It was actually a bit of a shock. I was flipping through an old journal and came across a bunch of notes I had taken listening to free podcast.

Everything was incredibly familiar to me. Not because of the podcast, but because after listening to the podcast, I signed up for a coaching program with the speaker spending several hundred dollars to work with him for the next 8 or 9 months.

I knew the material from his program, the coaching calls and applying the information to me personally.

I recognized the information because I had paid for it, not because I heard it for free on a podcast. Reviewing the notes I was so shocked to see all the main bullet points were there. All the take-home points were already mine.

But I couldn't claim them until I had invested money, time and energy. I needed skin in the game.

Let me give you another example.

My husband hauled out the Christmas decorations from the crawl space. When he saw all the stuff he remembered that his mom had given us a bunch of Christmas lights, most of them white. We're a bright colour kinda household, so he said, "Because these are white they can be left up all the time, even in the back yard." I said, "Won't they wear out more quickly that way? Doesn't that ruin them?" He said, "So what? They were free!"

Yeah. No skin in the game. In this second example, sure, they were just lights. But do you see how in the first example I didn't benefit until there was some sort of exchange?

I can’t know for sure, but it seems to me since I started offering direct billing at the office, my patients aren’t getting better as quickly, as well, or for as long as before. I know, this is a bold claim, one I don't take lightly. In fact, this post has been sitting as a draft for 4 months.

To be honest I’ve been rather confused for the past couple of years. Did I suddenly become less skilled as a doctor of naturopathic medicine? Did I forget how this first-do-no-harm, stimulate-the-healing-power-within, treat-the-root-cause, heal-the-whole-person-as-an-individual, teach-preventative-medicine, thing works?

Doubt it.

Frankly, it’s been very unsatisfying to do my job, which is wack-a-doodle- because I LOVE my work. More on that in this article.

Thankfully I still know naturopathic medicine works.

It’s the compliance that’s not working. People will say, “No I didn’t get around to doing what we talked about for x, y, and z reasons.”

But that's not until they've come back only to express their dissatisfaction because nothing has improved. And when I start to dig into why that might be, that's when they admit that they haven't done what we talked about, usually, because it was too hard or some variation. And I wonder, but living in pain or anxiety or diarrhea or acne is easy?

Meeting with dissatisfied people is very dissatisfying.

How can they (you?) expect results when they (you) are not willing to make any changes?

AKA: If you keep doing what you’re doing you’ll keep getting what you’re getting.

AKA: What got you here won't get you there.

AKA: You want things to be different but you don't want to change things.

Naturopathic medicine works when you work it.

Drinking the proper amount of clean water, changing your diet and lifestyle, reducing stress, and taking the natural medicines that will improve the functioning of the body will have an impact on your health. The formula is not complicated. It just needs to be done.

These two examples above got me thinking, "Maybe people aren't making the necessary changes because they don’t have any skin in the game?"

Canadians aren't used to paying for health care. To pay privately for naturopathic services seems ghastly to some. Direct billing takes some of the financial pressure off because the patient pays less out of pocket.

And therein lies the conundrum, and my hypothesis.

Without the investment, the habit changes aren’t incentivized.

There is nothing to lose or risk, and therefore, unfortunately, nothing to gain.

Let the lights sit outside all year - sun, rain, wind or snow. Who cares? They were free!

It’s like the podcast notes I took. When I found them in my journal, it's as if they were yelling to me, "Here is everything you need to know about the transformation I can offer you, but good luck integrating until you invest in this coaching program."

And guess what? I’m not only a doctor. I’m a human, with medical challenges and needs of my own.

I pay privately for my health care. I see a naturopathic doctor. I run labs on myself. I buy supplements. I eat organic food. I move my body. I see an osteopathic doctor, an acupuncturist, a Rolfer, and a Brain-Based Transformation Coach.

I’m self-employed so I don’t have the benefit of an extended health plan. I still pay. I can’t think of anything more important to spend my money on.

A homeless person once said, "If you don't have your health, you don't have anywhere to live."

When I miss appointments I pay. When I can’t show up when I said I would I pay. As a patient, I honour my side of the sacred contract between myself and my practitioner. And it's not for them. It's for me. I honour the sacred contract I've made with myself.

There is a certain level of responsibility that I’m just not seeing in patients anymore, and gosh, it all seems to have begun when I started direct billing as a courtesy for my patients.

I worry now that it did more harm than good.

I’m seriously wondering if direct billing is keeping patients sick. It’s mostly impossible to know for sure. I don't have hard or specific data and I understand how this is a rather amorphous claim I’m making. This dissatisfaction I'm seeing in my clients and myself has been rather insidious over the past 2-3 years.

But if there is a thread of that hypothesis that is true, then I’m breaking the first part of my naturopathic oath: FIRST DO NO HARM.

I’m not making any drastic change in the office right now. But I’m going to watch this. And who knows... I might go back to having people pay in full, providing them a comprehensive receipt that they can take and submit to their insurance companies on their own behalf, giving them back the responsibility it requires to get and stay well.

The title of this article is provocative. I know. And if you've made it this far, I'm impressed. You may be hella triggered right now, and that's okay. I'm writing this to help people even though it may feel really uncomfortable as you reflect on yourself and your own path.

Here's one last thought.

It's not the extended health plan keeping you or anyone sick. Ultimately that's up to you, and only you. Seeing me or any other health practitioner can be the most empowering thing you ever do IF you take the reigns and make choices that will actually help you get to where you want to go.

I'm really good and showing you the choices that are available. But at the end of the day, you have to choose them. 

And I understand you may not have the same values as me. That’s okay. But I implore you to consider this. If you’re seeking me out for care, please be willing to make an investment. It might not have to be money. It might be time, or energy, or courage. But know this. You won’t get a satisfying outcome if you don’t participate in some kind of exchange.

To your healthy, happy, delightful life,