Chronic Illness & Empathy: The Formula for Care You Deserve
If you've been living with chronic illness, you've probably left a doctor's appointment feeling dismissed, unheard, or more confused than when you walked in. You're not imagining it — and it's not your fault.
In this episode of Fast Metabolism Matters, Haylie Pomroy sits down with Dr. Irina Rozenfeld, DNP, a board-certified Nurse Practitioner at the Institute for Neuro-Immune Medicine, to break down the exact formula for patient-centered care that actually works — and how you can start applying it right now, even with your current practitioner.
There Is a Formula
Dr. Rozenfeld has been treating patients with complex chronic illness for over a decade, working alongside Dr. Nancy Klimas at INIM since 2012. What sets her approach apart isn't just clinical expertise — it's a deliberate, multi-step framework she returns to with every patient, regardless of their diagnosis.
"Each patient is individual," she says simply. "Each patient is individual."
It sounds obvious. But in a healthcare system built around seven-minute appointments and reductionistic diagnoses, truly treating each person as an individual is quietly radical.
Step 1: Empathy — Not Sympathy
The first and most foundational piece of the formula is empathy. Dr. Rozenfeld is careful to distinguish it from sympathy.
"I don't need to be sorry for my patient," she explains. "I want to show my empathy. I try to be in the patient's shoes."
This isn't a soft concept — it has real clinical consequences. Empathy is what allows a practitioner to build what Dr. Rozenfeld calls a therapeutic relationship: the foundation on which everything else is built. Without it, patients don't feel safe enough to fully disclose what's happening, don't trust the treatment plan, and are less likely to follow through.
Haylie puts it plainly: "If a patient isn't received with empathy from their practitioner, that's a barrier to getting well."
Dr. Rozenfeld's response: "Yeah. The empathy helped me to build therapeutic relationship. And the therapeutic relationship is really important."
For patients with conditions like ME/CFS, fibromyalgia, and chronic fatigue — where symptoms are frequently dismissed or labeled as psychological — having a practitioner who genuinely believes them isn't a luxury. It's medicine.
Step 2: Personalized Medicine — The Whole Person, Not the Diagnosis
The second piece of the formula is personalized medicine — and Dr. Rozenfeld defines it more broadly than the genetic testing most people associate with the term.
"The body is not a collection of cells. It's not a collection of organs. It's not a collection of systems of organs."
She teaches her patients to think in triads: what's happening between the brain and the gut and the immune system; between the nervous system, the endocrine system, and the immune system; between the kidney, liver, and gut. Chronic illness, she explains, almost never lives in just one system.
A patient might arrive with a stack of diagnoses — fibromyalgia, chronic fatigue syndrome, autonomic dysfunction, Ehlers-Danlos syndrome — and a different practitioner might treat each one separately. At INIM, the goal is to understand how all of those things interact in this specific person, at this specific moment in their life.
That's why initial appointments can run up to three hours. Follow-up visits typically last one to two hours. As Haylie notes: "We're not talking about being able to achieve this in a seven-minute visit."
Personalized medicine also means specialized lab work: immunology panels, genetic testing, epigenetic assessments — understanding not just what's happening in the body, but why, and what environmental, lifestyle, and genetic factors are contributing.
Step 3: Closing the Knowledge Deficit
The third piece of the formula comes straight from nursing education: the knowledge deficit.
"Treatment for knowledge deficit is removing the deficit," Dr. Rozenfeld explains. "I teach my patient, and then I see how they become empowered. When we understand the disease process, we understand what we're trying to achieve, why we have to take medications, why we have to change our lifestyle."
This is the gap between a patient being given a prescription and a patient actually understanding what it does, why they're taking it, and what they're working toward. Most patients with chronic illness have significant knowledge deficits — not because they aren't intelligent, but because the system has never prioritized explaining things to them.
Haylie describes seeing clients who had been on medications for years with no idea what they were for. Contrast that with patients who come out of INIM able to discuss their lab results in detail — explaining what their red and white counts mean, how their immune markers have shifted, and what the next step in their treatment plan is.
That kind of patient is not just more informed — they're a better advocate for themselves. They communicate more effectively with other practitioners. They know when something is wrong. They can avoid exacerbations.
"Closing that gap — the knowledge about their body, what's happening to their body, what their symptoms mean, what their labs mean — that's what knowledge deficit means," Haylie says.
Step 4: Ongoing, Iterative Care — There Is No Magic Pill
The fourth element of the formula isn't a single intervention — it's a commitment to the process.
"There's no magic bullet, there's no magic pill," Haylie says, "because the body is complex and amazing."
Dr. Rozenfeld works through issues one at a time: sleep, environment, exposures, infections, immune reconstitution. Each visit builds on the last. Some patients improve quickly. Others need more time, more support, more integrative approaches — and that's expected, not a failure.
She shares the story of a young patient who arrived at the clinic in a wheelchair. Years later, Dr. Rozenfeld is writing accommodation letters so that same patient can pursue a master's degree independently in Europe.
"Each patient has its own history and trajectory," she says. "Some achieve it faster, and some need longer time and more tender love and care."
Building Immune Resilience: The Role of Allostasis
One of the most important concepts Dr. Rozenfeld introduces is allostasis — the body's ability to adapt and return to a state of balance after stress or illness.
It's not just about making the immune system stronger. Sometimes, particularly with autoimmune conditions, the goal is to make it more tolerant — to reduce the hyperactivation that causes the immune system to attack the body's own tissues.
Everything affects this balance: how you sleep, what you eat, what you're exposed to environmentally, your stress load, your infection history. The work at INIM is about identifying every factor that's throwing the system off, and systematically addressing each one so the immune system can reconstitute and reset.
How to Get Better Care — Right Now
Dr. Rozenfeld and Haylie close the episode with practical, actionable advice for patients who want to apply this formula with whatever practitioner they have access to today.
Before your appointment:
- Bring a complete, written list of all your medications and supplements — don't try to recall from memory
- Gather and send your medical records ahead of time so your provider can review them before you arrive
- Consider bringing a family member, partner, or trusted friend — having support in the room helps close the knowledge deficit and ensures important information isn't missed
During your appointment:
- Let the specialist be the specialist. Resist the urge to come in with a predetermined diagnosis or treatment request
- Share something personal — your hobbies, your life, something that makes you a full human being rather than a diagnosis walking through the door
- Name your knowledge deficit out loud. It's okay to say: "I don't fully understand what's happening with my condition. I don't understand my labs. Can you help me close that gap?"
On using the internet and AI tools: Dr. Rozenfeld acknowledges that Google and AI can be helpful for gathering information — but cautions that they cannot replace clinical reasoning or the therapeutic relationship. "Computer doesn't have clinician reasoning," she says. "And there's the relationship."
You Deserve to Be Believed
Perhaps the most powerful thread running through this entire conversation is validation. For patients with chronic illness — especially those who have spent years being dismissed, gaslit, or told their symptoms are psychological — simply being believed is transformative.
"We always say at our institute: we believe you," Haylie says. "And if you feel like there's nobody in your corner today, or tonight, we are in your corner."
Dr. Rozenfeld echoes this: the most meaningful moments in her practice aren't the complex test results or the treatment breakthroughs. They're the patients who come in and say — sometimes for the first time — thank you for recognizing my illness. Thank you for not sending me away.
That is the formula. Empathy. Personalized medicine. Closing the knowledge deficit. Ongoing, iterative care. And the unwavering belief that every patient deserves to get better.
About Dr. Irina Rozenfeld
Dr. Irina Rozenfeld, DNP, MSHS, APRN, ANP-BC is a Board-Certified Nurse Practitioner at the Institute for Neuro-Immune Medicine at Nova Southeastern University, where she has practiced since 2012. She holds degrees in nursing, integrative medicine from George Washington University School of Medicine, and a doctoral degree from the University of North Florida. She also serves as adjunct faculty at Nova Southeastern University College of Nursing and has extensive experience in clinical research.
Connect with Dr. Rozenfeld:
About Haylie Pomroy
Haylie Pomroy is the Founder and CEO of The Haylie Pomroy Group and a New York Times bestselling author of The Fast Metabolism Diet. A leading health strategist with over 25 years of experience, she combines expertise in nutrition, biochemistry, and patient advocacy to help others reclaim their health — rooted in her own journey with autoimmune disease.
Learn more and connect with Haylie:
Tune in to Fast Metabolism Matters — available wherever you listen to podcasts.
Transcript
Haylie Pomroy: Welcome to Fast Metabolism Matters, where we examine the scientific approach to how your metabolism influences every aspect of your life. I'm Haylie Pomroy, number one New York Times bestselling author. For the past 30 years, I have been creating a support system for vibrant health.
I was in my early 20s battling a life-threatening autoimmune disorder when I learned how vital metabolic health is to our whole being. Join me as I share these insights, and together, let's find out why having a fast metabolism matters.
Today I have an incredible guest who is going to help us shed light on some pearls of wisdom that we can all use to really improve the situation we're in today. I would like to welcome Dr. Irina Rozenfeld. Thank you so much for being our guest today.
Irina Rozenfeld, DNP: My name is Irina Rozenfeld. I'm assistant professor at the Institute for Neuroimmune Medicine at Nova Southeastern University. I'm really happy to be here today.
I think our institute has a formula. I do think we have a formula. First of all, I was lucky to be invited to join Dr. Klimas more than 10 years ago.
Haylie Pomroy: I'm going to jump in. You just mentioned one of our — we call her our fearless leader — Dr. Nancy Klimas. I just want to make sure our whole audience is with us. We want to bring you behind the velvet ropes pretty quick, get you guys the help that you need, and make sure that you have access to things that I know a lot of people dealing with complex illness don't have access to. So fill us in — who is Dr. Nancy Klimas?
Irina Rozenfeld, DNP: I think she doesn't need my introduction. I'm really happy to mention her, and she's my mentor. She, together with her mentor Dr. Marianne Fletcher, founded this Institute for Neuroimmune Medicine. And she, for many, many years — more than 30 years — has been paying attention to and treating patients with chronic fatigue syndrome, which also has the name myalgic encephalomyelitis. She also treats patients with many different complex chronic illnesses which unfortunately sometimes don't have a name yet.
And I think the hope and help philosophy of this institute comes from Dr. Klimas — that we never say to our patients, don't come back. Sometimes we're honest: we don't know what's wrong. It's a lot of peeling the onion. But we try to share hope with the patient. We're doing research, we're looking for cures.
Haylie Pomroy: I'm going to stop you for a second, because you're not good at bragging about yourself. So I want our community to know who I have the pleasure of talking with today. You are Dr. Irina Rozenfeld. You came to the Institute — how long ago?
Irina Rozenfeld, DNP: I joined in 2012. Just over 10 years.
Haylie Pomroy: We're going to talk a lot about chronic fatigue. We're going to talk a lot about neuroimmune medicine, inflammatory disorders, individuals dealing with even Gulf War injury. You always, for me, instill that no matter what, you hold out hope for a patient to get better. Can I ask you just on a personal level — you've been here over 10 years — what inspires you every day to still believe that there's hope?
Irina Rozenfeld, DNP: Because I see the results. And it's actually helping us when we see good results — and we honestly do have good results. I have a formula for what helps us help the patient. And when a patient improves or manages their illness and comes back and we see good results, this is actually what keeps us going.
Haylie Pomroy: It's like a ripple effect. So you said my favorite word — you said you have a formula. Because so many individuals dealing with chronic illness or chronic fatigue don't have access to adequate care. By standardizing or making things accessible in a way that's manageable, maybe things they can incorporate with their own practitioner or communicate effectively with their own practitioner — I'm going to hold you to that formula word. Help me dissect out for our listeners what you mean by a formula. What do you look at when patients come through the door? What type of treatment do you like to apply with individuals dealing with chronic illness? Because let me just tell you, it's really hard to get good care when you're dealing with this.
Irina Rozenfeld, DNP: So the formula — me personally, I think there is a formula. I start, and it doesn't matter — patients with chronic fatigue syndrome and myalgic encephalomyelitis absolutely need this approach. But any chronic illness, environmental illness, chemical sensitivity — we see different patients from different walks of life.
It's really important to understand who your patient is. As a clinician, I trained as a doctor of nursing practice, so I'm a nurse. My role with the patient, first of all, is to show my empathy — not sympathy. I don't need to be sorry for my patient. I want to show my empathy. And what I understand about how empathy shows for the patient — I try to be in the patient's shoes. I need to assist this patient to recognize their illness, to control their illness, to find the appropriate specialist, to find the appropriate treatment.
Haylie Pomroy: Would you go out on a limb and say that if a patient isn't received with empathy from their practitioner, that's a barrier to getting well?
Irina Rozenfeld, DNP: Yeah. The empathy helped me to build a therapeutic relationship. The therapeutic relationship is really important.
Haylie Pomroy: That just sincerely gave me chills, because that's not what a lot of patients receive. A lot of patients don't get that. But I love that you put that first — and I get to watch your work — and you're saying that's just a must.
Irina Rozenfeld, DNP: It is a must. And it's not my opinion — it's already in the books. It's a scientific fact. It's a fact that it's important. Sometimes it's more important to know who your patient is than what their diagnosis is.
It is really important for me to know a lot about my patient. And this therapeutic relationship, it sounds very official, but sometimes it feels like friendship with your patient — but you are there for the patient. Sometimes you cannot do anything, but you're still there. You're present. You're their champion. And sometimes it's not your specialty and I cannot really help, but I can find somebody who is the best in this field. And this is my role.
For some patients, that will be my only role. Most of the time not, but it's a really important role, because we have discovered that chronic fatigue belongs to so many diseases. And for some patients, my role will be to connect them to specialists who will be the best choice for them.
Haylie Pomroy: Having an advocate with your obvious expertise in this space shortens the distance between a person needing to maybe see a cardiologist and actually getting to see a cardiologist. And what we find a lot in this community is that having you believe them helps and it empowers them to be a better advocate for themselves.
I know people that are lucky enough to get to see you and they're emboldened after the visit. They feel validated. They feel listened to. And they're much better at articulating or communicating what they're experiencing. There's a lot of teaching that happens in that visit with you about helping people distill down how they communicate with their practitioners. You communicate with their practitioners on their behalf all the time, but they walk out doing a better job.
Irina Rozenfeld, DNP: You talk with the patient not just about illness. You have to talk about life. You have to talk about lifestyle. But it's not all. The formula includes, of course, empathy and personalized medicine.
I started working with Dr. Klimas. I took immunology classes — university level immunology classes. We are an immunology clinic. But then I went into the area of anti-aging medicine. I joined the Academy for Anti-Aging Medicine. I went for integrative medicine at the best medical school in the country.
Haylie Pomroy: George Washington.
Irina Rozenfeld, DNP: And regenerative medicine. And then I learned that personalized medicine exists.
Haylie Pomroy: I think one of the biggest takeaways is defining what personalized medicine means. How do you see that for your patients? How do you communicate to nurses and doctors about how to integrate personalized medicine? So personalized medicine — what is that? When I say I would like personalized medicine, what does that mean?
Irina Rozenfeld, DNP: Well, there are different meanings in some descriptions — it will be genetic medicine and personalized medicine. I would say it's a little bit wider what I'm trying to call personalized medicine. Each patient is individual. Each patient is individual. Is individual.
With chronic illness, in the body, it's not a collection of cells. It's not a collection of organs and it's not a collection of systems of organs. The patient comes in and it looks like a little bit of neurology, a little bit of immunology, and there are many diseases interacting. A patient can have a lot of different comorbidities: fibromyalgia, chronic fatigue syndrome, autonomic dysfunction, Ehlers-Danlos syndrome. You have the whole alphabet.
But in reality, when you see your patient — and I teach pathophysiology — you have to look at your patient and help them understand what really happened in the body. Integrative medicine really helped me to see that in the body, it's not one particular diagnosis.
Haylie Pomroy: It's not heart disease. It's not...
Irina Rozenfeld, DNP: It's what happens between your brain and your gut and your immune system. What happens between your nervous system and endocrine system and immune system. How your kidney, liver, and your gut work together. So this is kind of triads.
And then you start working with your patient and understand — now personalized medicine with this patient: how are they living, what are they eating, what are they breathing, what are the allergies, what are the many, many factors that affect them. And this is where it's important for me to know that this patient is sleeping well.
Initial visits can last all the way up to three hours. Follow-up visits from one to two hours. It depends how much you already know your patient and where you are in the process.
Haylie Pomroy: But we're not talking about being able to achieve this in a seven-minute visit.
Irina Rozenfeld, DNP: No. This is part of personalized medicine. And the second part of personalized medicine is that we are trained and empowered with specialty labs. We can have genetic labs. We can do assessment of epigenetics — so what's the environment doing to you, what's your predisposition from birth, what happened at different levels of your body, and how do all these systems work together? This is why visits are long. Our immunology assessment, all the tests, environmental testing — it takes time to explain to the patient why we're doing this testing. And then it takes even longer to explain what we find and how we have to treat it.
Haylie Pomroy: So in the formula, we're talking about empathy. We're talking about personalized medicine. Let's continue with the formula. So far, empathy. I want to make sure that our community understands some of the language to articulate successfully so that they can ask for — and have a right to — personalized medicine. What's the next step?
Irina Rozenfeld, DNP: I think the next step is actually a nursing diagnosis. We teach it in nursing school. It's called knowledge deficit. And the treatment for a knowledge deficit is removing the deficit. I have to teach my patient, and then I see how they become empowered. When we understand the disease process, we understand what I'm trying to achieve, why we have to take medications, why we have to change our lifestyle, why sometimes we have to change jobs — sometimes really big, drastic changes. But this is a part of treatment for the knowledge deficit, because we got empowered. We understand what happened. We can avoid exacerbations.
Haylie Pomroy: So it's kind of closing the gap between them not understanding what's happening to their body. I've had so many clients come in who are taking medications and when we ask why it was prescribed, what it's for, what they're looking for, how long they were supposed to be on it — more often than not, there's no knowledge about what they're consuming, even pharmaceutically, let alone what shows in their labs.
What I notice that we do really well is take the time to educate the patient. And it's because we get to see individuals who come out of the Institute — and some of them could almost teach a class. They can say, well, my red count was this, my white count was that. And that's not common. So that's what you mean by closing that knowledge deficit — closing the gap of knowledge about their body, what's happening, what their symptoms mean, what their labs mean, what the meds and supplements mean.
Irina Rozenfeld, DNP: The information given to a patient by us or by another provider can be overwhelming. Sometimes I've had the experience of a patient giving me a hug and saying, thank you for recognizing my anxiety.
Sometimes a patient needs to understand what makes them sick. Even descriptions — when a patient comes in the first time and everything sounds like fatigue, everything may sound the same. But dizziness may be felt differently by different people, and so does fatigue. There is a patient who is fatigued after working eight hours a day and trying to get a second job. But that goes back to personalized medicine. The problem is when patients with chronic fatigue syndrome don't find a response — when they're given the answer, 'everybody gets fatigued' or 'I'm tired too.' That is wrong.
Haylie Pomroy: One of the things that I hear so often with individuals who have chronic illness — definitely with individuals that have fibromyalgia or chronic fatigue — is that it feels patronizing. A lot of their experience is that they say they're tired and a doctor says, well, yeah, I'm tired too. I work all day, I see patients all day. It's just so dismissive, and it's sad and it's frustrating.
I want to hear the other aspects of the formula, because I want us to knit together a walk away for everybody — how they can apply this formula. Even a 10% change in how they receive care can make a tremendous shift in how they realize wellness. So talk me through the other aspects of the formula.
Irina Rozenfeld, DNP: So the formula — sometimes my patients will recognize when I'm saying it — I tell them that I'm just a cheerleader here sometimes. I do have a long arsenal: a list of medications to offer, a list of questions to ask, and interventions to implement. But if my patient tells me they go to bed at 1 a.m. and sleep until 12, and we haven't really evaluated their sleep well, we don't complete the sleep cycle, we don't understand what a sleep cycle is — I have to unravel it and explain that they have to be fatigued because of their lifestyle, and we need to fix it with medication and intervention. With each patient personally, we kind of fix one problem at a time: it's going to be sleep, it's going to be environment, it's going to be exposure.
Haylie Pomroy: So if we're talking about a formula — empathy, personalized medicine, closing the knowledge deficit — what is this next step? There's no magic bullet, there's no magic pill, because the body is complex and amazing.
Irina Rozenfeld, DNP: And this is how we do see results. I have to write letters for my patients for accommodation, but at the same time, it was a young patient who came into the office in a wheelchair — and now I'm writing a letter for accommodation for a university abroad where that student is going to live alone and get her master's degree independently in Europe. It's such a process that gives us as clinicians a goal and the pleasure to go back to work and do it over and over and over.
And each patient has their own history and trajectory. Some achieve it faster and some need longer time and more tender love and care and help to cope. Sometimes when we start with empathy, they may not even hear us. The patient may be absolutely overwhelmed by this illness. So I have to recognize that the patient needs help with coping, help with psychological support and medications, and we use a lot of integrative approaches which are helpful.
Haylie Pomroy: And I'm going to have you back — we're going to talk a lot about integrative medicine, obviously a passion of mine. But how important it is to have a 360-degree view of the patient, and also a 360-degree view of the help that we can provide the patient.
Irina Rozenfeld, DNP: I want to note that from the medical point of view, with chronic illnesses — and we see a lot of chronic illness from different causes — what is important for me in our patients with chronic fatigue and myalgic encephalomyelitis is the immune system. I have to discuss with the patient how the body operates and how our immune system is very sensitive.
We find that there is the innate immune system and the adaptive immune system. It's affected by how you sleep, how you eat, the environment you're exposed to — everything affects how strong your body is. And it's kind of — we studied homeostasis in school, but it's allostasis. It's how your body is able to back up and adapt to a normal, good state.
And it is a process of building the strength of the immune system and the strength of the body to build back — to be able to detox environmental pollution, find food that has real nutritional content, and at the same time have medication to control infections and let your immune system reconstitute and be strong again. And reset itself. Or sometimes actually not to be strong — to be more tolerant.
Haylie Pomroy: Be more tolerant, right — so that we don't have an autoimmune or hyperimmune aspect. So everybody is going to want to come see you after listening to this. But there are going to be a lot of people, so here's my question: if there were three things we could empower patients with to communicate effectively with their practitioner, what would those three things be? And in case we run out of time — I'm listening to this, I'm wishing I could come see you, but I have a visit with my internal medicine doctor in two weeks. How do I prepare myself to have a better relationship? What could a person do to be prepared for that visit so that they receive better care?
Irina Rozenfeld, DNP: I would not recommend patients who think they have chronic fatigue syndrome to call ahead and ask the receptionist whether the doctor does this or that particular therapy. I would not recommend that. If you go to see a specialist, let the specialist be the specialist and ask their questions.
If we choose to go to a clinician, I think we have a reason and some understanding of why we go to see that clinician. Trust the clinician and be prepared — have a list of your medications, bring a list of your medications and supplements, bring a list of your medical records. There are companies that make medical records very convenient, saved on iCloud. You can just give the doctor a code and everybody can access that one space and read your records.
I have a lot of respect for my colleagues — physicians, nurse practitioners, physician assistants. The majority of us choose this profession because of calling. It's not a job. It's a calling.
Haylie Pomroy: A lot of times I'll tell people — even just the basics — when you go in, have a list. Don't wait for them to ask you, don't try to remember, don't try to look at pictures on your phone. Make sure you have a list before you walk in. Be organized. Have all of your charts.
Irina Rozenfeld, DNP: I would love our patients to send their records before the visit so the provider knows they have arrived. We do have records.
Haylie Pomroy: Send them before your visit, confirm with the physician. My other thing that I always tell people is make sure you communicate with your practitioner that you're a human being. Share something — even if it's anecdotal — whether you love dogs or you ride horses. Something that reminds them, and I always say it's one of the best ways to get personalized care: share something about your person.
Make it a personal relationship. Oftentimes we lead, when we go to a doctor's appointment, with our disease or our diagnosis. And when that's the case, especially if it's reductionistic — like I have a diagnosis of chronic fatigue or I have a diagnosis of diabetes — when we lead with that, it's conducive to not getting personalized medicine, because you're communicating that that's the focus for the day and the focus for the visit.
Irina Rozenfeld, DNP: Let them be the specialist, the expert, and listen for their expertise, and then you compare.
Haylie Pomroy: And that's that knowledge gap. So would you say it would be beneficial to communicate to your practitioner that you're aware of a knowledge gap? Because to call that out — to say, I'm here, I'm having this symptom, but I want you to know that I don't really understand what's going on with my autoimmune disorder. I don't really understand my labs. Calling that out and asking for help from your practitioner, having that vulnerability — when you taught me about that knowledge deficit, I went, okay, I can walk into my next visit and really try to shorten that gap.
Irina Rozenfeld, DNP: You have to recognize, as a patient, that Google and the internet are very serious tools for us, but they also create a lot of anxiety, and they are not a substitution for the clinician's mind. Computers, all these programs and databases — they can collect a lot of information. ChatGPT can provide you with some information. But the computer doesn't have clinician reasoning.
And there's also the relationship.
Haylie Pomroy: And the expertise.
Irina Rozenfeld, DNP: More than 10 years ago, when I saw my first patient with chronic fatigue syndrome, I felt very, very intimidated and scared. And expertise builds with movement from novice — I'm still a novice — but you develop a kind of intuition that this patient needs a particular approach, and another patient needs another approach. You have to calm someone, and you need to actually push somebody to do something.
And this builds up. It's not one visit. You have to make this effort and come back and build a relationship with the patient. And with the clinician-patient relationship also, we expect to work together to build a therapeutic relationship.
Haylie Pomroy: This is amazing. And this is why I wanted to do this podcast with you. I want people to feel that there are scientists and physicians and practitioners out there that are inspired by the changes that happen in their patients. We are all inspired by our patients.
Irina Rozenfeld, DNP: We come into the clinic, we talk with each other after we see patients, and we share with each other. We have lunch together and we talk. This is what happened with my patient — and we all have this melting moment where it's just so gratifying.
Haylie Pomroy: I really feel like this is a gift. I know that you're a gift to all the patients that get to see you. But this is a gift to the community at large. We wanted to start having this conversation about what true healthcare should look like — how we want to envision that for ourselves, for any patient out there, but definitely for the patient dealing with chronic fatigue, chronic illness, autoimmune disorders, individuals who have environmental toxicity, chemical sensitivity...
Irina Rozenfeld, DNP: Can I stop you? I forgot to mention — when you are dealing with a knowledge deficit and when you bring to the clinic your list of medications and medical records, bring your family. Bring your partner. Bring a friend. Bring the partner, spouse, family, children.
Haylie Pomroy: That's a great suggestion.
Irina Rozenfeld, DNP: Because if your whole family doesn't believe in your illness or doesn't support your therapy, it's really hard on a patient. This is one of the parts of the knowledge deficit. My dream is to have a clinic facility where a patient can be inpatient and family can be there, and we can teach the whole family how to really take care of this patient with their illness.
I do have a couple who came for their first initial visit on Valentine's Day, and they were both crying. They were saying they were really happy that I was the first to recognize the illness, want to treat them, and not send them away. And that was a Valentine's Day gift. It was very, very moving.
Haylie Pomroy: We always say in our institute: we believe you. And if you feel like there's nobody in your corner today, or tomorrow, or tonight, we are in your corner. Our purpose in doing that is to help you have more tools, more skill sets, shorten that knowledge deficit, know that we have empathy for you, we're rooting for you, and we're going to continue to give you more and more pearls of wisdom, experiences that we've had, anecdotal patient stories.
I need you to promise me that you'll come back.
Irina Rozenfeld, DNP: And of course, we are always looking for what we can apply. We're doing research, we're studying, we're traveling, we're attending all the conferences possible. We're trying to bring everything new that's possible.
Haylie Pomroy: I need you to promise me that you'll come back.
Irina Rozenfeld, DNP: I will.
Haylie Pomroy: And this is going to help so many people. And this is why we do this. I just want to thank you so much for being here. This is an institute full of hope. And these are people that are here to serve and to be of help. And we're going to just keep giving more and more tools so that we can get people well.
Irina Rozenfeld, DNP: Thank you.
Haylie Pomroy: Absolutely. We'll see you soon.
If you've been living with chronic illness, you've probably left a doctor's appointment feeling dismissed, unheard, or more confused than when you walked in. You're not imagining it — and it's not your fault.
In this episode of Fast Metabolism Matters, Haylie Pomroy sits down with Dr. Irina Rozenfeld, DNP, a board-certified Nurse Practitioner at the Institute for Neuro-Immune Medicine, to break down the exact formula for patient-centered care that actually works — and how you can start applying it right now, even with your current practitioner.
There Is a Formula
Dr. Rozenfeld has been treating patients with complex chronic illness for over a decade, working alongside Dr. Nancy Klimas at INIM since 2012. What sets her approach apart isn't just clinical expertise — it's a deliberate, multi-step framework she returns to with every patient, regardless of their diagnosis.
"Each patient is individual," she says simply. "Each patient is individual."
It sounds obvious. But in a healthcare system built around seven-minute appointments and reductionistic diagnoses, truly treating each person as an individual is quietly radical.
Step 1: Empathy — Not Sympathy
The first and most foundational piece of the formula is empathy. Dr. Rozenfeld is careful to distinguish it from sympathy.
"I don't need to be sorry for my patient," she explains. "I want to show my empathy. I try to be in the patient's shoes."
This isn't a soft concept — it has real clinical consequences. Empathy is what allows a practitioner to build what Dr. Rozenfeld calls a therapeutic relationship: the foundation on which everything else is built. Without it, patients don't feel safe enough to fully disclose what's happening, don't trust the treatment plan, and are less likely to follow through.
Haylie puts it plainly: "If a patient isn't received with empathy from their practitioner, that's a barrier to getting well."
Dr. Rozenfeld's response: "Yeah. The empathy helped me to build therapeutic relationship. And the therapeutic relationship is really important."
For patients with conditions like ME/CFS, fibromyalgia, and chronic fatigue — where symptoms are frequently dismissed or labeled as psychological — having a practitioner who genuinely believes them isn't a luxury. It's medicine.
Step 2: Personalized Medicine — The Whole Person, Not the Diagnosis
The second piece of the formula is personalized medicine — and Dr. Rozenfeld defines it more broadly than the genetic testing most people associate with the term.
"The body is not a collection of cells. It's not a collection of organs. It's not a collection of systems of organs."
She teaches her patients to think in triads: what's happening between the brain and the gut and the immune system; between the nervous system, the endocrine system, and the immune system; between the kidney, liver, and gut. Chronic illness, she explains, almost never lives in just one system.
A patient might arrive with a stack of diagnoses — fibromyalgia, chronic fatigue syndrome, autonomic dysfunction, Ehlers-Danlos syndrome — and a different practitioner might treat each one separately. At INIM, the goal is to understand how all of those things interact in this specific person, at this specific moment in their life.
That's why initial appointments can run up to three hours. Follow-up visits typically last one to two hours. As Haylie notes: "We're not talking about being able to achieve this in a seven-minute visit."
Personalized medicine also means specialized lab work: immunology panels, genetic testing, epigenetic assessments — understanding not just what's happening in the body, but why, and what environmental, lifestyle, and genetic factors are contributing.
Step 3: Closing the Knowledge Deficit
The third piece of the formula comes straight from nursing education: the knowledge deficit.
"Treatment for knowledge deficit is removing the deficit," Dr. Rozenfeld explains. "I teach my patient, and then I see how they become empowered. When we understand the disease process, we understand what we're trying to achieve, why we have to take medications, why we have to change our lifestyle."
This is the gap between a patient being given a prescription and a patient actually understanding what it does, why they're taking it, and what they're working toward. Most patients with chronic illness have significant knowledge deficits — not because they aren't intelligent, but because the system has never prioritized explaining things to them.
Haylie describes seeing clients who had been on medications for years with no idea what they were for. Contrast that with patients who come out of INIM able to discuss their lab results in detail — explaining what their red and white counts mean, how their immune markers have shifted, and what the next step in their treatment plan is.
That kind of patient is not just more informed — they're a better advocate for themselves. They communicate more effectively with other practitioners. They know when something is wrong. They can avoid exacerbations.
"Closing that gap — the knowledge about their body, what's happening to their body, what their symptoms mean, what their labs mean — that's what knowledge deficit means," Haylie says.
Step 4: Ongoing, Iterative Care — There Is No Magic Pill
The fourth element of the formula isn't a single intervention — it's a commitment to the process.
"There's no magic bullet, there's no magic pill," Haylie says, "because the body is complex and amazing."
Dr. Rozenfeld works through issues one at a time: sleep, environment, exposures, infections, immune reconstitution. Each visit builds on the last. Some patients improve quickly. Others need more time, more support, more integrative approaches — and that's expected, not a failure.
She shares the story of a young patient who arrived at the clinic in a wheelchair. Years later, Dr. Rozenfeld is writing accommodation letters so that same patient can pursue a master's degree independently in Europe.
"Each patient has its own history and trajectory," she says. "Some achieve it faster, and some need longer time and more tender love and care."
Building Immune Resilience: The Role of Allostasis
One of the most important concepts Dr. Rozenfeld introduces is allostasis — the body's ability to adapt and return to a state of balance after stress or illness.
It's not just about making the immune system stronger. Sometimes, particularly with autoimmune conditions, the goal is to make it more tolerant — to reduce the hyperactivation that causes the immune system to attack the body's own tissues.
Everything affects this balance: how you sleep, what you eat, what you're exposed to environmentally, your stress load, your infection history. The work at INIM is about identifying every factor that's throwing the system off, and systematically addressing each one so the immune system can reconstitute and reset.
How to Get Better Care — Right Now
Dr. Rozenfeld and Haylie close the episode with practical, actionable advice for patients who want to apply this formula with whatever practitioner they have access to today.
Before your appointment:
- Bring a complete, written list of all your medications and supplements — don't try to recall from memory
- Gather and send your medical records ahead of time so your provider can review them before you arrive
- Consider bringing a family member, partner, or trusted friend — having support in the room helps close the knowledge deficit and ensures important information isn't missed
During your appointment:
- Let the specialist be the specialist. Resist the urge to come in with a predetermined diagnosis or treatment request
- Share something personal — your hobbies, your life, something that makes you a full human being rather than a diagnosis walking through the door
- Name your knowledge deficit out loud. It's okay to say: "I don't fully understand what's happening with my condition. I don't understand my labs. Can you help me close that gap?"
On using the internet and AI tools: Dr. Rozenfeld acknowledges that Google and AI can be helpful for gathering information — but cautions that they cannot replace clinical reasoning or the therapeutic relationship. "Computer doesn't have clinician reasoning," she says. "And there's the relationship."
You Deserve to Be Believed
Perhaps the most powerful thread running through this entire conversation is validation. For patients with chronic illness — especially those who have spent years being dismissed, gaslit, or told their symptoms are psychological — simply being believed is transformative.
"We always say at our institute: we believe you," Haylie says. "And if you feel like there's nobody in your corner today, or tonight, we are in your corner."
Dr. Rozenfeld echoes this: the most meaningful moments in her practice aren't the complex test results or the treatment breakthroughs. They're the patients who come in and say — sometimes for the first time — thank you for recognizing my illness. Thank you for not sending me away.
That is the formula. Empathy. Personalized medicine. Closing the knowledge deficit. Ongoing, iterative care. And the unwavering belief that every patient deserves to get better.
About Dr. Irina Rozenfeld
Dr. Irina Rozenfeld, DNP, MSHS, APRN, ANP-BC is a Board-Certified Nurse Practitioner at the Institute for Neuro-Immune Medicine at Nova Southeastern University, where she has practiced since 2012. She holds degrees in nursing, integrative medicine from George Washington University School of Medicine, and a doctoral degree from the University of North Florida. She also serves as adjunct faculty at Nova Southeastern University College of Nursing and has extensive experience in clinical research.
Connect with Dr. Rozenfeld:
About Haylie Pomroy
Haylie Pomroy is the Founder and CEO of The Haylie Pomroy Group and a New York Times bestselling author of The Fast Metabolism Diet. A leading health strategist with over 25 years of experience, she combines expertise in nutrition, biochemistry, and patient advocacy to help others reclaim their health — rooted in her own journey with autoimmune disease.
Learn more and connect with Haylie:
Tune in to Fast Metabolism Matters — available wherever you listen to podcasts.
Transcript
Haylie Pomroy: Welcome to Fast Metabolism Matters, where we examine the scientific approach to how your metabolism influences every aspect of your life. I'm Haylie Pomroy, number one New York Times bestselling author. For the past 30 years, I have been creating a support system for vibrant health.
I was in my early 20s battling a life-threatening autoimmune disorder when I learned how vital metabolic health is to our whole being. Join me as I share these insights, and together, let's find out why having a fast metabolism matters.
Today I have an incredible guest who is going to help us shed light on some pearls of wisdom that we can all use to really improve the situation we're in today. I would like to welcome Dr. Irina Rozenfeld. Thank you so much for being our guest today.
Irina Rozenfeld, DNP: My name is Irina Rozenfeld. I'm assistant professor at the Institute for Neuroimmune Medicine at Nova Southeastern University. I'm really happy to be here today.
I think our institute has a formula. I do think we have a formula. First of all, I was lucky to be invited to join Dr. Klimas more than 10 years ago.
Haylie Pomroy: I'm going to jump in. You just mentioned one of our — we call her our fearless leader — Dr. Nancy Klimas. I just want to make sure our whole audience is with us. We want to bring you behind the velvet ropes pretty quick, get you guys the help that you need, and make sure that you have access to things that I know a lot of people dealing with complex illness don't have access to. So fill us in — who is Dr. Nancy Klimas?
Irina Rozenfeld, DNP: I think she doesn't need my introduction. I'm really happy to mention her, and she's my mentor. She, together with her mentor Dr. Marianne Fletcher, founded this Institute for Neuroimmune Medicine. And she, for many, many years — more than 30 years — has been paying attention to and treating patients with chronic fatigue syndrome, which also has the name myalgic encephalomyelitis. She also treats patients with many different complex chronic illnesses which unfortunately sometimes don't have a name yet.
And I think the hope and help philosophy of this institute comes from Dr. Klimas — that we never say to our patients, don't come back. Sometimes we're honest: we don't know what's wrong. It's a lot of peeling the onion. But we try to share hope with the patient. We're doing research, we're looking for cures.
Haylie Pomroy: I'm going to stop you for a second, because you're not good at bragging about yourself. So I want our community to know who I have the pleasure of talking with today. You are Dr. Irina Rozenfeld. You came to the Institute — how long ago?
Irina Rozenfeld, DNP: I joined in 2012. Just over 10 years.
Haylie Pomroy: We're going to talk a lot about chronic fatigue. We're going to talk a lot about neuroimmune medicine, inflammatory disorders, individuals dealing with even Gulf War injury. You always, for me, instill that no matter what, you hold out hope for a patient to get better. Can I ask you just on a personal level — you've been here over 10 years — what inspires you every day to still believe that there's hope?
Irina Rozenfeld, DNP: Because I see the results. And it's actually helping us when we see good results — and we honestly do have good results. I have a formula for what helps us help the patient. And when a patient improves or manages their illness and comes back and we see good results, this is actually what keeps us going.
Haylie Pomroy: It's like a ripple effect. So you said my favorite word — you said you have a formula. Because so many individuals dealing with chronic illness or chronic fatigue don't have access to adequate care. By standardizing or making things accessible in a way that's manageable, maybe things they can incorporate with their own practitioner or communicate effectively with their own practitioner — I'm going to hold you to that formula word. Help me dissect out for our listeners what you mean by a formula. What do you look at when patients come through the door? What type of treatment do you like to apply with individuals dealing with chronic illness? Because let me just tell you, it's really hard to get good care when you're dealing with this.
Irina Rozenfeld, DNP: So the formula — me personally, I think there is a formula. I start, and it doesn't matter — patients with chronic fatigue syndrome and myalgic encephalomyelitis absolutely need this approach. But any chronic illness, environmental illness, chemical sensitivity — we see different patients from different walks of life.
It's really important to understand who your patient is. As a clinician, I trained as a doctor of nursing practice, so I'm a nurse. My role with the patient, first of all, is to show my empathy — not sympathy. I don't need to be sorry for my patient. I want to show my empathy. And what I understand about how empathy shows for the patient — I try to be in the patient's shoes. I need to assist this patient to recognize their illness, to control their illness, to find the appropriate specialist, to find the appropriate treatment.
Haylie Pomroy: Would you go out on a limb and say that if a patient isn't received with empathy from their practitioner, that's a barrier to getting well?
Irina Rozenfeld, DNP: Yeah. The empathy helped me to build a therapeutic relationship. The therapeutic relationship is really important.
Haylie Pomroy: That just sincerely gave me chills, because that's not what a lot of patients receive. A lot of patients don't get that. But I love that you put that first — and I get to watch your work — and you're saying that's just a must.
Irina Rozenfeld, DNP: It is a must. And it's not my opinion — it's already in the books. It's a scientific fact. It's a fact that it's important. Sometimes it's more important to know who your patient is than what their diagnosis is.
It is really important for me to know a lot about my patient. And this therapeutic relationship, it sounds very official, but sometimes it feels like friendship with your patient — but you are there for the patient. Sometimes you cannot do anything, but you're still there. You're present. You're their champion. And sometimes it's not your specialty and I cannot really help, but I can find somebody who is the best in this field. And this is my role.
For some patients, that will be my only role. Most of the time not, but it's a really important role, because we have discovered that chronic fatigue belongs to so many diseases. And for some patients, my role will be to connect them to specialists who will be the best choice for them.
Haylie Pomroy: Having an advocate with your obvious expertise in this space shortens the distance between a person needing to maybe see a cardiologist and actually getting to see a cardiologist. And what we find a lot in this community is that having you believe them helps and it empowers them to be a better advocate for themselves.
I know people that are lucky enough to get to see you and they're emboldened after the visit. They feel validated. They feel listened to. And they're much better at articulating or communicating what they're experiencing. There's a lot of teaching that happens in that visit with you about helping people distill down how they communicate with their practitioners. You communicate with their practitioners on their behalf all the time, but they walk out doing a better job.
Irina Rozenfeld, DNP: You talk with the patient not just about illness. You have to talk about life. You have to talk about lifestyle. But it's not all. The formula includes, of course, empathy and personalized medicine.
I started working with Dr. Klimas. I took immunology classes — university level immunology classes. We are an immunology clinic. But then I went into the area of anti-aging medicine. I joined the Academy for Anti-Aging Medicine. I went for integrative medicine at the best medical school in the country.
Haylie Pomroy: George Washington.
Irina Rozenfeld, DNP: And regenerative medicine. And then I learned that personalized medicine exists.
Haylie Pomroy: I think one of the biggest takeaways is defining what personalized medicine means. How do you see that for your patients? How do you communicate to nurses and doctors about how to integrate personalized medicine? So personalized medicine — what is that? When I say I would like personalized medicine, what does that mean?
Irina Rozenfeld, DNP: Well, there are different meanings in some descriptions — it will be genetic medicine and personalized medicine. I would say it's a little bit wider what I'm trying to call personalized medicine. Each patient is individual. Each patient is individual. Is individual.
With chronic illness, in the body, it's not a collection of cells. It's not a collection of organs and it's not a collection of systems of organs. The patient comes in and it looks like a little bit of neurology, a little bit of immunology, and there are many diseases interacting. A patient can have a lot of different comorbidities: fibromyalgia, chronic fatigue syndrome, autonomic dysfunction, Ehlers-Danlos syndrome. You have the whole alphabet.
But in reality, when you see your patient — and I teach pathophysiology — you have to look at your patient and help them understand what really happened in the body. Integrative medicine really helped me to see that in the body, it's not one particular diagnosis.
Haylie Pomroy: It's not heart disease. It's not...
Irina Rozenfeld, DNP: It's what happens between your brain and your gut and your immune system. What happens between your nervous system and endocrine system and immune system. How your kidney, liver, and your gut work together. So this is kind of triads.
And then you start working with your patient and understand — now personalized medicine with this patient: how are they living, what are they eating, what are they breathing, what are the allergies, what are the many, many factors that affect them. And this is where it's important for me to know that this patient is sleeping well.
Initial visits can last all the way up to three hours. Follow-up visits from one to two hours. It depends how much you already know your patient and where you are in the process.
Haylie Pomroy: But we're not talking about being able to achieve this in a seven-minute visit.
Irina Rozenfeld, DNP: No. This is part of personalized medicine. And the second part of personalized medicine is that we are trained and empowered with specialty labs. We can have genetic labs. We can do assessment of epigenetics — so what's the environment doing to you, what's your predisposition from birth, what happened at different levels of your body, and how do all these systems work together? This is why visits are long. Our immunology assessment, all the tests, environmental testing — it takes time to explain to the patient why we're doing this testing. And then it takes even longer to explain what we find and how we have to treat it.
Haylie Pomroy: So in the formula, we're talking about empathy. We're talking about personalized medicine. Let's continue with the formula. So far, empathy. I want to make sure that our community understands some of the language to articulate successfully so that they can ask for — and have a right to — personalized medicine. What's the next step?
Irina Rozenfeld, DNP: I think the next step is actually a nursing diagnosis. We teach it in nursing school. It's called knowledge deficit. And the treatment for a knowledge deficit is removing the deficit. I have to teach my patient, and then I see how they become empowered. When we understand the disease process, we understand what I'm trying to achieve, why we have to take medications, why we have to change our lifestyle, why sometimes we have to change jobs — sometimes really big, drastic changes. But this is a part of treatment for the knowledge deficit, because we got empowered. We understand what happened. We can avoid exacerbations.
Haylie Pomroy: So it's kind of closing the gap between them not understanding what's happening to their body. I've had so many clients come in who are taking medications and when we ask why it was prescribed, what it's for, what they're looking for, how long they were supposed to be on it — more often than not, there's no knowledge about what they're consuming, even pharmaceutically, let alone what shows in their labs.
What I notice that we do really well is take the time to educate the patient. And it's because we get to see individuals who come out of the Institute — and some of them could almost teach a class. They can say, well, my red count was this, my white count was that. And that's not common. So that's what you mean by closing that knowledge deficit — closing the gap of knowledge about their body, what's happening, what their symptoms mean, what their labs mean, what the meds and supplements mean.
Irina Rozenfeld, DNP: The information given to a patient by us or by another provider can be overwhelming. Sometimes I've had the experience of a patient giving me a hug and saying, thank you for recognizing my anxiety.
Sometimes a patient needs to understand what makes them sick. Even descriptions — when a patient comes in the first time and everything sounds like fatigue, everything may sound the same. But dizziness may be felt differently by different people, and so does fatigue. There is a patient who is fatigued after working eight hours a day and trying to get a second job. But that goes back to personalized medicine. The problem is when patients with chronic fatigue syndrome don't find a response — when they're given the answer, 'everybody gets fatigued' or 'I'm tired too.' That is wrong.
Haylie Pomroy: One of the things that I hear so often with individuals who have chronic illness — definitely with individuals that have fibromyalgia or chronic fatigue — is that it feels patronizing. A lot of their experience is that they say they're tired and a doctor says, well, yeah, I'm tired too. I work all day, I see patients all day. It's just so dismissive, and it's sad and it's frustrating.
I want to hear the other aspects of the formula, because I want us to knit together a walk away for everybody — how they can apply this formula. Even a 10% change in how they receive care can make a tremendous shift in how they realize wellness. So talk me through the other aspects of the formula.
Irina Rozenfeld, DNP: So the formula — sometimes my patients will recognize when I'm saying it — I tell them that I'm just a cheerleader here sometimes. I do have a long arsenal: a list of medications to offer, a list of questions to ask, and interventions to implement. But if my patient tells me they go to bed at 1 a.m. and sleep until 12, and we haven't really evaluated their sleep well, we don't complete the sleep cycle, we don't understand what a sleep cycle is — I have to unravel it and explain that they have to be fatigued because of their lifestyle, and we need to fix it with medication and intervention. With each patient personally, we kind of fix one problem at a time: it's going to be sleep, it's going to be environment, it's going to be exposure.
Haylie Pomroy: So if we're talking about a formula — empathy, personalized medicine, closing the knowledge deficit — what is this next step? There's no magic bullet, there's no magic pill, because the body is complex and amazing.
Irina Rozenfeld, DNP: And this is how we do see results. I have to write letters for my patients for accommodation, but at the same time, it was a young patient who came into the office in a wheelchair — and now I'm writing a letter for accommodation for a university abroad where that student is going to live alone and get her master's degree independently in Europe. It's such a process that gives us as clinicians a goal and the pleasure to go back to work and do it over and over and over.
And each patient has their own history and trajectory. Some achieve it faster and some need longer time and more tender love and care and help to cope. Sometimes when we start with empathy, they may not even hear us. The patient may be absolutely overwhelmed by this illness. So I have to recognize that the patient needs help with coping, help with psychological support and medications, and we use a lot of integrative approaches which are helpful.
Haylie Pomroy: And I'm going to have you back — we're going to talk a lot about integrative medicine, obviously a passion of mine. But how important it is to have a 360-degree view of the patient, and also a 360-degree view of the help that we can provide the patient.
Irina Rozenfeld, DNP: I want to note that from the medical point of view, with chronic illnesses — and we see a lot of chronic illness from different causes — what is important for me in our patients with chronic fatigue and myalgic encephalomyelitis is the immune system. I have to discuss with the patient how the body operates and how our immune system is very sensitive.
We find that there is the innate immune system and the adaptive immune system. It's affected by how you sleep, how you eat, the environment you're exposed to — everything affects how strong your body is. And it's kind of — we studied homeostasis in school, but it's allostasis. It's how your body is able to back up and adapt to a normal, good state.
And it is a process of building the strength of the immune system and the strength of the body to build back — to be able to detox environmental pollution, find food that has real nutritional content, and at the same time have medication to control infections and let your immune system reconstitute and be strong again. And reset itself. Or sometimes actually not to be strong — to be more tolerant.
Haylie Pomroy: Be more tolerant, right — so that we don't have an autoimmune or hyperimmune aspect. So everybody is going to want to come see you after listening to this. But there are going to be a lot of people, so here's my question: if there were three things we could empower patients with to communicate effectively with their practitioner, what would those three things be? And in case we run out of time — I'm listening to this, I'm wishing I could come see you, but I have a visit with my internal medicine doctor in two weeks. How do I prepare myself to have a better relationship? What could a person do to be prepared for that visit so that they receive better care?
Irina Rozenfeld, DNP: I would not recommend patients who think they have chronic fatigue syndrome to call ahead and ask the receptionist whether the doctor does this or that particular therapy. I would not recommend that. If you go to see a specialist, let the specialist be the specialist and ask their questions.
If we choose to go to a clinician, I think we have a reason and some understanding of why we go to see that clinician. Trust the clinician and be prepared — have a list of your medications, bring a list of your medications and supplements, bring a list of your medical records. There are companies that make medical records very convenient, saved on iCloud. You can just give the doctor a code and everybody can access that one space and read your records.
I have a lot of respect for my colleagues — physicians, nurse practitioners, physician assistants. The majority of us choose this profession because of calling. It's not a job. It's a calling.
Haylie Pomroy: A lot of times I'll tell people — even just the basics — when you go in, have a list. Don't wait for them to ask you, don't try to remember, don't try to look at pictures on your phone. Make sure you have a list before you walk in. Be organized. Have all of your charts.
Irina Rozenfeld, DNP: I would love our patients to send their records before the visit so the provider knows they have arrived. We do have records.
Haylie Pomroy: Send them before your visit, confirm with the physician. My other thing that I always tell people is make sure you communicate with your practitioner that you're a human being. Share something — even if it's anecdotal — whether you love dogs or you ride horses. Something that reminds them, and I always say it's one of the best ways to get personalized care: share something about your person.
Make it a personal relationship. Oftentimes we lead, when we go to a doctor's appointment, with our disease or our diagnosis. And when that's the case, especially if it's reductionistic — like I have a diagnosis of chronic fatigue or I have a diagnosis of diabetes — when we lead with that, it's conducive to not getting personalized medicine, because you're communicating that that's the focus for the day and the focus for the visit.
Irina Rozenfeld, DNP: Let them be the specialist, the expert, and listen for their expertise, and then you compare.
Haylie Pomroy: And that's that knowledge gap. So would you say it would be beneficial to communicate to your practitioner that you're aware of a knowledge gap? Because to call that out — to say, I'm here, I'm having this symptom, but I want you to know that I don't really understand what's going on with my autoimmune disorder. I don't really understand my labs. Calling that out and asking for help from your practitioner, having that vulnerability — when you taught me about that knowledge deficit, I went, okay, I can walk into my next visit and really try to shorten that gap.
Irina Rozenfeld, DNP: You have to recognize, as a patient, that Google and the internet are very serious tools for us, but they also create a lot of anxiety, and they are not a substitution for the clinician's mind. Computers, all these programs and databases — they can collect a lot of information. ChatGPT can provide you with some information. But the computer doesn't have clinician reasoning.
And there's also the relationship.
Haylie Pomroy: And the expertise.
Irina Rozenfeld, DNP: More than 10 years ago, when I saw my first patient with chronic fatigue syndrome, I felt very, very intimidated and scared. And expertise builds with movement from novice — I'm still a novice — but you develop a kind of intuition that this patient needs a particular approach, and another patient needs another approach. You have to calm someone, and you need to actually push somebody to do something.
And this builds up. It's not one visit. You have to make this effort and come back and build a relationship with the patient. And with the clinician-patient relationship also, we expect to work together to build a therapeutic relationship.
Haylie Pomroy: This is amazing. And this is why I wanted to do this podcast with you. I want people to feel that there are scientists and physicians and practitioners out there that are inspired by the changes that happen in their patients. We are all inspired by our patients.
Irina Rozenfeld, DNP: We come into the clinic, we talk with each other after we see patients, and we share with each other. We have lunch together and we talk. This is what happened with my patient — and we all have this melting moment where it's just so gratifying.
Haylie Pomroy: I really feel like this is a gift. I know that you're a gift to all the patients that get to see you. But this is a gift to the community at large. We wanted to start having this conversation about what true healthcare should look like — how we want to envision that for ourselves, for any patient out there, but definitely for the patient dealing with chronic fatigue, chronic illness, autoimmune disorders, individuals who have environmental toxicity, chemical sensitivity...
Irina Rozenfeld, DNP: Can I stop you? I forgot to mention — when you are dealing with a knowledge deficit and when you bring to the clinic your list of medications and medical records, bring your family. Bring your partner. Bring a friend. Bring the partner, spouse, family, children.
Haylie Pomroy: That's a great suggestion.
Irina Rozenfeld, DNP: Because if your whole family doesn't believe in your illness or doesn't support your therapy, it's really hard on a patient. This is one of the parts of the knowledge deficit. My dream is to have a clinic facility where a patient can be inpatient and family can be there, and we can teach the whole family how to really take care of this patient with their illness.
I do have a couple who came for their first initial visit on Valentine's Day, and they were both crying. They were saying they were really happy that I was the first to recognize the illness, want to treat them, and not send them away. And that was a Valentine's Day gift. It was very, very moving.
Haylie Pomroy: We always say in our institute: we believe you. And if you feel like there's nobody in your corner today, or tomorrow, or tonight, we are in your corner. Our purpose in doing that is to help you have more tools, more skill sets, shorten that knowledge deficit, know that we have empathy for you, we're rooting for you, and we're going to continue to give you more and more pearls of wisdom, experiences that we've had, anecdotal patient stories.
I need you to promise me that you'll come back.
Irina Rozenfeld, DNP: And of course, we are always looking for what we can apply. We're doing research, we're studying, we're traveling, we're attending all the conferences possible. We're trying to bring everything new that's possible.
Haylie Pomroy: I need you to promise me that you'll come back.
Irina Rozenfeld, DNP: I will.
Haylie Pomroy: And this is going to help so many people. And this is why we do this. I just want to thank you so much for being here. This is an institute full of hope. And these are people that are here to serve and to be of help. And we're going to just keep giving more and more tools so that we can get people well.
Irina Rozenfeld, DNP: Thank you.
Haylie Pomroy: Absolutely. We'll see you soon.
