SPEAKER_01 0:00

You're listening to competent project auditors. What is competence deployed? Healthcare helping private practice and healthcare and the data challenges related to regulation and building private. In every episode, we tackle different issues based on healthcare practitioners and entrepreneurs, but we interview a guest who is working on the leading edge of private healthcare building something that matters in their sector or profession. My name is Jody Rainsford, and on today's episode I'll be discussing with Christopher Coach Brown and Roger Houston, directors at Our List, about the unique challenges around marketing, promoting a functional medicine practice or healthcare business and some of the issues that arise on a regular basis. We discuss what information needs to be provided and available to clients and what claims can be made around treatment and providing evidence to support this. So let's get over to the discussion. So, what is the burden that is placed on functional medicine practices in terms of how they market and promote their business and their services and attract patients? Is there specific guidelines? Who is the body that effectively polices how businesses promote themselves in this area?

SPEAKER_00 1:16

Yeah. I think Jody, it's very much a GMC issue for doctors and really maintain within the GMC guidelines, as we Roger and I often say, the GMC rules by guidelines, which become absolutely rigid when they want them to be. So you do have to be very aware of those, particularly for the less well accepted treatments. So when it's mainstream, it's really about managing patient expectations as to what the treatment is and what the possible outcomes might be. I think it's very much you have to not give people the impression of some kind of sort of miracle cure or somehow that it's going to be so much better than what's generally available on the NHS, and you have to be very clear and realistic in what the treatments are and what the expected results might be.

SPEAKER_02 2:12

Yeah, so you have a duty that's akin to a fiduciary one in the sense the GMC require that you act in the patient's best interest, and they specifically mention that includes a situation that's contrary to your financial interest. So you have a very high duty. That's they don't call it a fiduciary duty, but in other areas of life that's exactly what it is. So, yeah, that's the duty. Again, dentistry is very similar. So those that are entering the profession having qualified abroad often fall foul of that. The idea that you have an obligation to direct patients to the NHS where you know that treatment's available, free at the point of delivery. Functional medicine is slightly different on the basis that the whole, if you like, medical ideology of it is that it is not mainstream medicine, it is something that's different. It looks at things in a system type way, it doesn't treat in isolation or doesn't treat symptoms, it tries to get to root cause. All of that's admirable, but it has to be declared specifically and it has to be referenced in consent that's applicable to the patient's own particular circumstances, and then you get into risks and benefits once you've determined what you need to do and what the cost is because you can't determine whether you've got an overall benefit unless you know the cost and the risks. Yeah.

SPEAKER_01 3:37

And when do when does the marketing become an issue? Is this something that becomes an issue uh further down the line when there's a particular issue with a patient, or yeah, when they decide they don't want to pay the bill, Jake.

SPEAKER_00 3:53

It's very much like a contract. You only worry about the marketing when there's a dispute. So it always comes back to you promised me all this and nothing's happened. I went to your website, I saw this amazing thing that was going to be better in three weeks. Turned up to you, paid you all this money, it's three weeks, and I feel worse than ever.

SPEAKER_02 4:13

Yeah, the other pitfall that I'm finding a lot on the complaints and claims side is that there's not a clear understanding with patients about privately funding investigations that may or may that are available elsewhere on the NHS. So there's a timing issue with that, possibly.

SPEAKER_00 4:31

But again, you know, and there's also a communication issue in that a lot of functional medicine has blood tests, but they do enormously detailed blood tests. They look at hundreds of indicators, but blood tests are available on the NHS. But the NHS blood tests are far narrower and blunter. So you can go along to a functional medicine practitioner, they say, Oh, we'll do a blood test. You go, the NHS would have done that for free. And those blood tests are expensive that are hundreds of pounds. So that's where you need to be very clear about why you're doing this private blood test, what the difference is, what the markers are. Again, interestingly, one of the big differences between NHS medicine and functional medicine is NHS medicine has very particular thresholds. So when blood marker you're fine until your blood marker gets to a certain number, and that number is normally a fairly critical number in terms of health. So once you drop over, flip through that number, whichever way up or down, then you're sick in NHS terms. In functional medicine land, if your number's sort of heading in the wrong direction and in the wrong end of the spectrum, then there's something a bit out, and we need to find out what it is and start to correct it. So there's a big difference in mentality, but you can imagine for somebody who's presented a bill for several hundred pounds and says I could get that in the NHS.

SPEAKER_02 5:57

Yeah, so I recently had a case where there was an awful lot of heat and noise uh around the case, and it came down to poor communications, Chris says, on the basis that the plan had been outlined, but running parallel with that and really underpinning that was a whole host of tests which ran into a multiple thousands. So a patient was saying, I've gone through all this, you know, and nothing's happened, nothing's new. You've prodded and pushed and taken an arm for blood, and for what effect? So I liken it to a builder. So builder A doesn't give you a detailed schedule of work, just asks you periodically for money that you can't relate to work done. Builder B takes you through a step-by-step schedule, and you can see where the pricing adds up by way of an interim payment, which who are you going to trust? So once that's gone, it's very difficult to get it back. So I've had yeah, I would say probably somewhere between 40 to two-thirds, 40 percent to two-thirds of complaints as distinct from claims I deal with are predicated or miscommunication, and it is so often not around scope of works, if you like, want to use that construction term, it's about what people say are non-treatment related costs.

SPEAKER_00 7:18

And it's there's also you need to communicate the contingency because people do people form a view, they do the test to test that view. It either confirms a view or doesn't. In the case it doesn't, then there's something else that they might need to do. And of course, it's not the NHS, all of these things cost. So, as Roger says, these things things can ramp up. And we were discussing this with we went to see one of our clients a few weeks back, didn't we? It was exactly that discussion is how do you manage that process with the patient to say, yeah, you've just done one expensive test, and I still don't know what the problem is. So I need to do another expensive test to try my next idea. And you've you need to be very clear in your communication on that because uh you can imagine people just start to scratch their heads.

SPEAKER_01 8:06

So when it comes to if we're talking about the whole area of kind of marketing and promotion and and bringing patients on board, it seems like there's some distinct stages where you very clearly have to do certain things. There's the the the marketing side, the kind of the the things that you put out that communicate on things like social media in terms of your advertising in the way that you actually bring people in. But then there's also the other elements that you more closely control, which seem to be the the processes by when someone has shown an interest, that you you're talking about reasonable expectations, you're making all of these things clear, and all of these things are very clearly about getting the processes right and getting that in place to ensure that everything else that falls into place.

SPEAKER_02 8:56

Yeah, I think it's also cultural shift. So, quite a lot of our clients, or in fact the majority have come from the NHS. They want to do something different, functional medicine is that platform, but they've they've gone through training, they've gone through rotation, they've become senior in what they do, but they've never really, doctors here on the NHS, they don't sit down and talk about money with patients. You can't assume that people will equate further investigations with an additional bill. Quite a lot of people think you've done the wrong test. So why should I pay for you to do the right test? And in reality, all you're doing is a scientific investigation from a medical perspective, and it's standard practice, it's standard routine, but it's not something that's dealt with from a financial point of view within the NHS because it just isn't, it's all free at the point of delivery. There is a cost, but not to the individual doctor nor the patient. So you've got to switch that mindset. Think of the builder going through the schedule of works.

SPEAKER_01 9:57

It's a cultural aspect on both sides, there's a cultural aspect in terms of doctor feeling as though I can, yeah, go to the case.

SPEAKER_02 10:08

You think it's of course, but the patient doesn't know that. You're assuming too much.

SPEAKER_00 10:17

The marketing's got to start with that setting the groundwork for that. But if you like you discussed in any business, any interaction with the business is marketing. So all of your interactions with the business have to have that concept in mind. Uh, at the end of the day, the you are exploring and to a degree experimenting, and the patient is paying for that, so they need to understand why it's sensible and why it's worth the cost.

SPEAKER_01 10:43

In terms of thinking about the the the front-end marketing, because of the nature of functional medicine, that people who are attracted to it have already have an interest in it. You know, they're they're quite knowledgeable, not necessarily deeply knowledgeable about what happens, but knowledgeable because they've heard other claims which might have been in the media, they might have been in circles where they've heard those, and so they come with a certain level of expectation, particularly as functional medicine becomes more mainstream. We hear more and more stories in in the media, we hear more stories being shared on social media, and so people are coming to that with a with a level of expectation.

SPEAKER_00 11:21

I would almost say it is the other way around. Okay. So the the what's appearing in the press now is a nice clickbait, big headlines. I did these ten things and it cured my cancer, sort of headline. And so people then read that and expect to be able to do those ten things in it to cure their cancer or whatever it is, or massively reduce their weight without surgery or whatever, whatever it is. It's the the headlines are based on big promises for people, quite unhealthy people, and it's based on something that might or might not have worked for somebody without an awful lot of tracking details as to what actually happened and why it worked. Remember, this is personalized medicine. So what works for person A doesn't necessarily work for person B. I think it is more that problem. So you need to very much tackle that issue. You need to tacklise the personalized nature of it, and you might have read some great headlines, but I can't guarantee you that we'll get anything to work for you.

SPEAKER_02 12:18

I guess it breaks into two categories. One I would say that they come with a tabloid diagnosis, as Chris has described, the other is a Google diagnosis. Both need to be uh dealt with particularly on the basis that, as you could say, Chris, it's personal, but you have to determine what it is. So I've spoken to lots of people on the complaint side where the opening conversation, the initial consultation is I've looked this up on Google, I have this. Can you do this for me? Yes, and yeah, that's almost certainly wrong, or partially wrong. And then you need to try and that's what that's underpins informed consent. So we have to go through this journey. Yeah, but you don't it's important to not forget the cost schedule because otherwise you end up in that camp. So it's yeah, it's a slightly different slide. You should argue apart from the finance, it should be the same in the NHS, but it's not so yeah, it's about communication and understanding, and there will be an underlying trust and an expectation that you are the specialist in the room, or they wouldn't be there. So you you start on the plus side, the patient relationship and trust is yours to lose, and that's how you lose it in our experience.

SPEAKER_00 13:31

And I think it's also our very strong advice is you know the marketing is great and you want to attract patients, but you also want to have a fairly serious filter as to who you actually want to take on. So, our very strong advice to practitioners is be even in the early days, and uh appreciate it's difficult because when you're starting a business, you want revenue and you'll possibly be attracted to things that you wouldn't be once you're more established, but you want to be really quite careful about the patients that you take on. The person who marches in and says, I read this in the in the mirror last week and I want the same, is not the kind of patient you want.

SPEAKER_02 14:07

That's the difference between marketing and a consultation, isn't it? Yeah, there's two levels as you say, JD.

SPEAKER_00 14:14

Yeah. And I guess we we would also see it so you'd be very careful about using articles in in the press or on Google or or anywhere else for your own marketing. It's you really have to describe the process and what it is and what the benefits of that process are. And again, interestingly, just popped into my head, this is one place where case studies might not be might be a double-edged sword in terms of marketing, because if you say, Oh, I did this for person X, person Y might not be the same. So it's you use case studies with care, I would say.

SPEAKER_02 14:48

Yeah, and by definition, to make them relevant, you almost have to breach the patient's confidentiality, don't you? Yes. And therefore, you need to be very careful about how you get permission from people to use case studies. Because if you want it granular enough to make it relevant, that's a re-rehearsal of their notes.

SPEAKER_00 15:08

Yeah, and their notes in functional medicine is uh their their family's sort of medical history and minute to the grandparents or something. It's you know, it's incredible. And the take-on forms are 40 pages long with all sorts of very personal questions in them.

SPEAKER_01 15:21

Yeah. Have you seen any particular examples of practices or healthcare businesses that that have done this well that managed to balance obviously the need to grow, the need to attract people, need to bring people into this world with just getting it right in terms of how they did it? Because what you mentioned there in terms of sharing articles, that was that's been extremely prevalent in terms of people making the case for functional medicine generally. There's some some advocates for functional medicine generally sharing things like that. But are there examples of the kind of approach that you would suggest for say new business who wanted to do the right things, who wanted to stay on the right side in order to make sure that they were going to avoid any of the problems that that people run into?

SPEAKER_02 16:08

Yeah, so I think in my experience, Jody, it's really several levels. So the marketing as as you describe it are broad descriptions of categories of suffering, almost putting a sort of label on it. Do you have untreated Lyme's disease? And the key symptoms of Lyme disease are this. If you feel that you're getting nowhere, then please call us. Then you get into the details of their case. So it's striking that balance between trying to be too specific and therefore almost wrong, and therefore misrepresenting what it is you can do for that individual versus the broad swath of people that you think you can help and you know are being poorly served elsewhere. That's probably the way to describe it. And you can go through what's low dose lockstone used for, what's Lyme's disease, what are the symptoms. So it's almost are you lethargic, are you this, are you that? And do you feel that your current arrangements are not sorting out your long-term problems? So you almost bring them in through an acknowledgement that they've got a problem and they don't feel they're being well served. That's about as specific, I think, as you can get, because then you need to start detailing, screening people, as Chris said. So you don't really want the Daily Mail reader who's looking for a cure when it doesn't exist. That doesn't mean you can't do something for them, but it's not what they think it is. So again, you've got to be honest with people. The best doctor I know of that is is an aesthetic client of ours who is absolutely brutally honest with people. Yeah, you know, you are not a basket of fruit, and you're never going to be. But I can do this. Here are the risks, here are the benefits.

SPEAKER_01 17:50

And so when because the the we've talked about about case studies there and using things like testimonials in order to attract people. So when it comes to content like that in terms of marketing, then the best way to stay on the right side would be to avoid claims being made in things like testimonials and case studies, and instead focus on maybe the the quality of the care, the quality of the clinic, the quality of the processes, uh, and avoid anything about oh, I was cured of this simply because of the personalized aspect of it.

SPEAKER_02 18:26

Yeah, because no serious physician, no serious functional medicine doctor ever uses the word cure. Yeah. And yet it's tabloid fodder. Everyone is seeking a cure. This idea of perfection, it doesn't exist. So you will never hear a medical professional use the word cure. And that's no coincidence.

SPEAKER_01 18:46

Is there any way that a functional medicine practice can stay on the right side of this and suggest the results that they've got from a particular client? Is there any way of doing that?

SPEAKER_02 18:58

Yeah, providing it's suitably contextualized and qualified. The other thing, in terms of medicine, in terms of ethical duty, is by definition you're appealing to a cohort of people who are compromised in some way. So the the emotional balance is not equal, and that's where the whole misrepresentation thing comes in. Now, advertising standards deal with that in some way, medical ethics deal with it in another, but the root cause is the same.

SPEAKER_00 19:25

Yeah, and that was interesting, uh, JD, because uh again at the IPM that we were at recently, there was a lot of talk, and there was a uh a lovely 82, 83-year-old lady who came seaming round to us to tell us all about how she had she'd had her dementia reserve reversed through diet, exercise, and lifestyle, and she thought that was a a small miracle, which in some ways it is. For her it was, yes, and so on. Now, the reality is that there is a doctor in the states who's created a protocol, and there's actually thousands of people who who that's happen to. Uh, so that's great and great news for promoting it. But the issue is you don't want to say to anybody we'll cure you a dementia with diet exercise and lifestyle because there's numerous factors which mean that might not happen. So it's all presenting it, you need to present it as these are the results that we're getting, but not everybody gets those results.

SPEAKER_02 20:23

Yeah, it's not a cult, that's the other thing.

SPEAKER_00 20:26

Yeah, yeah. You're speaking to the man behind cults. Yeah, have you not read his book? Yeah, yes. Have you not read his book, How to Start a Cult? Yeah, yeah.

SPEAKER_02 20:38

So this is yeah, this is specifically not that, Joder. Sorry to say that, but it's but it's it's it's not in the sense that if you define a cult as a following that's irrational, and I'm not suggesting you are for a moment, you can have a medical following based on a whole load of successful outcomes for a variety of people, providing you you know you deal with that. Because you're selling, if you like, you're not selling faith, are you? You're selling buying into a medical process that has some increasingly some very sophisticated biochemical rigour behind it.

SPEAKER_00 21:10

Yeah. That that that is the thing, and I do think increasingly that is the way to sell it, is what utterly blows my mind in all of this is the detailed scientific knowledge, and I'm gonna say scientific to differentiate it from medical, because all of these practitioners have an incredible knowledge of the biochemistry circuits and pathways and how those work and how those interact. And in fact, I have been I have been talking to a number of practitioners to really understand what that level of knowledge is, and it is much higher than I always anticipated. It's it's this might be through a different podcast, actually. There's a big difference emerging between clinical, which would be medical practice, and and a sort of scientific biochemistry. And actually, nutritionists versus dietitians is to me the absolute leading aid. So a dietitian is actually an HCPC registered individual. So they do have the capacity to diagnose basically nutrition dietary related disease, so obesity, even cancer, diabetes, all those sort of metabolic diseases. So if you are a dietitian, you're HCPC registered and you can make those diagnoses. If you are a nutritionist, you are not registered with a recognized regulatory body. Most nutritional therapists are members of Bent, the British Association of Nutritional Therapists, but that isn't a recognized medical body. Nutritionist is not so dietitian is a protected title. That means that you have to be qualified and registered and so on to use it. Nutritionist isn't, but the nutritionists do a lot more biochemistry. And interesting, when I looked at all our sort of leading clients and practices, all of their ancillary staff, bar one, who did that kind of stuff, were nutritionists. And the one dietician who did it called himself a therapeutic nutritionist and was a member of Bent. So there seems to be the sort of science clinical divide developing. And the clinical end is, and I think this is what functional medicine is trying to get away from, and I've heard in conferences. The clinical approach is you have a list of symptoms, which pasty face, diluted pupils, fat around the middle, whatever they are, a whole list of them. And if you get half more than 65% of the symptoms ticked off, then that's the diagnosis. And so it's very much a sort of pattern matching. You just look at the person, whereas the whole approach of functional medicine is this root cause. They test and they test, and they're looking at all the blood and the biomarkers and all sorts of other tests. They test saliva, they test stools, they there's they test urine. There's more and more tests, which gets back to that expense thing. But they would argue we're not guessing on just by looking at somebody and poking them. We're actually looking at what's happening in these processes that we understand how they affect the body.

SPEAKER_02 24:13

Yeah, and that's the tragedy of it. When I get to speak to them, that's a really good story that they ought to be telling and costing and not be ashamed of it. That's the other thing. NHS doctors are always ashamed to talk about money, they're in business now. That's the other point. And but by the time they get to me, they've had a series of emails and rude phone calls, and people want to check in the post. And they could have avoided all that by some sensible conversation and notation in the notes. So it's a shame. I'm sure we'll get there, and hopefully, podcasts like this. Because again, to come back to an old ad is a problem avoided is far better than one overcome. And they start from this, they have the moral high ground, the ethical high ground, and the trust, and they and it seeps away because they don't explain things to people. And they're not intellect, they're not arrogant people. It's not oh pat on the head, doctor knows best. It's not that they're absolutely not that way. But they end up with a whole world of trouble which could have been resolved from a 15-minute conversation. So to me, it's almost like a checklist with our people to say this is we're not telling you how to suck eggs, but please cover off these things and don't forget the costs. You almost need a schedule running the side by the side of the treatment plan. If you've got the treatment plan on the left-hand column of what you're going to do, you want the right-hand column to deal with cost.

SPEAKER_01 25:35

So it so really it's more of the trying to overcome the cultural element around having a discussion around money, and actually say many of the challenges that you see, the issues that come across your desk, could simply be avoided by yeah.

SPEAKER_02 25:50

So, in fact, if a judge talks about competing parties, he puts one side's case on another in the right-hand column, the other side's case, and looks at them. That's called a Scott schedule, named after the judge that could first introduced it or dealt with it. So I think we need the holicity schedule for treatment cost.

SPEAKER_01 26:10

Yeah, the good news of that is that's a relatively simple thing.

SPEAKER_02 26:14

It's not like they don't know it, it's how they present it, which makes it all the more tragic when they don't, then it goes horribly wrong on them. And they're giving money back. Some of our people in their initial stages work for nothing because they're giving it all back in refunds.

SPEAKER_00 26:27

They're giving back in refunds, or they're doing the follow-ups for free.

SPEAKER_02 26:31

Yeah.

SPEAKER_00 26:31

Yeah. So it's really funny, isn't it? It sounds like a lot of money. And this is maybe one for the whole sort of a podcast on the whole the whole nature of the business. But it sounds like a lot of money, but what's actually going in is vast. So, really, when you work it out, it it literally ends up with the practitioners in their early stages effectively working for free. That might take a little bit, but they're effectively working for free.

SPEAKER_02 26:56

That's very NHS, isn't it? I'm working for free at the body delivery, but I'm not getting a salary. Wonderful.

SPEAKER_00 27:04

Yeah, yeah, yeah. That's a big thing, and and a big thing in managing the business is keep keeping your patients happy whilst not working for free. And in fact, to go full circle, I think what we see is they are we we have four or five clients who are very successful practices, you know, they have at least 10 different staff, they have growing revenues, they're everybody's paid, the owners are doing, I wouldn't say they're gonna be the next billionaire, but they're they're making a living out of it and growing it nicely. But I think their approach is very much on starting again functional medicine's root causes medicine medicine, and you need to communicate root causes practice. That's it's being a proponent of the process rather than the why the process is so much better rather than specific results as some kind of miracle. I think sorry, Roger.

SPEAKER_02 28:02

No, no, I agree, absolutely. Yeah, yeah.

SPEAKER_01 28:06

Okay, so I think that's a really good place to finish up the discussion. I'm sure there's more we can discuss around this as this progresses as well. So thank you very much, and I will see you on the next podcast. Thanks, Jody. Cheers, Jody. Thank you for listening to Confidence to Thrive. Before you go, please rate, review, and subscribe to Confidence to Thrive on your preferred podcast platform and help us spread our message to others who are making a difference in private healthcare. This podcast was brought to you by Our Litity, insurance advisors who support your business ambitions. Our litity advises practitioners, owners, and entrepreneurs of healthcare practices on mitigating risks so your business can thrive. Learn more about how Our Licity can support you by finding the link in the show notes or visiting our licity.co.uk.