Episode 13 - "Healing Is Relational, Not Transactional" - Dr. Tieraona Low Dog on Presence, Purpose, and the Business of Integrative Medicine

Erik Well, welcome back to another episode of the Root Cause Business of a Root Cause Business of Medicine podcast. And today our guest is Tieraona Low Dog. Uh if you go to her website, drlodog. com, you'll it'll take you about ten minutes to read through all that she has accomplished, because she has accomplished a lot.

Uh what were some of the things that you took away from today's uh interview with her. Davin Well, it becomes very clear quickly how much love she has for her patients and for what she does and for this opportunity to to have a healing relationship with people. And she also talks about in kind of her journey to like find her most authentic self or be aligned with her most authentic self and then the way her practice sort of evolved um to match and support her in being able to practice being present, being, you know, having a a a t you know healing touch with the patients, a a great relationship.

And I think that that um really exemplifies having that frequency of love which is the healing frequency, according to, you know, one of my favorite authors, Dr. David Hawkins. And so I think we could all learn from letting our practice business model match that, like who we really are, rather than, you know, just picking a model that we feel like we have to stick with. Erik Uh, one of the things I love that she said is that, you know, our our interactions with our patients are relational and not transactional.

Um, and they we need to be really present with those. The last thing that she said that I really found uh insightful was being flexible over being strong. And she said she got that from her martial arts training that, you know, that the you have to be flexible in business. And know that there's gonna you're gonna be learning from your mistakes and you're gonna be able to profit from those mistakes later on, but don't get so caught up on having the perfect practice right from the beginning.

So you guys are in for a treat today, and we really look forward to having you join us today. Welcome to the Root Cause Business of Medicine Podcast. where we explore what's broken in healthcare and what we can do about it. I'm Dr.

Erik Lundquist and I've been practicing functional medicine for the past 15 to 20 years I'm excited to co-host this podcast with my brother, Dr. Davin Davin Lundquist, who's just beginning his journey into functional medicine. We come from different points on the path, but we do share a common goal. We want to rethink how many.

Medicine is practiced and help others do the same. Erik The U. S. healthcare system is in crisis, rising costs, declining outcomes, and physician burnout at an All-time high.

But you know, we found a different way. Davin Another way. A better way. On this podcast, we dive into real stories from medical professionals who've stepped away from the traditional model.

Kinda like me And have found a new purpose in integrative, functional, and alternative approaches to care. Erik These are authentic conversations with practitioners and friends who redefine success, not just for themselves. but for their patients and communities. Davin Whether you're a clinician feeling stuck, a student seeking direction, or just curious about what is possible, Erik You're in the right place.

This is the Root Cause Business of Medicine Podcast. Welcome back to another episode of the Root Cause Business of Medicine podcast, where we often say the first step is the hardest. And today we have a special guest, Dr. Tierona Lodog.

And for those of us who've been in the integrative and functional medicine space, that name is very familiar to a lot of us. Um, and you know, I'll start off the questioning here, Tieraona. Um, you know, it's interesting because in your situation, you know, a lot of us went through a period where we were in conventional medicine, we were Uh, we got our training and then we went in, we practiced for a little while, and then we somehow transitioned into an integrative and functional medicine practice.

You jumped right in with both feet right from the get go, right out of uh residency. Why don't you why don't you give us a little bit of uh background on kind of how that happened and and and why you chose to do that versus, you know, kind of getting your feet settled in the conventional medicine world first. Tieraona Well, um I came to it in a different way. So I already had a practice before I went to medical school, right?

So I I didn't I didn't go from like college to medical school. I uh I had a whole life before then. And it's so interesting because like when I was a kid, I never wanted to be a doctor. I wanted to be a park ranger.

Um, that still kind of holds true, right? It seeps in in lots of places. Um I had this profound love of nature. I loved being outdoors, I loved paying attention.

Um, I was very interested in ecosystems and how those fit together. And I I guess when I was a kid, I didn't have a language or words for what I was feeling, but I did grasp that there was something around balance and resilience and there was this intelligence of living systems. And that was really deep in me, even as a kid. And then when I got older Um, much to my family's dismay, I left high school early.

Uh, I was not happy with high school. Um and I went I started doing martial arts. I got head over heels in love with Taekwondo. And and that opened up this whole door to Eastern philosophy.

for me. I mean who heard of that back then? I mean, like we didn't know anything. It was like Western history.

We didn't know anything about Eastern philosophy. And Learning Taekwondo with our Korean instructors, it really taught me a lot about discipline. It taught me about being present. Um, and it certainly opened me up to really understanding that there was forces uh that were greater than just ourselves.

And You know, one of the beautiful things about martial arts is it teaches strength without domination, right? It's like that's not what martial arts is about. Um, it really comes, strength comes from alignment. And that was a core feeling for me.

And so y I I saw threads of this from a k being a kid and then this alignment piece for martial arts. And my instructor, Master Kim, used to talk a lot about how the body has this wisdom if you'll just listen to it, right? If you're just willing to listen to it, the body has this wisdom. And then when I got into midwifery and massage therapy from there I realized that all of these things were were truths that kept reinforcing themselves, right?

Because birth, being present at birth and working, you know, with hands and plants and and bodies and breath. Um I really I really began to understand that healing was relational, right? It was relational, it was participatory, and it was deeply human. So when I went to medical school, back to what you originally asked me, was was it wasn't a departure from any of this path for me, right?

It was It was like a continuation. I wanted to become fluent in pathology and diagnosis because I didn't have that with these other things I was learning, right? Um, and I I wanted to understand disease really thoroughly and I wanted to get a grasp for it like I understood healing, right? Because I felt like I had a deep feeling for what healing was, but not really pathology and diagnosis and I wanted to become fluent in both of those languages.

And I've never practiced in any other way than what I what people call integrative medicine today. I never I never didn't practice in that way. So from the time I first was an herbalist and a massage therapist and and studied midwifery in that, all the way until I was a physician and then practicing as a family doc. I have I've always had, I guess, a holistic or natural kind of bent to that.

And even when people said to me, Well, you know you have to have an hour, you have to have two hours to see patients. My model for a long time was pr just primary care. And it's amazing what you can accomplish in a 15-minute visit if you're completely, totally present. You don't interrupt and and um and you're just completely attuned to what's happening with this individual in front of you.

Um So I think presence sharpens diagnosis. I don't know what you think, but I think being present really sharpens diagnosis and I think it builds trust. Um And I I in many ways I think it reveals what lab tests can never show. So anyway, long answer to your question.

Erik No, I think it was great. And I'm gonna I'm gonna recap just a couple of actually three important things that you you shared. Um and that was that, you know, your experiences that you had before you went to medical school really started to help you get a sense for who you wanted to be and what you wanted to be and that and so that allowed you to align yourself with the perspective that you wanted to approach medicine from, right? It wasn't It wasn't just a, oh, I just I want to be a doctor and I'm gonna go take care of people, right?

It was it was no, I and and I uh I sensed that there was a real spiritual component to what you were bringing to the it the healing process, what I'm hearing you say, that when you approach your the the the healing mindset, it wasn't a pragmatic diagnostic situation where you were identifying a problem and and then here's the solution. It was a Who are you? Where are you coming from? How can I connect with you?

And then that kind of leads me to the second point, which was relational, right? You not only did you want to have a re a relationship to what you were doing, but to the people you were involved with in that, right? So I think the alignment That once you have the alignment kind of set up, then this this sense of I'm connecting with people and then realizing that If I'm going to connect with them, I need to be present and really really know and learn from them so that I can then share my experience, my knowledge.

uh my wisdom with them in a way that can be transformational. Did it did I understand you correctly? Tieraona Yeah, you you just said it so much more eloquently. But but you know, it's so um but it is It is interesting because um I loved conventional medicine and medical school, right?

Because it was asking a different question. It was asking sort of like, what is the pathology and what are these symptoms and how do we begin to fix it? But that was a very different question from what my experience was previous to that, but they were both very important. Um what my perspective was always is like, what has been disrupted?

Like what has been disturbed in this individual? What is the body saying? And where has coherence been lost? I think that in conventional medicine, what we've done is pay a lot of attention to the first question and not much to the second, right?

I think they're both important, but for me. it felt a little out of balance to to not have the ability to make the diagnosis, to not be able to understand pathology I needed some um consistent sort of training to really take me to that place. And I think that that the the combination of those things are so important. I mean that's why I love integrative and functional medicine.

I believe that functional medicine in many ways is asking the same question. What's been disturbed? Like what's upstream? Like what's getting in the way of this person getting better?

And I think that integrative medicine restores meaning. So I I believe that integrative and functional medicine together create this amazing way to be with patients and to practice, you know. So Erik Well it's almost as if if if you came into medical school you had this integrative lens that you saw you you're coming from an integrative medicine perspective, right? So you had that lens on, and because you had that lens on, I feel like that allowed you to then see the science uh of medicine from a functional medicine perspective, right?

You were looking at it as a way of finding out the why to the pathology versus just saying Okay, so what drugs do I need? What what's the solution here? How do I fix this problem? Right.

I no, I think I think it's I think it's really interesting. Gavin, it looks like you had a question. I jumped in, sorry. Go ahead.

Davin Yeah, I mean I maybe I'll just have you react to some some thoughts that came to my mind, which is when you talked about present, being present, um, and then you also mentioned this idea of like framing a question like you you you had a like a question and a curiosity and I I I like that sort of combination because I think I've heard you know, being present even framed as living in the space of a question. Tieraona Yeah, that's nice. Davin You know, and and so and then, you know, I uh I come from a background of of healthcare technology and One of the themes that popped up during my tenure was this, you know, um similar to distracted drivers, you know, like I used to call 'em distracted doctors.

Um, because their technology became more of a distraction than than uh than a help, you know, or you know, they became distracted by not just technology, but also like all the little silly requirements, you know, boxes to check, right? Tieraona Yeah. Davin And so I'm what I'm hearing from you is like, okay, you're not distracted by these other things. You're living your present, you're in this the space of a question, but you have these different lenses, right?

Like you had the the healing lens and the the scientific conventional medicine lens, the functional medicine, you know, you had all these lenses, but you were that moment of just understand truly understanding the patient. Tieraona Yeah. Davin You know, before you sort of apply it any of those tools, I guess. Tieraona Yeah.

It's it's so interesting because we, um and I mean myself, uh There is this desire to compartmentalize like lens, like a functional lens, an integrative lens, a conventional lens, you know, and for me there's only one lens. Right. And I mean I think any human would just sort of say it's your own unique way of looking at the world. Yeah.

Um and And also the piece about technology is very interesting because I think that it can help us in a in a big way. I do. Um But I also think medicine is at a threshold. Um I and I mean medicine in the big terms.

I mean it can become faster, it can become more technologically driven, it also can become more hollow. Um, and I think we want to make it more human. I want my technology to serve wisdom, not replace it Right. I want it to be a servant.

I don't want it to be my master. And I think that data um can certainly inform a care, but it is a presence and a heart and a healer that delivers it. So um Yeah, so very interesting. Uh I'm I'm not afraid of AI or I'm not afraid of technology.

Um I will say that I think it it was one of the worst things in the world to ask people to ask clinicians to sit in an office and to type on a computer as they're being present with a patient. Um Which has never worked for me. Um, so there are data scribes and and you can hire a scribe to be in your room and I would just put things on my paper. And then would um go at the end of the day.

And my husband would be like, Honey, like you're spending an extra hour and a half at the end of the day trying to fill out these charts. And I'm like, Yes, but it's impossible for me. to be trying to do this while I'm sitting with a patient because for me, um, just the nature of who I am I'm like knee to knee and I'm right there and I'm looking at you and I'm feeling and I'm reading between the lines and And that that gets disrupted when you hear my click click click of my fingernails on my computer.

So, you know, as well I said, I think that um that that we're kind of at a threshold and I think that we're gonna figure out we're gonna figure it out. I'm always the optimist. We're gonna we're gonna figure out how to do this, but some of these things, you know, the corporate part of medicine, that that corporate piece of that. Um, you have to be careful with that.

Um, we don't want to get faster. We don't want to have more techno technological. We don't want to become more hollow. We want to we want to be more human uh, in how we practice medicine and deliver care.

Davin Yeah. Well, you know, just carrying on that theme. So Um sometimes I've shared this, you know, like scenario coming from conventional medicine, and I probably did it longer than any any of you. You you guys maybe didn't do it at all, hopefully, but For me, you know, I was definitely locked in a system where, you know, I was seeing thirty patients a day and and so, you know, I I remember having this epiphany one day of like, what other industry you know, takes their most complicated problems and then tries to solve them in ten minutes You know?

Yeah. And you know, so when someone shows up and like for them, whatever problem they're bringing to you is their most important problem at that moment. And and for us to like try to figure it out quickly, you know, like one, understand it, two, come up with a solution. in in a frame, you know, in a time span, like you have some time limit.

And I don't think most of us as humans function that way. um in terms of solving problems or in connecting or healing, certainly you can't like um do it quickly. I don't yeah think. I mean you can accomplish a lot, but What are your thoughts around just you know that like just having more time or just slowing down the the process?

Tieraona Well so It comes back a lot to me to stillness, not just time, but stillness. And I do think that um I'll only speak my for myself, but I'd love to hear what you guys think. But for me, it's when things are more quiet, not so hectic. Now, in an emergency room, things are moving very quickly.

You have to make decisions very quickly. I mean, so Let's be clear that I I get that. When I do global health, there are times when we're in a real emergent situation, right? So you have to be able to do that.

On a uh in primary care Which was sort of my main practice, was in primary care. Um stillness was diagnostic in many ways, like being more quiet and more still. Allowed me to interact with my patients better and also to be able to use my knowledge and experience and allow my intuition and wisdom to come through. Um, and I and I think a bigger and deeper thing that you're mentioning is something that a lot of clinicians are really wrestling with.

And, you know, if you don't define your path, the system will. If you do not define your path as a clinician, the system is going to do it for you and it is ruthless. I mean it's ruthless. Medicine will take as much as you'll give it and if you're just giving everything all the time, there's nothing left for family.

There's nothing left for your own sense of being and moving in the world. So there was a lot in what you said there. Time is one piece of it, but I've been with clinicians who wanted to spend an hour with me. And I'm like Why are we spending an hour?

Like we could have done this in 20 minutes because you've just got a laundry list. You're just asking me a lot of questions and you're not here with me. And then you ordered a hundred lab tests instead of only ordering those tests that really mattered. I mean, so to me, time is a component of it, but stillness and presence are are Which sometimes we need more time for that to happen.

But I would just say that I have been with functional medicine physicians who spent an hour with me, and I was like, we did not need to spend an hour doing this. And we just didn't need that. And I spent an hour with you and I and you never really ask me the why. Why do I think this is happening?

Like what do I think is really going on inside? You know, what's my meaning here? And how is this really affecting my life? So yeah, it's big.

Clinicians being in medicine's a cool place to be, you know, even if we're at a time where it's very tumultuous. I I and I and we are. Um You know, but but that's again, you know, Davin, you're you're looking at how you want to do practice differently, right? Do I want a micro practice?

Do I want a small group practice? Do I want a cash pay basis? Do I want, you know, what am I looking at? And I don't see these as trends.

I just see this as course corrections, right? These are just course corrections. Um, because Most of us, and again I'll speak for myself, but I didn't come into medicine so I could be s part of some big industry of medicine. You know, I came in because I wanted to lean into People's suffering.

And I wanted to partner with them along their journey. And in helping them find ways to heal themselves, I continually find ways to heal myself Erik I love that. And I think that the key, that key word you said there in partnering. So if you take the time component, but your your mindset is relational and partnering.

Then what ends up happening is the curiosity drives you to ask questions that it really help you learn about the individual And not about again trying to put put the problem into a box that you feel like you can solve, right? I think that to your point, I think, you know I I think asking asking questions and getting, you know, these using questionnaires to get a broad sense of what's happening can be important. And sometimes particularly when we're a little lost, we're not sure where, you know, we've kind of heard their main thing.

We're still trying to figure out, okay, where where is the actual fire going on here? I think those things can be helpful and we may need to take a little extra time, but I love what you said about being efficient and being being present, asking the right questions. you can discern a lot about where that individual's at on their health journey uh without having to spend a long time. And then The other point I wanted to bring up that you mentioned the knee-to-knee, which I think is awesome.

And that's uh I I have found that I you know once once I started that I could never go back in and do any other type of uh practice And you know, Davin was involved with a company that uh I I utilized with a a a virtual scribe that allowed me to You know, I I would spend a little bit of time at the beginning, at the end of my visit in the computer to to get things going, but I could really look at the patient uh really connect with them, get the information I needed. And I still, you know, I'm like you, I I still write things down because it I think it helps me organize things and I don't I I I can't do that in a computer.

I need I I I need to draw circles and lines and arrows and and and it helps me in telling the the patient's story. And so I think uh all of this I think is really critical as people are looking at what type of practice they want to have. Um going back to the alignment of who they really are and what they want to do from a healing perspective. I think all of that's I think you've you've mentioned some amazing things.

Tieraona Yeah. And you know, um there's a lot to, you know, I I don't know about you, but I think one day, no, two hours in residency on a day. Somebody talked to us about contracts and the business of medicine. Like that was kind of it.

I mean, we just didn't get there wasn't training on like how you should think about you know, how you would have a practice or the challenges of staffing or if you're going to have an on-site pharmacy or the finances or, you know, they just didn't teach you all of that. I guess the good news is there, is that it's all learnable. Um and and that um And that medicine is all about living with uncertainty because we're always living in uncertainty. If you if you if you are not comfortable with uncertainty, you should have gone into accounting Or something physics, something that had more certainty.

I'm not even sure physics qualifies anymore, but um but business is also a lot about uncertainty and then getting more getting more comfortable. with that, right? Um and I get a lot of young you know, clinicians that ask me, you know, about wanting to build their business and, you know, all of that. I would just say that um You know, I do think these membership models, my my son belongs to a membership model, uh, and he's a school teacher.

But it really works for their family. So it doesn't cost a ton of money, but he really likes that. Um, my daughter is part of a of a concierge kind of membership in Santa Fe. And again, these are not super expensive, but what both of my kids like, neither one of them that have a lot of money, it's like They're available.

They know me. I have more time with them. They'll answer emails. I think that those things are really important.

And I think that we have to, you know, I think there's a lot of feelings that people have around money and medicine And let me be clear about that, that people, you know, are uncomfortable. It's like if I get a salary from the hospital, that's okay, but if I'm charging for my time or I'm wanting a cash practice, or if I'm doing anything like that, there's this conflict. Um, because medicine and spirituality is almost like is like the pastorhood or the priesthood where you're you're kind of giving it all away for free, except that never happens even in the priesthood, right?

There's there's there th that's not real. And I just see that a lot of people are really struggling with this. And I would tell young clinicians not to be in a hurry to build their brand. Or to build their practice, right?

And building your practice is like building a brand. You have to think about it like that. And you have to have strong internal alignment. And that usually takes a little time.

Like what what really matters to you? And then you begin to think about what would that look like? And for me, you know, insurance is interesting when it comes to health insurance. And um I've always taken health insurance for patients.

So let's be clear about that. But I have home insurance. I've never actually used my home insurance for anything. Um I have home insurance in case a catastrophe happens, right?

I have car insurance. Um, I have a high deductible for it. If my windshield breaks, I fix it. I don't it's for an accident.

Health insurance It's interesting what we think it should cover everything versus any other form of insurance. We don't think of it like that And um I think we have to get more clever um with our system, our health system. That's not just on individuals, that's the system itself and clinicians are a part of that about how do we want to think about that? Um you know time, relationship, alignment, um how how do we get comfortable with that.

And, you know, health serving savings accounts, those are all part of it. But I think it's an interesting time right now for people. Um, you know, when I had my business, uh I was running one of the first integrative clinics in Albuquerque. We had acupuncturists and chiropractors, we had an herbal pharmacy.

I had a psychiatrist. Um, we had a s we had a nutrition, PhD nutritionist there. I was the only physician um in the practice. And you know, I was running this and so we had a number of challenges, but I took I took insurance medicate and Medicare.

And about sixty percent of my practice was Medicaid and Medicare. And uh when we were looking at finances and we had somebody come in to help. with like looking at the business plan, they're like, You're gonna need to cut this down to twenty to thirty percent. You can't you know and I'm like, how am I gonna do that?

You know, and they're like, Well, you're gonna have to figure that out because your numbers, you know, are th this isn't sustainable. And so that was really interesting. um and how we wrestled with that and um and how I had to have conversations around with patients and and and you know like how do I trim this back? So it wasn't easy.

So if I would have been smarter on the front end I would have I would have had a better business model up front to know how much I could take and and where the where those kind of points, you know. Nobody goes to school. and spends all that time to make less money than the massage therapist, right? I mean it's just I was a massage therapist and I'm looking going, I I was already making this much money when I was doing a lot of massage.

So You know, and then the other thing was just as a side note that was really interesting for me in an integrative practice was um there was so much, we didn't have a common language. So acupuncturists were using their own language, and then I was seeing that patient, the nutritionist was seeing a patient, the acupuncturist was seeing the patient, the chiropractor, so everybody was seeing the same patients. And and I remember one woman whose front name first name was Genevieve.

She writes me a long letter and she says, You're such a nice doctor. I really like you. And I liked your idea of having everybody work together to take care of me. But I'm so confused.

The acupuncturist told me something was wrong with my kidney. And I asked you and you told me my kidneys were fine And I went to the nutritionist and they told me I needed to do this because I have heart problems and diabetes, but I went to the chiropractor and they told me something totally different. And I'm just really confused. So I really wish you well and I think you're a lovely lady and goodbye.

And I was like, wow. And you know what I did? I hired a um I hired an anthropologist who specialized in uh language. Um and I paid her to come to our clinic and we had a series of meetings.

Um, because we had to find a common language. We had to find a way that we could all work together with our patients to communicate. And it could not just be physician-led, it had to be all of us working together. to find a common language that we could communicate together and also communicate with our patients.

So be bold in what you do. Oh, an interesting thing. Erik You had to communicate in a way that they I mean you couldn't say they had kidney problems and when their creatine was cut. Tieraona Oh your kidney-in.

Your your kidney-in is a little off. I mean, so it was a very interesting so all I'm saying is that, you know, if you wait until everything's perfect to start a business, um, you'll never start. So you have to um have you you have to you know get the help you need for business planning and that, but just know that you don't have to have it all figured out. And You know, I do think to Davin's point that when there when you have more control over your schedule and how you're gonna practice and your hours, that when care can kind of slow down, in many ways healing speeds up.

I mean people get better faster. Erik Well, why don't you take us back though a little bit? 'Cause I'm curious, you know, you had had a little bit of some business background before you went to medical school, right? You you were yeah, i from you know, doing your herbal medicine business.

uh to also m making some money doing mid riffree and and with the massage therapy. Tell us one, how that experience kind of helped you in setting up your practice from a business standpoint. And then also how much, you know, you said, well, I wish I would have done a little bit better planning, but what what kind of business plan did you have? What kind of vision did you have going into that?

um to get started right out of residency to to start having an integrative practice with all of these individuals. Tieraona Yeah Um, so I kind of knew what I wanted. So that vision was fairly clear. And because I'd already run a school, an herb school, two year school, I'd already run a free clinic, one of the first free clinics in the United States actually, um, training clinics for herbalists.

Um I I I had done a lot of things and had been successful at them. What my mistake there though a little bit was that a lot of the patients that I saw at UNM at the Indian Health Service wanted to follow me to my practice. And because they were following me, many of them were Medicaid, Medicare, um, and and insurance. And the insurance wasn't really a problem.

Um, it was how much Medicaid Medicare goes, boy, you have to have somebody do your billing for you. So I had to have I had to have a billing person to do all this billing for insurance and Medicaid and Medicare, all this stuff, right? Um So I would have I didn't know that because before I did that I was only cash. Everything was cash.

You know, it's like people pay you cash for your massage. They pay you cash for your herbal medicine. Everything was cash. So that was different for me.

Um and and I wished I would have known a little bit more about billing and insurance and codes and coding and all of those kinds of things before I started. I loved my I loved my practice before I went to medical school. I loved being an herbalist. I loved doing massage.

um the body, you know, touching people's body. I mean, I and you can see all of those things still influence me today Um, it's very hard. Like when I was in residency, or even as a med student, you know, I'd always want to listen to their heart and lungs and I want to touch them and everything. And I remember one of the attendings saying, you know, you don't really have to, they're just here for a quick follow-up.

You don't have to do listen to their heart and lungs. That's not something you have to do every time. And I'm like, I know, I'm just trying to find a way to touch them. Big you know, and he kinda looked at me, he was a great Dr.

Kaufman, he was a great attending, but he was just kinda like you know, and I'm like I want to touch them. Like I I want I want to put my hands on them. And I realize that, you know, that power of touch Um, you know, and that that that actually happened to me as a massage therapist. I had a I had a I had a man who came in, I was running really late.

I was going, finishing my undergrad to go to medical school. I'm I'm scheduled to do a massage. I'm running into the into my practice, my office in Las Cruces, New Mexico. And Susie, a woman who worked with me, she said, I'm putting on my apron, I'm kind of getting ready to go in and do the massage.

And she said, I don't think you should go in there. And I was like, what? And she goes, man, like he has sores all over his body. And I'm like, he has sores.

Now we gotta remember this was what, 1987, 88? And um I said, okay, well I, you know. So I walk in, the room's dim, you know, beautiful sheets on the massage table, Carlos Nakai playing on the tape quarter, right? It was tapes back then.

And I realized that he had these sores on him. He had heard what had been said. And he said, You don't have to do this if you don't want to. It's like it's okay.

And I put my hand on his arm because they were outside of the sheet. And I said, I'm so sorry you heard that. I said, do you think it's okay to massage you? I said, do these sores hurt?

And he goes, it's kaposis. It's kaposis sarcoma. I have AIDS. And uh I said, I'm so sorry.

And he said, it's okay, I can just go. And he was so frail and he was so thin. And I said, No, how about in some of the areas Maybe I I do more kind of energy work or just gentle touch. And and you let me know if it's okay.

And he said, okay. And he kind of closed his eyes. And I was working on him. I was down near his feet.

And I could feel him shaking, and that's not uncommon. A lot of people get cold on the table. So I reached down to get a a blanket to put on him and I realized he was sobbing. He was just sobbing.

And I went over and I and I said, Are you okay? And he said, It's been so long since somebody's touched me. And his husband had died from AIDS, and he had come back to Las Cruces because his mom was there, and he felt so alone. And in that moment, I can say all I could feel in my body was, if this was my son.

If this was my father, what would I want for him? And I finished the massage and I hugged him and he died. A couple months later his mother came in. um to share that I never saw him again.

That had such a profound effect on me at that point in my life And I realized the power of touch. I realized that healing is always relational. It's never transactional. It's always relational.

And that the ability to just be present. to another human being suffering was one of my responsibilities, one of my privileges, and one of my gifts And later, when I was thinking about that, I remembered that when I was a child in Sunday school. The teacher was talking to us about Jesus going to the lepers. And I kept thinking she was talking about leopards, like a cat, right?

Like because I was little. I didn't know. I didn't know what a leper was. And finally she explained that it was a person that people were afraid they were going to get sick.

And she said, but Jesus would go and help ease their suffering and help them heal. And so, you know, it's interesting. The reason I share this, I think, is because when you look at the trajectory of your life, You realize that if you're just paying attention, even the things that happened when you were small, the stories that you learned, stories are terrain. To me, the stories are the soil This the that it's it's all terrain.

It's never a distraction. Stories they're what they're what allow us to live a full life, but That story of that man, that man was a great teacher to me. And so when I say I always want to touch people, I want to put my hands on them, it's because I've had some very profound experiences of what touch can do. for another human being.

Erik I love that. Um and it's really powerful. And it it it I can see why that experience would really shape you in terms of of how you wanted to practice medicine because you Yeah You realized at that moment that the massage therapy was healing for his soul, right? It wasn't just you weren't gonna fix his carposis sarcoma, right?

You weren't gonna cure him of AIDS. But you helped him in healing his soul. And and I and it's that's that's that's really powerful But I'm gonna pull us back to the business portion. All right.

So you said something really interesting. Tieraona Okay. Sorry, you know me. Erik Exactly.

We know and it's it's but I think this is it this is good because I think there has to be a balance. You can't it just can't be like this you said If you want fixed things, go into accounting, right? Um but but I it's interesting because you you said something that I want to I want to I want to figure out where your headspace was at. Here you were in a system where you were taking care of people who were on Medicaid and Medi-Cal.

You were working in a free clinic, but yet you were charging them cash. for your herbs, for your for the for the things that you provided from a service standpoint, right? Yet when you got in to medicine and now you're going to practice medicine, you chose to use insurance. Um why?

Why did why didn't you just go cash right off the bat? Tieraona I think that for me, I was a young clinician and that was the model that came to me from what I was practicing in, right? So I was at the University of New Mexico Family Medicine and UNM Hospital. And of course, everybody used insurance or had Medicaid or Medicare.

Um and so it just sort of extended that I was going to take that into here. Now it's interesting that a lot of the other clinicians in the office, the massage therapists and that the chiropractor took insurance and workmen's comp. He had a lot of workmen's comp. Um and acupuncture, because their primary care providers in New Mexico often would also take insurance.

So there were other people taking insurance. Uh and then there were cash pay, right? Um so if I had to do it all over again back then, you know, hindsight's always 2020. I probably would have had a sliding scale type of payment system, which was more like what I did at our free clinic, even though we called it a free clinic, it was a sliding scale.

So we asked people to pay what they could. Um and You know, and one of my barometers was like, Did you take a vacation this last year? How did you get on your vacation? And it's like if they flew to Europe, then they needed to pay.

Right? I mean it's like uh and I'm joking a little bit, but we would have people that say, I don't have any money and and so you know, sliding scale, you always have to figure out like how you're gonna manage that. But Um for me when then I when I later went back to practice, um, it was cash payment, but it was always sliding scale. So I don't want to turn away somebody because they don't have the money to pay.

Um, but I didn't want to get back into the insurance thing and I didn't want I didn't want and because of challenges with Medicare, Medicaid, if you're also doing cash and doing other things, I mean 'cause you can't Um I just did cash. And and I would tell people, you know, um, this is what I charge for you to see me. And and then that also then I I worked it out in my own mind because I do believe that, you know, I I have a gift also, um, that I would do that in more global medicine where I've done a lot of volunteer work.

in other countries um uh and giving and just and giving not not asking for any payment um and working long and hard hours there. So I think it's been a balance for me. And when I say that clinicians, I think sometimes wrestle with this, I speak for on behalf of myself. I think that um I had to wrestle with Um, how much can I charge?

How much do I value my time at? What if somebody really needs my help but can't pay? Um And then, you know, and then I also realized, well, I'm not the only doctor. There are lots of doctors.

There are a lot of people that can help feet people. So it's like, you know, don't take the whole world on Tieroni. But I mean, so I I've spent a lot of times wrestling with that. And um, but I don't think I'm alone in that.

I think many clinicians do wrestle with that. And it was the same thing with speaking and teaching. You know, it's like when I was be asked to go speak at a conference. Oh my God, when I was an herbalist, I would like for ten dollars or lunch, I'd go do a talk for the chili dilies or the high nooners or whatever women's group there was, right?

I mean, but then later on, when I ha I was doing more talks, more lectures, and I was realizing how much time it was taking to put together talks and to and to go and travel and do all that. I realized that I needed to charge more. And so some people would say, oh, I can't pay that. And I'm like, oh, that's okay.

That's okay. I got so few other people I could recommend. So it's like there is a certain place once you have coherence in your life and an internal alignment, you can say, I'm okay with what I'm gonna charge. I'm okay with how I'm going to deliver my care.

And maybe take a a playbook from the dentist. The dentists are mostly cash. They have dental plans, but they don't do insurance like doctors do. They do not And they're some of the most philanthropic people I've ever known.

Like in Albuquerque, every year there's three days at the at one of the big convention centers where the dentists all come and they provide dental care for like three days, dental cleaning, dent dental appointments, and they don't take a penny for it. And when I was talking to a number of the dentists, because I've worked a lot with dentists, they're like, we don't want to take insurance. We don't want to get into all of that. And we know that some people really have a hard time, so we need to provide that care.

And they do it in these short bursts in their communities. And I just I love that model. So I think there's a lot of ways to think about how we want to deliver medicine and how we want to charge for our time and not being ashamed. to say this is the amount that I need to charge uh to to for me to provide for my family, for me to be able to to live a life that's not rich, rich, rich.

If you want to be rich, be an orthopedic surgeon. I mean, if you if you want to make a good living though as a primary care provider, you have to figure out, you know Is a membership model good? I love these micro practices. I had a micro practice.

I love micro practice. You don't have a nurse, you don't have all the you know, you just kinda cash only and it's a small practice. And I think for a lot of us that works really well. I love taking blood pressure.

I love drawing labs. I mean I love doing all those kind of things. So it's not for everybody, but I I think that that's another really good model for people. Davin You know, I Since I started my journey, uh the the one the only thing I knew from a business standpoint was I wasn't gonna take insurance.

Um but as far as like how much to charge, is it a membership, a consultation? And what's happened to me is, you know, I I did settle on a membership model, but there were times when someone were like, Can I just pay you for one visit? I'm like, okay, sure, you know, like You kind of you end up sort of accommodating depending on what sort of comes through the door, right? And then but also like I've changed my price Think I think I'm on my fourth different iteration of like, you know, price change.

It's gone it went up and down and back up. I mean so and I'm hearing something similar from you. Like you it sounds like you were aligned maybe more so than some of us in terms of how you wanted to provide care and healing But the business model has maybe changed a few times on you. Oh, yeah.

As you learned and grew from just an understanding of the marketplace, of the different factors. And so I love that you haven't been afraid to change that that model. And I think that's what that's been my experience, but would that be your advice to people? Maybe don't worry too much about getting it right out of the out of the gate, but be open to changing.

Tieraona Yeah. I think you have to have an entrepreneurial mindset. though. I mean entrepreneurs never wait until everything's perfect.

Apple does not wait until everything's perfect for their next launch. They're already coming out with patches just shortly after their new phone is released, right? I mean so it it becomes the enemy of the good, perfection is. And so um being willing to say this isn't quite working, it's not the way I thought it was going to work.

I mean, you just have to be flexible. That was one of the gifts of martial arts. It's like, uh, yeah, strength is important, but flexibility is really what it's about, right? So being flexible physically but mentally being agile, I think is I think is important.

We have this, you know, but I I would also say, you know, our veterinarian, he's cash. You know, he's cash. Your dog gets sick, you take him to the vet, you pay the cash. I mean some people have like insurance for their pets.

I never have. But then I've also I've also donated money for like people who didn't have enough money for their animals and like he he he'll work with you on however. So I don't think this is something new. I think doctors a hundred years ago You know, they would take your money and if you didn't have the money, they were still gonna give you care, but you're gonna give 'em goats, you're gonna give 'em chickens, you're gonna there's some sort of reciprocity that that was an exchange uh uh between the the healer and the patient.

And let me give you another example. You know, amongst the Navajo, the Danay If you're going to go for one of the big healing ceremonies, you know, like a Kills the Animer ceremony or one of the big ceremonies, that's like $3,000. It's a lot of money. The community comes.

It's like this whole big involvement. There's feasting. I mean, it's this big, big, big thing. And the healer's charging quite a lot of money, right?

So people think like, oh no, that was never done in traditional systems or anything like that. I I I just want to say there's always been a form of reciprocity And um and and that the healer and the community has to kind of work that out. Smaller communities might be able to do this a little bit better because um you can negotiate. My husband's father was a vascular surgeon and He ended up doing a lot of, you know, like just care of patients afterwards.

And, you know, Jim talks about how his dad often had patients 15 years later that was still paying $10 a month. Like we're we're still paying it off. And I mean, you know, they were making like their ten dollar payments. But he just he just would kind of do what was necessary, though the bill was still there.

But you could pay it off longer. So I I just think don't be afraid to play with this and follow your heart and know that if you have a family, you have a house, you have bills You know, as a midwife, it's like, can we trade? Can we trade? Can we trade?

I'm like, yeah, but you know, your astrology reading doesn't count when I gotta go to the pay my electric bill. I mean I mean there's just realities there It's like you know, so you just have to you have you have to be sensible about it. But know that But know then also that you have to be very clear. You have to be very internally aligned with yourself and know that if somebody really needed your help, What how are you going to handle that?

How are you going to manage that? Yeah. Yeah Davin No, no money, no mission, right? We used they used to say at our at our Catholic healthcare system.

Tieraona Yeah, yeah. Well there you go. I had a little bit of that a little bit of that system myself. Um, but you know, it's uh but but you know but again I think part of my issue was that I did not see healing as transactional.

I saw it as relational. And And when you start stepping into the transactional piece of it, for many clinicians that can feel uncomfortable. So if that is uncomfortable for you, have an office manager And have the office manager deal with that, right? Hire somebody that you can work with that's going to manage all of that for you and so that you can keep the relationship, the relationship, and they can manage the transactional piece for you where there's less emotional involvement.

Um because what are you gonna do when she has breast cancer and now she's very, very ill and she doesn't have money and she doesn't have insurance and Yeah. And you're now going to suddenly say, No, I'm not going to see you. I mean, so I just think you have to be comfortable. Uh it's hard for me and let's be clear, I'm sure this happens to you too, but I get I get probably in a month 30-40 handwritten letters.

People still write letters handwritten letters, usually three, four pages long with all these health problems for somebody who just really wants me to help them. And You know, and it's so hard because sometimes I really do want to help them, but it's so even just to read it's 45 minutes. Um So you have to think th well it is and you just have to think through how do I do this? And so we have um my daughter does that for me and she's really good.

She has all kinds of resources for people. where they can find other clinicians that are closer to them, books and resources for whatever their problem was. I mean, so it's not that we don't help, but we don't get into that. uh anymore either.

Yeah. And that can be hard. Somebody spends that much time to write real letter, you feel bad. Erik We d like you said, you know, earlier, right?

We we don't have to be everybody's solution. Right? We we just need to be um available to help those that we are available to help and and it's okay not to to to help everybody to be the end all be all for every single person. So I think I that's that's some really you you you shared some amazing advice with us Tieroni, and it's been such a pleasure to have you on today.

And I'd I'd I'd love for you to kind of finish off. You you've kind of hinted at it a little bit uh throughout our podcast today, but I'd like you to just kind of close up with Where do you see the kind of the future of integrative and functional medicine in terms of that maybe insurance business landscape? You know, like where how How do you think things are going to change over the course of the next five, maybe ten years that it's going to continue to be the forefront of medicine versus a side?

light of medicine, right? Wh how do you see things changing? Tieraona I think that um David Katz and others who sort of called this lifestyle medicine were smart and present in some ways. I think lifestyle medicine's easier to get on board with.

Um, and I think infusing that into all medical schools, nursing schools, PA schools, so they're getting all the lifestyle stuff, right? They are. They're getting stuff on nutrition, they're getting stuff on exercise, they're getting stuff on stress management, they're getting stuff Sleep And then I think in residencies, I think that um, you know, integrative and functional medicine need to become more and just embedded. And again Keeping the curiosity, what's upstream?

What's happening? What's disrupted? Where's the coherence been lost here? Why is this individual not getting better?

Right? Um, better pattern recognition. So we're looking not at just like, oh, this symptom, this box, right? But we're going, you know, it's like when people are like, somebody interviewed me on adaptogens the other day and I'm like, I okay, I just don't want to talk about adaptogens.

I said because like Ashwagandha, Rhodiola, Shazandra, Shatavri, Holy Basil, you call them all adaptogens, but they are so different from one another. It's about pattern recognition, recognizing the pattern that each one of those is most suited to. And I think we do this in Western medicine and we could do it much, much better. I think functional medicine brings that in And I would hope that integrative medicine remains right in there so it keeps the meaning and purpose alive, which helps protect us from burnout.

Um, you know, I I just, you know I I think that um the science part of me, the scientist, um I love how it explains how the body works and how things go wrong with the body, you know, and And I I guess I love this deeper part of, I guess we would call it spirituality that helps us understand why a life is lived. Right? They're asking different questions. And I think most people are living somewhere between the two of them.

They're wanting to know a deeper sense of purpose and meaning and they're also wanting to understand what's going wrong with their bodies, right? So Both of those things. And I think that, you know, our our role as clinicians isn't really to resolve that tension. is not to resolve that tension, but to just respect it, to listen for meaning, and to meet that patient wherever they're at, like with respect, wherever they're at coming into it.

I'm hopeful. I I'm hopeful. I'm hopeful that the American people have said I'm spending $27,000 a year for my family to have health insurance and we don't feel good. We're tired, we're exhausted, we don't sleep well.

You know, we don't know our our diet's not good. Um, you know, I my 35-year-old son is obese and he's got hypertension and lipid problems, and like this is not working. And I think it's when grassroots, when the grassroots, the people themselves say, We're not happy with this. You guys need to fix this.

Then I think it's the opportunity for us to say, you know, what are some models that could work better? And what will insurance cover? And how can people help? health savings accounts and and how can we begin to help people um at all ends of the spectrum from the very wealthy to the to the people who are most poor, how do we how do we come alongside and help them?

And knowing that it's a team, it's not one person. It's a team of people. And it's the school teachers. And it's I mean, it's everybody.

It's You know, I had Home Egg as a kid, you know. We learned about babies, babies, and child care and cooking and groceries and managing your checkbook and all that kind of stuff. We don't have anything like that. Why is why why does a high school student know more about uh a frog than about their own health?

Right. You know, they do frog dissections and things like this. It's like this ridiculous. So I would overhaul the whole school system a as a homeschooling mother.

I'm that's a bold thing to say. But You know, I would overhaul the school system, I'd help overhaul the healthcare system, I'd keep the things that are good, and um and I would uh And I would nurture the people that you're asking to do the work. I would nurture the nurses, the lab techs, the doctors. the PAs.

I I I would nurture the people you're asking to do the work, not beat up on them, but nurture them because you're asking them to work under very, very hard circumstances. Yeah. And they're burning out. Well that's it.

That was great. Erik I love it. W when when should we s watch you running for office here, Tieroni? Tieraona Never.

Never never never never that's not my that's not my jam. That's not my calling this year, this this time of my life. Davin Hopefully those that do will at least ask your opinion 'cause those were great those were great ideas. Tieraona Thanks guys.

Well it's been a pleasure being with you today. Yeah. Thank you. Thank you for the work that both of you are doing.

Yeah. Erik Oh thank you. All right. Well take care and And again, uh happy healing and happy connecting.

Tieraona Yeah. Erik Thank you. Tieraona Yeah, thanks. Thanks guys.

Bye-bye.