of that. The other side of that super important question and it is unfortunate that it does kind of filter the care to the people who can afford to lay out that money and we’re really trying to up and out and there’s some colleagues of ours as well. Dr. Robin Beras in charge of the health care they have a really nice sort of monthly fee model. It’s not unreasonable you know anywhere from 100 to 250 dollars a month to get services. We’re working also to leverage technology and also health coaches so that we can offload a good amount of that care to a less expensive provider and or to a technological solution that then also provides more of a fabric more of a support system patients but there’s also the health care system is starting to wake up a little bit to this. The best example of that is that the Cleveland Clinic one of our friends and colleagues Dr. Mark Hyman who’s a New York bestselling author even Patrick Kennaway started the Cleveland Clinic Center for Functional Medicine.
Saul Marquez: [00:20:23] Nice.
Sunjya Schweig: [00:20:24] Toby Cosgrove of the Cleveland Clinic was very forward thinking and basically said what do you need. How are we going to make this work. Cleveland Clinic I think between 50 to 60 million dollars for this product. And the functional medicine center opened.
Saul Marquez: [00:20:37] 50? 60?
Sunjya Schweig: [00:20:37] 50, yeah.
Saul Marquez: [00:20:37] That’s a serious commitment.
Sunjya Schweig: [00:20:43] They’re believers. And if that clinic is completely booked up from waiting lists are struggling to hire enough doctors and staff to fill the need. And they’re gonna be in the next one to five years providing us with more and more research showing outcomes and showing how this kind of care where you invest up front in the visit. You know the reason why it’s costly is not because we’re gouging the system is because we’re asking to have more time with our patients. My new patient visit is 90 minutes. My follow up is 45 to 60 and our current system paves doesn’t pay for time. And that’s why the primary care doctors have to move people through in six 15 minute increments. Talking does it pay. Procedures pay that imaging pays allows that is pay but talk doesn’t. And so you know in order to offset that cost they’re going to provide that research that shows that this is the effective cost effective the invest upfront more time dig into these complex problems that you again prevent the cost to the system on the back end in exponential measure.
Saul Marquez: [00:21:45] Very cool. Thanks for diving into that detail and providing that example did not know that the Cleveland Clinic had done that.
Sunjya Schweig: [00:21:52] Yeah very exciting project. It’s wonderful.
Saul Marquez: [00:21:55] And to have an institution like that backing care type like the one you guys are are rolling with it just that research that they’re going to pump out that helps back up what you guys are doing. It seems like it’s a really exciting time for this practice and this field.
Sunjya Schweig: [00:22:09] It’s a very very exciting time. Yeah it’s wonderful. The challenge is to find bandwidth to jump into all the aspects that need attention. Yeah very very fun time having a ton of fun.
Saul Marquez: [00:22:20] That’s awesome.
Sunjya Schweig: [00:22:21] And that’s basically that’s the wonderful thing you know my partner Chris Gresser who’s well known in the area you know he’s developing a clinician training program galta and vote out and also a health coach training program the Institute for Functional Medicine trains doctors in this and over and over and over again you hear from these doctors and providers that there is burnout track. I don’t know how I’m going to continue I can’t keep doing this. I know you’re.
Saul Marquez: [00:22:45] It’s very real
Sunjya Schweig: [00:22:46] Real. They find functional medicine and they transition their practice and all of a sudden the lights come on again excited passionate real wanted. Yeah. So it’s really fun.
Saul Marquez: [00:22:55] That’s so cool even transforming a provider lives. Yeah that’s exciting. If your provider listening to this. Something to think about. Wow. I’m just looking at the clock care Sunjya that time just flies. We’re here to the end. So I want to do the quick lightning round with you. Wrap it up with just a couple of takeaways for the listeners. So we’re going to do the 101. The ABC is of Dr. Sunjya Schweig and so I’ve got four lightning round questions for you followed by a book that you recommend to the listeners. You ready.
Sunjya Schweig: [00:23:26] I’m ready to do it. Right.
Sunjya Schweig: [00:23:28] What’s the best way to improve health care outcomes treat the root cause and not just the symptoms.
Saul Marquez: [00:23:33] What’s the biggest mistake or pitfall to avoid.
Sunjya Schweig: [00:23:36] We can no longer allow ourselves to believe that our current trajectory in health care is sustainable. They really really must act to change course to offer better care better solutions for both patients the doctors and the health care.
Saul Marquez: [00:23:50] So how do you stay relevant as an organization or a practice. Despite constant change.
Sunjya Schweig: [00:23:55] Yeah the word that comes to mind there is connection. You know I think that you have on many different levels a connection to myself and my own values our connection to my patients that we can anticipate their needs and connection to colleagues like yourself or other professionals even across this really diverse space in technology in AI and so in that kind of cross pollination I think it’s beautiful.
Saul Marquez: [00:24:17] Love it. What’s one area of focus should drive everything else in your practice.
Sunjya Schweig: [00:24:22] Yes this was kind of old school. You know I think service service to our patients are practitioners and our staff that’s one of the most important thing.
Saul Marquez: [00:24:31] That’s beautiful especially in this 6 to 15 minute world that we live in. As consumers we want service. And so I think Sunjya you guys are answering a cry for more. And so I want to acknowledge what you and your team are doing. It’s so beautiful. And I know that it’s resonating with your patients so I just want to acknowledge you and just say wonderful job.
Sunjya Schweig: [00:24:55] Thank you, Saul. I really appreciate that. Thanks.
Saul Marquez: [00:24:58] Absolutely. What book would you recommend to the listeners.
Sunjya Schweig: [00:25:00] I really would like everyone to take a look at the book my partner just wrote called unconventional medicine. It’s a deep dive into the multiple aspects that we’ve been talking about here. And another book that’s really resonated for me is Thomas Friedman’s book. Thank you for being late it’s a really wonderful deep dive into what we’re talking about here with this healthcare issue with functional medicine and chronic illness management. It’s kind of indicative of this age of acceleration that we’re living in where we really have to shift much of what we’re doing and how we’re doing it on a societal level as we transition so.
Saul Marquez: [00:25:34] Outstanding listeners don’t worry about writing any of that down all the show notes book links website links are available at outcomesrocket.health/sunjya that’s S U N J Y A . So Sunjya this has been awesome. You can just share closing thought with the listeners and the best place that they can get in touch with you.
Sunjya Schweig: [00:25:55] Absolutely. Well again it’s been an honor and a pleasure. I’m so glad that we had a chance to meet Health 2.0 last year. Best place to get a hold of me. You mentioned it previously at our clinic website ccfmed.com my personal website is drschweig.com. That’s also my Twitter handle @schweig.
Saul Marquez: [00:26:14] Outstanding and a closing thought.
Sunjya Schweig: [00:26:17] Yes. So let’s all brainstorm let’s all work together. Let’s all acknowledge that we need this kind of change and let’s all work together to make it happen. Connect the dots.
Saul Marquez: [00:26:28] Love it. Dr. Schweig. Thank you so much for your time and excited to get this one out to the listeners.
Sunjya Schweig: [00:26:33] Awesome thank you, Saul.
: [00:26:38] Thanks for listening to the outcomes rocket podcast. Be sure to visit us on the web at www.outcomesrocket.health for the show notes, resources, inspiration and so much more.
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