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.

I'm not Spiritual

Herb Benson said:
-choose a word, phrase, thought or prayer and repeat it throughout the day
Deepak Chopra taught:
-repeat your mantra over 20-30 minutes twice a day
Andy Weil gave me:
-478 breathing

The common theme is to develop some form of repetition activity, verbal/auditory and eventually linked to breath.  As Dr Weil Guided my fellowship class, breath/respiration is the easiest body system to control.  (see video)  As you gain control over the voluntary portion (taking a deep breath) of this system, eventually control comes over the involuntary system (breath/blood pressure/heart rate).  Thus the reason why modern scientists have embellished breath work as part of high blood pressure treatment.  The problem with delivery of modern treatment plans to newly diagnosed hypertension is time.  It is faster to write a prescription than to teach relaxation response, meditation or just plain "living in the moment".   It's also easy to crank up the heat over the phone....if the home blood pressure readings don't go down, increase the dose, maximize on the medicine then add another.  If only the drugs from the pharmacy came with an instruction manual on the above techniques to be done when taking pills.

I have had to soften the idea of meditation (all 3 techniques in my opinion) to my patients for making it more appetizing a practice.  If I say meditation - some people bite.  If I say prayer - most adults mention being holiday church goers.  If I say spirituality - lost and sometimes repulsed.  Like the DrOz show, if the pathology of disease or treatment is illustrated visually in layman's terms, it makes understanding and initiation of treatment more empowering.  My passion is being physical.   I love running, cardio, yoga, hiking....nature.  What better way to adopt a meditative practice than to combine it with a very tangible movement activity.   I like to change the performance of classic weight training to a modern cross fit type of activity.  I believe at any age we can adopt and perform repetition and link it to movement.

A little plug for hiking.   A nice way to say walk.  But walk is not associated with weight loss or exercise.  Those of you who count steps and calories know 30-60minutes of exercise pales in comparison to the calories burned with total steps per day.  Anyone who has calculated the calories burned on a treadmill with know moderate to intense running will burn a small amount of calories in an exercise session.  Adding up walking before, after and during the day will lead to a bounty of weight loss after a 12 week boot camp.  If walking steps helps with getting back health, repetition of mantra/breath/word should be easy to combine.  Wouldn't it be nice to rev up a single action to make a bigger impact?

Thus was born DrRic's Meditative Hiking.  I learned a walking technique while taking a Harvard course and it was breezed through in less than 15 minutes but the concept stuck with me.  I found peace with hiking in Yosemite and but the Half Dome trail was long and tough (and my first big hike) so I added the breath finger technique and I credit that to getting me back down the 7 miles of return trail.   I also felt astoundingly high (was it the summit of Half Dome or the meditative movement .....I don't know).  Regardless of the for feeling good, why not do a little more intentional walking this summer, a little intentional breath/finger tapping (no one will ever know!) a little more "unplugging" and get out the blue sky brown trail and green foliage.  Nature has a way of taking over after about 30 minutes (Shin Rin Yoku) no matter what mood rules you upon entry.

Bottom line is no matter what your religious upbringing, spiritual diversity, time for exercise, feeling of being outdoors are; you can use standard medicine to lower your blood pressure numbers or you can incorporate and adopt lifestyle change to decrease risks for disease AND get rid of your medicine!

DrRic's Out of Network Fee Schedule

Question: Which business model offers reimbursement after 90 days of submitting a bill?
Answer:   Medical insurance.
Question: Which business model is guaranteed to reimburse you lower than what you charge?
Answer:   Medical insurance.
Question: Which service-base-industry requires you to pay back for intellectual services rendered to a patient if the non medical person says you never rendered services regardless of what the patient reveals.
Answer:   Medical insurance.
Question: Which industry does a 3rd party get between a healer and a patient then makes money from both?
Answer:   Medical insurance.

2014.  Insurance based medical care requires lengthy documentation, expensive recording software, full time staff to communicate, submit and approve medical procedures.  This is before a patient ever walks into an exam room.  The only way to break even between bills and reimbursement is to see high volume.  High volume leads to rapid diagnosis and generalized treatment plans.   This is where people become "symptoms" and prescription medicines become "cures".
2014.  My wife's office manager dies from colon cancer at 56 years of age.  She had the will to live but but was given a treatment plan that was based on generalized statistics.  She actually died from a demoralized lack of hope, dehydration, starvation, and side effects of antibiotics.....the cancer didn't kill her.  I watched Kathy go through the slow approval of medical therapy, the lack of compassion to her individual case and the poor knowledge of nutrition and alternative/complementary care that would have worked well with the non cancer complications she was going through.  She did not have to suffer.
2014.  I embark on promoting individualized health care using my board certified training in Family Medicine, my alternative training in Medical Acupuncture, Yoga/Meditation Instruction and Integrative Medicine (Board Eligible).  I utilize a 3rd party secure "Cloud" medical record system that costs an annual fee of $40.00+;  I sell no supplements in my office and defer patients to reliable supplement stores in my area (where I shop); I design treatment plans utilizing what we can from covered benefits while at the same time initiating lifestyle changes that will hopefully be sustainable with as much natural change as possible.  I have partnered with Advocate Medical Group to establish a footprint in the Bartlett area so there are many insurance companies that are contracted however designated days for Integrative Consults are once a week/standard medical visits ("speed medicine") apply for the majority of my office hours.  I have to honor the healthcare group paying my salary by being financially profitable but at the same time I must fulfill my calling to teach/empower/change people with more than just prescription medicines.  No matter how long we live or how many diseases we encounter, if we lived a healthy productive life-in the end there will be no regrets.

Fees for face-to-face time are related to the complexity of your case:

Consults at The Center of Healing (Integrative Medicine/Medical Acupuncture)

60 minutes=$300.00
45 minutes=$250.00

30 minutes=$150.00

Acupuncture=$100.00

Phone/Internet Consults (Online Link)
60 minutes=$200.00
30-45 minutes=$100.00
21-30 minutes=$60.00
11-20 minutes=$40.00
5-10   minutes=$20.00

As an alternative to seeing me, I have fellow graduates who have been trained through the same program and take medical insurance- Integrative Medicine Physicians.  Realize there is only one fellowship in the US that prepares physicians to qualify for the Integrative Medicine Board..... my alma mater-The Arizona Center for Integrative Medicine.

House Rules

When my patients come to me for lifestyle change, they usually don't bring family members in.  I love the process of creating steps to change but only assume everyone at home will be participating/supporting the steps.  No two plans are the same, everyone has different likes, educational levels, adverse memories, food 't intolerance's, stressors or previous attempts.  The one things I can't fathom is how the spouse and kids will react to the changes that are usually restrictive.

No question that if a parent is making a change the likelihood of the child having the same medical problem is high.  Whether it is expressing itself now or later doesn't matter, disease always leads to a bad outcome. To make a major shift in bad habits, craving control or trigger avoidance will take a lot of energy and may lead to some emotional "PMS-ing" even if you are a guy!  If your family and coworkers are unaware of your journey, relationships can be destroyed.  If they understand, they too may be inspired to drop a habit.

Counseling should be a requirement for the journey since unhealthy coping skills have been adopted to get you to poor health.  Excuses are abundant as to why the weight is high, cholesterol is in bold print, and kids tease you about body parts that belong in the zoo.  As tight as we hold onto and defend our reasons for ill health, it will be the ultimate "stress response" to let them go.   Think of  an addict going through the shakes, irritability, hallucinations, vomiting and headache......and that is just from caffeine!  If you are trying to let go of your "comfort food", your nightcap, your morning wake up, or any high risk behavior.....getting everyone to lend a hand would increase success.  Family should always be for you unconditionally but just in case, the behavioral health profession is very good at listening and making suggestions that have worked for your predecessors.

Home should be sanctuary as it encompasses 1/3 of your life.  During the worst times of your life, there should be a place to retreat away from stressors (work, traffic, cable TV, food industry).  If you can't harness the support of family, they should be the ones being counseled.   A happier/healthier you will exude positive energy, problem solving, creativity and love.....the law of attraction will bring positive results to those around you.  (The House Divided Against Itself Cannot Stand )

Is there anything natural for sleep?

The body should be able to regulate it's own circadian rhythm with proper care.  That means if you are healthy, work in the fields, get up at dawn, sleep at dusk and eat right-the brain has ways of secreting hormones that signal time to wake up and time to fall into brain rest.  The problem will come when we go over and above by watching TV for 24 hours, "sleeping in" for more than to consecutive days, eating poorly or with no regularity, taking stimulants like caffeine/bad carbohydrates/adhd prescriptions.  When you participate in repetative poor scheduling, the brain will think you are in a different time zone and it will not know when dusk is so the quality of deep brain wave rest will be compromised.  You will know by the mere fact that you wake up fatigued, fall asleep at the wheel, become irritable with problem solving, or memory is hampered.  

Snoring is not good.  We often attribute the sound of a child snoring to -"a good sleep".  If the snoring is associated with pauses of apnea (not breathing) then the brain  is not getting oxygen and sends impulses to the diapragm to gasp for air.  It may sound funny on youtube (or annoying to the partner) but the heart also gets shut out from oxygen and it will suffer by sending out a stress response and turning on adrenaline and epinephrine.......two hormones that are not supposed to be floating around the blood stream during peaceful shut-eye.  The only way to find out about if a loud snorer is going through apnea is a sleep study.  Medical insurance will pay for sleep studies in the lab but you usually have to get a "Home Sleep Unit" from the lung specialist and wear it for 1-7 nights.  This will document a problem and signal to your insurance doctor that a more formal and detailed test is required.  The end result is a positive pressure mask or nasal canula to wear at night so the soft tissues of the nose/mouth/throat stay open at night to allow air flow in and out.  (thus no obstruction)  NOTE-usually if you lose weight the soft tissue that is blocking the passageway will shrink allow the breathing tube to remain open.  Imaging that, a non surgical, non chemical way to get rid of sleep apnea!!!! Oh but weight loss isn't covered by insurance.  What is covered by insurance is a nasty surgery called the UPPP (see link)   

If there is not apneic issue and you are just suffering from shift work sleep problems, sometimes you can do things naturally to help the brain drift off into a sleep rhythm again but it takes ritual pattern establishment over 21 days or longer.  See my lecture on sleep  Today we have immediate access of over 100 channels of stimulating TV programs and usually a closet full of equally stimulating processed food.  Run away! Run away like you are running from zombies!!  It is too easy to open a package and say you will just have 1-2 bites but then feel guilty you ate 20 servings before the TV program finished!!  It is hard to stay true to a diet when you are weak....that is usually about 10pm to 2am. (and in ancient healing like Ayurveda and traditional Chinese medicine-one is not supposed to be filling the stomach at these hours)

You can schedule your macro nutrients to assist in bringing the brain to bedtime, you can also keep your exercise to day time, you can practice the relaxation response to induce positive serotonin secretion to help in training the brain to establish a good circadian rhythm but if this doesn't work then there are hypnotic prescriptions that will force you to sleep but it usually results in poor dream state and an addiction to the medicine.

I feel fine, do I need a check up?

I was in an online meeting with Deepak Chopra and he announced current research projects regarding telomeres.  These are the end caps of our chromosomes (DNA) that protect these delicate message carriers from chemicals, radiation, bad food, viral invasion....the external world.  His research finds if you meditate regularly, your telomeres stay long.  (when they get short the end is near-damage to DNA occurs and just a matter of time before mutation occurs and something grows the wrong way)  He has even enlisted the expertise of Elizabeth Blackburn who is a Nobel Laureate who discovered telomerase, the enzyme that keeps your telomeres long.

Dean Ornish's Program for Reversing Heart Disease has found reproducible results if people change to a mostly vegan diet, walk, practice stress reduction/yoga and go through group therapy.  He took the same program and proved with Elizabeth Blackburn's help the the telomeres in early prostate cancer patients stayed long and the prostate cancer in some was reversed.  Herb Benson and Jeff Dusek found the the more you meditate, the more genes change (published in PlosOne) .....imagine, that is a positive effect and you don't even have to leave your bedroom!  So now the problem is getting people to make changes like the above before disease occurs.  VERY HARD.

Luckily the price for checking telomerase activity is available and decreasing slowly.  The only company that offers the test to the public is Spectracell Labs.  For 200.00$ you can find out if you compare to others in your age group.  (The Today Show)   If your level is better than expected for age, it would be reinforcement that your lifestyle is probably healthy.  The problem could come up if an obese smoker gets the test and it looks "ok"- this might serve as positive ammunition to continue with dangerous living.  I think you would need 2 tests in time (spaced out by 5-10 years to figure if you are improving or worsening.

I would guide my patients to challenge their lives by introducing healthy Thinking/Eating/Activity to their daily routine.  It has to be a routine and you have to like it for sustainability.  If you jump off the deep end and just commit to taking vitamins and "eating when you can".....NOT SUSTAINABLE.  I believe every person has to construct their own template for change and often it is difficult to hold the microscope to yourself.  An outside opinion would always be valuable.  It is too easy to procrastinate the "Change" - something will always come up and we will reason our way out of our plans.  I like the way the registered dietitian at First Health Associates thinks.  Tom likes to develop an "implementation intention" when designing programs for weight loss.  You set a goal (easy) and when you attain goal, you are triggered to go onto the next challenge.  "Lets get you below 400 pounds first then talk about 395.".

Ultimately if you catch yourself saying, "I gotta stop this" or "I know what I am doing is bad"....every cell in your body has already unraveled the DNA, created a protein, changed the protein into a hormone, sent the hormone to your brain and created a message that "you have to change".  If you choose to ignore the message, the only thing that gets damaged is your DNA and sooner or later it won't be able to form messages anymore.  BYE!!