Wellness Package

What is Wellness Coaching?

“Wellness” is how you create health through specific practices. A wellness coach takes a holistic approach to your well-being by assessing the Seven Aspects of Wellness. These Seven Aspects include the following: physical, emotional, environmental, intellectual, spiritual, financial and social. Through a detailed analysis of these aspects, the coach and client work TOGETHER to formulate a plan for lasting lifestyle change.

A Wellness Coach is there to help you identify and make the lifestyle changes needed to achieve your personal and health-related goals. They are trained in specific strategies, techniques and methodologies and can provide tools to help in the process of lifestyle transformation.

What should I expect in a coaching session?

During the first session, you will go through a specific detailed questionnaire. This is for me, your coach, to learn about you as an individual. You will be explaining your wellness vision and where you see yourself from one week to five years from now. Once the “what” and “why” is established, you and I will address the “how”. This is done by establishing the potential obstacles to the desired behavior change, and where the strategies to overcome these obstacles are developed. Strengths are also identified and implemented to encourage lasting change.

My job as your coach is to encourage you to achieve your goals, which are made simple and short-lived to achieve the larger, more long-lasting goals. You set realistic and well-defined goals as I hold you accountable to your goals. Through this process, you become more accountable to yourself, and your self-confidence and self-esteem grows with each success. Before you know it, you are making changes that you never thought possible!

In our sessions together, I may utilize some of the following techniques to help in your wellness journey: Auriculotherapy (reflexology on the ear) can help with several things, such as weight loss, smoking cessation, pain management and a great way to relax; Essential Oils, which are also utilized in Auriculotherapy; Education on the uses of Essential Oils for emotional health and everyday use; Stress Management techniques such as breath work, meditation, progressive relaxation and guided imagery may be utilized for stress related issues; Flower Essence may be used as an energy medicine to balance emotional and spiritual imbalances; Energy Work is used to balance any aspect of wellness needing to be addressed; Food as Medicine, using nutrition as a major source of our Qi (Energy), to promote the health of our bodies and give the brain good fuel. Coaching tools such as the Wheel of Balance and the Values Sorter survey are used during coaching sessions to help you identify the areas of change and develop strategies for change that are lasting.

Wellness Package for Members:

For only $30/month per individual or $50/month for a 2+ person membership, you can have unlimited access to your Wellness Coach, including group classes on various topics. You will receive guidance on Food as Medicine, supplements for good health, and your guidance and care will be supervised by your private, personal physician.

 

Call (573)933-0870 TODAY to add your Wellness Package and get started living your life to its fullest potential!

The 21 Days That Changed My Medical Career

For a few months now, I’ve been personally using and recommending nutraMetrix supplements, especially the Isotonix product line, due to its superior absorption in the body. When I took time out of my schedule for a day-long teleconference on nutraMetrix products – offered only to health professionals – I learned about the TLS Weight Loss program and the 21 Day Challenge. But before I felt comfortable recommending this program to patients, I wanted to experience it myself. So I discussed this with my staff. Would they join me? Indeed, they would.

Between the three of us, 3 dress sizes (2 of them mine!) and 36 pounds were lost, and some visible body toning was achieved – all in only 21 days. We experienced it together, sharing zits and joint aches during the detox week while the toxins from the so-called “food” we had previously eaten were literally seeping out of our pores. We amazed each other with innovative ways to eat 3+ cups of vegetables in one meal. We kept our Culligan Man busy bringing us bottles for our water cooler. We begged the sales reps to NOT bring any cookies, breads, muffins or Starbucks when they visited our office. We learned about portions, how to fill up on GOOD, genuine food, and the importance of planning and preparing ahead for success. We learned to love water, even though it meant visiting the bathroom much more often. We discussed our cravings, but when the 21 days were over, none of us plunged head-first into any of those things. We’d seen such good success that we didn’t WANT to go back to eating junk.

All of this was very good to learn. But I experienced something that, as a physician, has changed how I approach health and the science of medicine.

For about 15 years, I have been on pharmaceutical blood pressure medication. A few years ago I had to increase the dose. I was then faced with either a) adding another medication to control my blood pressure, or b) switching to a super-strong, highly effective (and expensive) blood pressure medication, though initially at a lower dose. However, I recently had to increase that powerful medication to the highest dose, assuming it was a natural progression due to aging. But here’s what has happened:

Within six weeks of starting on the nutraMetrix OPC formula (powerful, highly-absorbable anti-oxidants), I had cut my high-power blood pressure pharmaceutical in half, but maintained my blood pressure in the 120’s-130’s. Then I started the 21 Day Challenge.  Within a week I was lightheaded while standing and had to stop the high-powered blood pressure medication altogether and switch back to the less potent medication. Today is Day 28, and I’m still avoiding processed foods as much as possible, and only drinking one cup of caffeinated drink a day– my Linghzi mushroom coffee! And as of this morning my blood pressure was 112/65.

This experiment of eating right and avoiding the so-called “foods” that I’d been gorging myself on has been largely responsible for my blood pressure improvements.  My goal is to be on the lowest dose possible and (hopefully) eventually stop pharmaceuticals altogether.  I am aware this will require a multi-faceted approach. But this experience has opened my eyes to the fact that food is medicine, and that THIS is the direction I need to take my medical practice.

As I incorporate Eastern Medicine’s use of acupuncture and its various methodologies, it is important to stress the role of the Qi (energy) entering the body from the food we eat. While the nutritional aspect of medicine was very weak in my medical school training (and non-existent in my residency training), I now need to further educate myself. But I also happen to know someone well, a person whom I respect and who IS trained in Food as Medicine (as well as Wellness Coaching, auriculotherapy, use of supplements and essential oils). So the thought came to me, “Why not bring her on as a member of our medical team to offer Wellness Packages with our memberships?” As I’ve experienced first-hand, patients can benefit from learning how to use the foods they eat, as well as having unlimited access to a Wellness Coach. For a small additional cost per month, our members can now have unlimited access to those services, including classes and group meetings. As our staff learned, making these changes with others is GREAT support and helps keep us accountable.

So, it is with great pride I introduce Ms. Rebekah Anglin as our latest full-time employee at Direct Primary Care Clinics. As part of the Wellness Package that members may add to their memberships at a very low monthly cost, Rebekah will be available some evenings and odd hours, based on the needs of our members and her clients. Call Ann Orr at our offices (417-664-5054) for more information.

By the way, we HIGHLY recommend the 21 Day Challenge through nutraMetrix. But now, you can talk to Ms. Rebekah about the program… in-person, right at our office.

What Happened to The Country Doctor?

Paging Dr. Welby and More Doctors Like Him.

Many of us grew up watching (and still watch) old Westerns where every little town has at least one saloon, one hotel or boarding house, a jailhouse and a doctor. That town’s doctor does everything from surgically removing bullets to splinting a fractured leg and then rushing off in the night to deliver a baby at a farmhouse several miles outside of town.

These Hollywood ideals were based on more truth than fiction when it came to the small town physician. I grew up in a small town, so the “town doc” of the Westerns was not unusual to my family or me. Doctor Holtzman took care of all of us, and he did the best he could under the circumstances.

During my family medicine residency, I was fortunate to experience a four-week rotation at a small Navajo reservation’s medical clinic in New Mexico. I saw firsthand what a family physician could do with very limited resources, including treating patients who had no running water or electricity.  Later in my career, two Russian physicians wanting to study our “rural” clinic in central Illinois visited me. These doctors were overwhelmed by the resources we had in our clinic, knowing there was no financial ability for them to imitate our model in their rural areas of Russia.

With all our advances in technology and medical support resources, you would think our medical care system would be the best of all time. We can diagnose a heart attack in a matter of minutes, treat an evolving stroke as it is occurring, have radiologic images read by someone miles and miles away and surgically treat with robots. But for all our advancement in technology, has it improved our relationship skills or instead, has it lead to devolution of our communication abilities?

What price has the medical community paid to enjoy these technological advances? Most people can’t even see their physician face to face these days when having an office visit, much less experience home visits or calling their personal physician on the phone. How far we have come from the accessible and personable small town doc like my own Doctor Holtzman?

It is not only inter-personal skills that have waned, but also the diagnostic skills of many primary care physicians have suffered from years of being encouraged to refer to specialists. Unfortunately, this “trend” has led to the point that diagnosing some of the most common human conditions are passed off to other physicians and the treatment of these diseases are left to others as well.
At one time, there was a great push for the primary care physician to be nothing more than a gatekeeper—performing a type of triage and only treating the acute “Urgent Care” medical problems, while referring off all the others.  Fortunately, my residency programs did not buy into that concept.

Nothing against specialists—one never appreciates a surgeon quite as much as when a surgeon is desperately needed! When I have a particularly tough case—for example a patient with external signs of cortisol excess but all the laboratory readings of cortisol deficiency—I am grateful for the existence of knowledgeable specialists, such as endocrinologists, to help me sort it out.

However, I fully expect myself to be able to recognize cortisol excess in the first place. Solving the puzzle is one of the most rewarding aspects of my career choice, and I love being able to quote The A Team with, “I love it when a plan comes together!”

It is human nature to want to mechanize or standardize a process. It would not be very helpful if we got totally different results from laboratory to laboratory when processing blood work, or varying results from hospital to hospital when getting mammograms. Standardization helps to keep results similar regardless of where the testing is done. But, the interpretation of results cannot be truly standardized, nor can the treatment.  The interpretation and treatment need to be individualized to the person from whom the result was obtained—and dependent upon each individual situation and constellation of symptoms.

Attempts at standardization results in the construction of a wall or barrier. Each regulation placed on the standardization results in further structure to the wall; and the next thing we all know, we can’t even find the patient due to the thick barrier of “stuff”!

Robert Frost wrote in his poem Mending Wall, “Something there is that doesn’t love a wall, That wants it down.”

Something, indeed. When we find that our technology, that our regulatory bodies, that our very way of diagnosing and treating patients has come between us—the physicians and the very people we are attempting to help—it is our duty and struggle to break down that wall so we can be reunited with those we serve. It should be our attempt to reinvent ourselves in the likeness of Marcus Welby MD and Doc Adams, even if it should mean giving up some of those “advances” in medicine.

 

 

 

Demise of the Individual in Medicine

“I worship individuals for their highest possibilities as individuals, and I loathe humanity, for its failure to live up to these possibilities.” – Ayn Rand, “Anthem”

One of the most concerning trends in medicine I see is the movement away from individualism and toward collectivism.

This trend manifests in multiple ways in our medical institutions, arising as such creatures as Evidence-Based Medicine and the notorious use of the Bell Curve (http://statistics.about.com/od/HelpandTutorials/a/An-Introduction-To-The-Bell-Curve.htm) to apply population-based statistics to the treatment of individual patients. While these statistics may be useful for adopting guidelines—i.e. MOST people will have this experience with this drug—attempting to apply guidelines as hard and fast RULES in the medical sciences is rather disturbing.

Many consider ancient Greek physician Hippocrates to be the Father of Medicine, as he lived in the 4th century BC.  A close look at the Hippocratic Oath, which many medical students take upon graduating from medical school, shows the importance of the individual patient above and beyond the concerns of the collective—the community, the society or the State. http://www.pbs.org/wgbh/nova/body/hippocratic-oath-today.html

While the original oath first upholds sacred the community of medical practitioners as a family, it goes on to state that treatment for the sick will never be given to intentionally harm, that is, “according to my ability and judgment, I will keep them from harm and injustice.”

We have embraced this to mean, “First, do no harm.” But when there is a clash between individual concerns and the public concerns, to whom shall the “no harm” be directed? I would fully expect the physician who works for a public health organization (or one with a Master of Public Health degree) to take the stand that the concerns for the public health outweigh that of any one individual. However, it is my belief that for me—as a primary care physician —the medical concerns of the individual are, well, PRIMARY.  If not the family physician, then who will be the advocate for the individual patient?

The Hippocratic Oath goes on: “Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves.” Personally, I interpret this to mean: I will not murder. I will keep private things private and to myself. I won’t take advantage of my position for personal gain.

These are the basic tenants of medical ethics. After the atrocities of the Second World War in the 20th century, it is no surprise that the oath I took with my classmates in 1999 includes refraining from unethical experimentation. If you read about the things that have been done to people in the name of “science,” you wonder how any physician could be encouraged to do such things. Then you find that it was all for the sake of “the good of the People.” The information gained could improve the lives of the Public; therefore, it was OKAY to subject others (particularly those considered to be sub-human) to all manners of experimentation, since it was for the Public Good.

As a modern example, let’s consider the “statin” debate. It is generally accepted in medical circles that statin drugs reduce cholesterol and therefore reduce the incidence of heart disease. Do we truly have a method of preventing heart disease by treating cholesterol levels, or have such a large number of studies (often sponsored by pharmaceutical companies that are developing statin drugs) been performed on certain populations that are sure to show improvement in cholesterol levels? Then, those same certain populations can be followed to see if heart disease develops, in order to create a logic that says “Using a statin reduces heart disease.”

I have trained myself to look directly at the study and see who was excluded rather than who was included as study subjects. This tells me who cannot be considered for a favorable result regardless of the results of the study! Think about it this way: if those individuals were excluded from the study, the designers of the study knew that portion of the population would skew the results away from what they want the study to show.

To further illustrate this, we can go to “Stenting versus Endarterectomy for Treatment of Carotid-Artery Stenosis” http://www.nejm.org/doi/full/10.1056/NEJMoa0912321#t=articleMethods, the CREST study. Scroll down to “Selection of Study Patients” and look at who was excluded from the study. Then please note the last line of the section: “The full eligibility criteria have been published elsewhere.” Why? Would the eligibility criteria be so exclusive for the study that it may render the study of little use? But no, surely this is only going to be helpful for vascular surgeons to be able to decide whether they need to scrape off plaque surgically (endarterectomy) or place a stent, right? But, if I wanted to know if my patient with carotid artery stenosis (plaque build-up in the carotid artery) should be considered for a stent or an endarterectomy, I would go to the footnote (see that little number 10 at the end of that section?) and read the full eligibility criteria. I would do this specifically TO SEE IF THE STUDY RESULTS WOULD APPLY TO MY INDIVIDUAL PATIENT. I cannot apply population-based statistics to my individual patient because my individual patient may fall out of that Bell Curve!

So, I click on the footnote, and it gives me two choices of where to get the entire article (Design of the Carotid Revascularization Endarterectomy vs. Stenting Trial (CREST).

I can rent the article to read for $6 (good for 48 whole hours!) I can pay $15 to read it on the cloud or pay $38 to read, print and/or save a PDF file—just to see the full eligibility criteria for the study! So, I rely on what the article in the New England Journal of Medicine (which surprisingly allows access to the full article for free online) tells me about eligibility. Finding the complete facts can be an arduous and expensive endeavor, which is why some physicians rely on drug reps for their information regarding the efficacy of drugs for certain medical end points.

So here we are with physicians having sales representatives tell us why their drug is best at preventing heart disease. But, what if the whole cholesterol theory—stay with me here—is also a medical “certainty” built on the statistics of a few studies that excludes what could be a large part of the population that a physician will be seeing? In other words, what if an entire “disease” could be “created” for which only certain drugs can help prevent or treat? Before I ask you to slip on your tin foil hat with me, realize that it is not so outlandish to suggest this as a possibility.  I nearly threw a drug rep out of my office once for even using the term Chronic Obesity as if it were a disease and not a condition of storing too much reserve energy. But since their drug product was created to address obesity, they need a Disease (with a capital D) with which to associate their product. I asked her how long a patient needed to be on the product and she said, “Oh this is for Chronic Obesity. They have to be on it forever.”

I refrained from explaining to her how the human body naturally works, because I knew she was simply regurgitating what she had been taught to say by her company. By the way…I don’t prescribe their drug!

My argument for having multiple blood pressure medications, even those that work the exact same way in the body, is that what may work for one patient may not work for another, or may have undesirable side effects in one patient and not in another. I have seen this even in the same drug families. Humans are truly snowflakes—the basics are the same, but there are little variations all over our bodies, and that is what we can SEE. There are untold individual variances, chemically and microscopically, which we can only imagine. With that much diversity at the cellular (and sub-cellular) level, imagine the vast variability at all levels at once when it comes to disease process and drug or nutrition intake!

But, as physicians we are supposed to stick to absolute guidelines and certain measuring tools to satisfy some lofty powers that be, guidelines that were established based on the same kind of studies as the CREST study that we looked at above, which has excluded some patients from the study??!!

This kind of “logic”, once one really thinks about it, is not consistent with what we were taught in medical school. We were taught that life is NOT composed of absolutes, but a vast amount of variance that means we can only give it our best guess as to what we should do (if anything) in any given circumstance.

As a direct primary care physician—one paid by the number of members DPC has, NOT the number of patients I see in a day—I do not have any Meaningless Use mandates from the federal government forcing me to follow guidelines.  I can tell you what the recommendations are, whether it is for the care of those with Diabetes Mellitus or for breast cancer screening; but, my pay is not tied to meeting certain bullet points in a bureaucrat’s mandated guidelines. Therefore, I will tell you the guidelines, but if I don’t think those guidelines necessarily apply to YOU, we will discuss our options. I do believe I need to know the guidelines, and I need to know the options; however, it is your decision since your body still belongs to you and no one else.

And, you can trust I’ll roll my eyes or argue in anger whenever anyone suggests I need to consider the good of the community/society/public/world over the good of YOU, the individual. I don’t WORK for the community, society or the public—I work for you, my patient.

 

 

 

 

Looking Forward While Glancing Back

 

While I have been looking to 2016 and our business goals for next year, I have to reflect on the past three years. I started this business January 1, 2013, and we opened our doors March 1, 2013. We have impacted many lives since then, and it is hard to believe it has been three years already.

We have helped revolutionize family medicine. We have taken the concierge model and translated it to the middle class. We have offered true 24/7 coverage for our patients, managed everything from upper respiratory infections to congestive heart failure exacerbations over the phone, cared for patients as remote as the Dominican Republic, removed melanomas and squamous cell carcinomas and provided liver-saving phlebotomies for a patient with hemochromatosis.

We have email consultations, phone and Skype visits and regularly text our patients. We send flowers when our patients are in the hospital, and send a sympathy card when we hear of a loss in a family. When ice covers the streets or floodwaters cover our roads, making it impossible to make the drive to the office, we man the cell phone and send prescriptions electronically.  We make house calls to our patients who are unable to get out of their homes, and we provide these services to our members because they believe enough in our practice, in our business, to pay a membership fee.  We supported, testified for and helped pass House Bill 769—the Direct Primary Care bill, which was signed by the governor this summer. Our members realize and understand that they are the ones who keep the lights on, who maintain a nice office for them to come to and who pay the salaries of all of us who care for them.  It seems the most natural way to provide medical care—folks paying a fair price for all we can possibly provide for them.  Free market medicine works!

We have found that the constraints of having a single office are many; and to better care for our patients, we are looking to become more mobile. We think this would be particularly helpful for our small business owners who could use the presence of their physician at the work site, or for our patients who require a face-to-face visit but find transportation to the Lake difficult. This is why one of our goals for 2016 is to have a mobile unit, and we are considering having a scheduled circuit for physical visits. Most of our patients who have to travel an hour or more have been excited to learn that we want to provide this for them. We are not sure whether this is going to be a reality yet, but planning is ongoing.

If we become mobile, and if our membership numbers grow accordingly, we will need more help at the office in Osage Beach. If our membership continues to grow in 2016, we may possibly add a nurse practitioner to our ranks.

Our mission statement, which is displayed proudly over the reception window in our office, is as follows: to break down the barriers that currently exist in the patient-physician relationship, to restore mutual trust, and to provide excellent individualized primary health care.

My staff and I take that mission to heart, and use it as our measuring device in all that we do. The relationships we build need to be open but professional. The trust must be mutual, as I put my license, the entire business and the livelihoods of the staff on the line with every prescription I write and every bit of advice I provide. And, “excellent individualized” medical care is what I was trained to provide, which means that I do not treat statistics, or consider all patients to fall in the width of the bell curve, but embrace the uniqueness of each individual human being.

Our ultimate goals for the coming year are:

  • To break down those barriers that still exist between the patient and the physician
  • To restore mutual trust and provide excellent, individualized care for all our members
  • To provide these services for more and more patients throughout Missouri
  • To continue to think outside the box

Wishing you all that is good and helpful in 2016, and looking forward to serving you better!!

~Jenny Powell MD                                                                                                                                                                     Direct Primary Care Clinics LLC, Osage Beach MO

 

Giving Thanks

The purpose of Thanksgiving is to set aside a specific time to be thankful for the bounty of the harvest. While Thanksgiving, and the holiday season that follows, has evolved into many different things, this is a time of year we focus on giving thanks for our blessings. I am always thankful for my many blessings, but this year I am particularly thankful for my medical practice.

I am thankful for the opportunity to participate in free market medicine. I realize there are places throughout the world this would be impossible. True, free market medicine provides freedom of medical practice for physicians, but it also provides freedom of medical care for patients. It means my patients are not slaves to a system that dictates:

  • Who they may see as a provider
  • Where they must go for their medical care
  • What medical services are available
  • How much it will cost for their care

I am thankful for the opportunity to break down barriers thrown up by insurance companies, hospital systems and governmental agencies between individuals and their physicians.

Are you aware of the walls instituted by hospital systems?

“No, you cannot see your physician today at 2:00 pm.”

“No, you cannot have your physician’s email address or cell phone number.”

“No, you can’t see Dr. Smith; you are assigned to Dr. Jones.”

Your insurance company may dictate what hospital system you may use, what diagnoses they will cover, what testing they will pay for and what treatment—including which medications—they will support. They will tell you not only how much your co-pay will be, but also how much your premium will be; and then, may still tell you they will not cover a procedure or office visit. They may mislead you to believe they will pay for an office visit, but if you did not go through their proper “hoops,” will leave you with the entire bill. And on top of all of this, they will still increase your premiums year after year.

In the name of subsidies and so-called “insurance plans” provided by the government (federal or state), it is even worse. Medicaid may pay for a medication in July, but no longer cover it in August, even if they had been paying for it for a couple of years. They may send reports to your physician, making veiled threats that the physician should discontinue medication or change it to something else. To frustrate the physician into discontinuing the medication, they may require new “prior authorizations” on medications patients have been on for extended periods without any problems. Of course this will NEVER be a stated reasoning for the means, but it is a roundabout way of achieving the desired end result.

Quality assessment programs, sold to the public and the societies of physicians alike, are designed to control the practice of medicine, to standardize treatment and to force away any individualization of medical care. I am thankful for the free market medicine practice model, because my policy of “kill as few patients as possible” is my quality assessment program.  When it becomes impossible to force physicians into following guidelines instead of using their reasoning power, then the measuring tool for “quality” will become obsolete, and better outcomes (which are often actually the ABSENCE of problems) will become the only measure for true quality of care.

I am thankful for the art of medicine and for those giants upon whose shoulders I stand. I am thankful for patients who seem to understand that all of life is much of an unknown, and that we tread lightly on what we consider “conventional wisdom.” I am thankful for my mentors, for the words of wisdom and the lessons (what to do as well as what NOT to do) I learned second-hand.

I am also extremely thankful for the excellent education I received from kindergarten through residency training. I am also thankful I learned how to study and how to learn on my own. These lessons have enabled me to enjoy a lifetime of learning, while improving my skills, bettering my trade, and thereby bettering the lives of my patients.

I am thankful for free speech, for the ability to write what I’m thinking and publish it for others to read—without fear from the institutions of which I am critical. I am also thankful for a forum whereby folks may choose to read or not read what I publish.

And finally, I am thankful for you—whomever you may be—thanks for reading to the end. Thanks for your attention, and may YOUR blessings be great in number!

~Jenny Powell MD, FAAFP