Concierge vs Integrative Medicine

A Medical Insurance CFO said she understood where I was coming from when I discussed my practice and the fact that I don't enroll in and insurance plans.  Being out of network/opting out of medicare has the benefits of not being required to purchase expensive electronic medical recording systems (and the tech necessary to maintain-I spent 2-3 hours negotiating a 30 minute compliance training slide show on Sherman Hospitals website just to maintain hospital admitting privileges...that was a chunk of an office day where I could have been paying bills!!!)
She then went on to stab me in the heart by saying, she goes to a doctor like me, her concierge doctor. Then I thought....if she negotiates price points between large corporations and medical practices, sets policy for the doctors on what they get reimbursed, "wheels and deals" strategic plans to be the middle man but show a profit to her board of directors......then she herself goes outside the usual medical insurance limitations to maintain her health-what kind of message is that for the masses of people trying to decide which plan is good for their family during open enrollment while at the same time not taking too much out of the bimonthly paycheck.   (see my blog on the Duality of Healing and Healthcare)

I am not a concierge doctor.  I do not charge a retainer fee to "cherry pick" my most loyal patient and create and exclusive membership club.   I destroyed my 401 K to study advanced techniques of mind body medicine, nutrition, acupuncture, yoga instruction so I could heal myself and my patients.   I gave up a 10 year practice to break away from a Hospital in the Center of Dupage so I wouldn't be giving up more unpaid weekend time to go back and finish charts/answer phone calls and help my patients heal their suffering.   (I was told at one point that since my acupuncture wasn't reimbursed by insurance....I had to do it on my own time.....you cant charge patients over and above the negotiated prices for evaluation and treatment if an insurance contract was signed by the hospital between provider and patient.....which makes me think a concierge retainer fee is illegal)  I was working 50 hours a week, plus giving away community lecture time, I missed my daughter growing up....in fact I don't remember much from those 10 years except eating bad food in the morning, drinking alot of coffee in the afternoon, downing beer to force sleep to come....then getting shocked in the ICU to bring down my heart rate from all the crap I was doing.

No question, the guys who do concierge medicine must have a knack for making patients want to come back and pay an annual fee over and above the co pays of insurance.  But I have yet to see any of these docs do any further training in medicine above the usual requirements for maintaining board certification every 7-10 years.  In fact most of them still refer out to the specialists, still follow standard prescription protocols, may or may not hand out nutrition information, don't use alternative medicine.   To get off my soap box, there is a benefit of going concierge.  You have one doc that knows your name, goes to the hospital to admit you, in the past they were supposed to offer going to the specialist consult alongside you (I believe that practice stopped), their back log of a waiting list to get in is supposedly short so you can get in same day.   So $1000.00 a year to insure a spot on his/her list may be worth it.  That is about the equivalent of a 12 week healthy lifestyle program with 3-4 coaches at your side.  (I medically cleared a lady for a
 Largest Loser  program who was able to get off medicine for high cholesterol, depression, high blood pressure and is now down to a body weight she hasn't experienced since college....now that would be a good way to spend "a doctor retainer fee")

You just have to ask yourself, do you want to be in an exclusive club and see your doctor or do you want to change your life, get healthy and not have to see your doctor?

Make a grown man cry

We often neglect our feet.  Women purchase shoes that perk up their butts, men buy shoes that "insulate" from the elements (but weight 10 pounds), we buy cheapies with no arch support boldly stating "I don't need no stinking fashion".  Then the foot pain starts, the ankle roll occurs, the knee swelling begins or the visit to immediate care for a back pain flare up.  To show how important feet are in daily living, a guy came to see me for 10/10 pain, in ability to walk, back pain and loss of work.  I investigated all his complaints then checked his feet.  There was a tiny bump that looked sparkly.  I proceeded to inquire where all his problems began....it started with a BBQ party.  I took the smallest forceps I had to explore this shiny object.  Bingo!!! this little sliver of glass came out!   I had him walk and the foot pain left, had him stand upright and the back pain was gone, within 5 minutes, his face changed.  Done!
Many of the podiatrists I know create orthotics to change the arch of the foot.  They are made to place in all your shoes and unfortunately some feet will wonder why did these comfy shoes change?   What people don't realize is if the foundation is moved, the structure will also shift.  There is a Q-angle that serves as an imaginary line from the front of the ankle to the point on the knee up to the front of the hip.  If this angle is straight, the mechanical movement of the lower body is fluid and fast.  When the angle is off (flat feet, bow legged, knock kneed, birthing hips) some friction points can develop.  The areas of irritation are angles we have carried since childhood but the weight......oh yes, the weight we carry is not from childhood.  It's from the pregnancies, the injury, the new job driving an 18 wheeler, the lack of sex, the alcohol, the persistent athletic appetite in the face of being a couch potato.   This is when childhood angles get stressed, under stretched, over used and pushed to 10 hours of day.  Time for disability, psychiatric evaluation, chronic pain clinic, diabetes/sugar monitoring, cholesterol medicine, blood pressure low salt and a scheduled orthopedic surgery.   All this because we never bothered to care for our feet.  Even in western medicine, orthopedic foot surgeons don't have time to make orthotics, they are too busy cutting, breaking and resetting.

 The ancient practice of reflexology isn't well accepted in doctor offices due to this split of not being endorsed/supported/studied by big pharma.   If there are not studies, it can't be valid.....what most of my colleagues say.  If only they would experience the rush of serotonin after I place acupuncture in the ear or sing my crystal bowl or nebulize sandalwood/lavender essential oil.
All this stuff does make a difference.  Vanity plays in as well.  Ignorance by physician community adds to it (docs are just too busy and untrained to help with weight loss/nutrition change/lifestyle modification).  The feet are a foundation to locomotion, travel and socializing, hunter gathering....when we don't honor any part of our body, that body part will deteriorate and become a burden.  Cutting it off, taking medicine, getting a handicap placard are not going to reverse the issue.  Looking for the source of dysfunction is the key.  Finding someone who will listen/brainstorm is crucial.