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.

The Opioid Epidemic and New Ideas

You cannot turn on a television without seeing it. You can’t read a magazine or a newspaper without it being there. It is all the buzz, from Washington DC to Jefferson City to Camdenton City Hall. If you believe the hype, you are now convinced that there is an Opioid Epidemic.

Admittedly, there are patients who do not use their medication but sell it.  There are folks who use SOME of their pain medication but share it with others. And there are some who have it stolen from them – either the medication itself from their homes/cars/purses or the paper prescriptions themselves. Saddest of all is when dying cancer patients have it stolen from them by those who are caring for them.

But it may relieve you to know that this is a small percentage of all the folks who legitimately require pain medication to make it through another day of work, or simply another day or night. The majority of responsible patients appreciate what the medications mean to them – salvation from the kind of pain that depresses the soul and that sends them to the edge of the pit, even considering suicide. Right now, we have few weapons in the arsenal against chronic severe pain besides opioid pain medication, and when it is one’s only genuine weapon, one must reach for it.

In search of a better understanding of what pain really is, and how to address it, I have taken the step into an ancient world.  With my right foot still firmly planted in allopathic, modern Western medicine – the science and art I was taught in medical school, trained in during my residency training and have practiced for 15 years – I step lightly into the world of Eastern medicine and its 5,000-year-old practice and refinement. I found a course geared entirely to the Medical Doctor – physicians educated and trained like me – which integrates Western with Eastern medicine, also known as Traditional Chinese Medicine.

With our understanding of the Central Nervous System, the concept of meridians and neurotransmitters intermingles and all the cogs fit together to illustrate a beautiful “machine” that is the human body. This course started in April and runs through the end of November this year, and I have studied and learned from my laptop up to now. In July-August, I travel out of state for several intense days of practical hands-on learning. Because we don’t learn everything we need to know from a book or a lecture – we have to PRACTICE.

When I complete this course of training, I will be certified in the Traditional Chinese Medicine Acupuncture method. But I will be no ordinary acupuncturist – because I have the solid medical education and training behind me, with the Paul Harvey-esque “The Rest of The Story” understanding. My hope is that this rounding out of my knowledge will not only help me address the Opioid Epidemic by providing my members with a real alternative to narcotic pain medication, but also help similarly treat a multitude of other diseases and conditions.

I look forward to putting into practice all that I am learning. I hope that you – my members – will benefit from all the hard work involved in learning not only a new skill, but centuries of practice of an ancient art.

It Takes Two to Trust

Our Mission at Direct Primary Care Clinics LLC is;

“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.”

But how does one “restore mutual trust?”

First, the word “mutual” comes before “trust” in the sentence – not just because of standard English sentence structure, and not just because it is the describer of the noun. Mutual is defined by the Cambridge Dictionary as:

“(of two or more people or groups) feeling the same emotion,
or doing the same thing to or for each other.”

It can also mean holding something in common. This indicates that the trust I will have for the patient must by definition be shared by the patient with me as their physician, and most certainly vice-versa.  The patient’s trust in me must be shared by me, the physician.  This sounds very simple, since it is the basis for all relationships. But it is a rarity in today’s medical world.

Let’s start with the example of a medical problem, such as hypertension (high blood pressure). The patient often does not know they have hypertension, until their blood pressure is taken.  They may not even realize that their recent daily headaches, or the reoccurrence of nagging chest pressure, may both be signs of high blood pressure. But when discovered, it is – or rather, should be – a concern for the patient. It should also be a concern for the physician, and not simply because it falls in their area of expertise. It should create a MUTUAL concern. Now, within their relationship, the patient and physician have a mutual concern. The patient then should trust that the physician has the knowledge and means to help the patient with the problem. The physician should trust that they have the knowledge and motivation to help the patient with the medical concern. But that is not enough to truly constitute trust.

Since I’m into defining for you, let’s see how the Cambridge Dictionary defines Trust:

  • to have confidence in something, or to believe in someone, or
  • to hope and expect something is true.

In our above scenario, the patient should have confidence in the physician and believe the physician is working in their best interests. The patient HOPES and EXPECTS something from the physician. In Mutual Trust, the physician also has confidence – in the patient. The physician HOPES and EXPECTS something from the patient in return. I believe it boils down to this: the patient and physician will be on the same page regarding their hypertension, or whatever the real-world medical problem may be.

It is my belief that this mutual trust is absolutely essential to provide the “excellent individualized primary health care” we commit to in our DPC Clinics Mission.  If the trust is one-sided – either on the side of the patient, or the physician – and not mutual trust, the delivery of excellent care is impeded. If the patient has full trust and confidence in their physician, but the physician is suspicious of the patient and is confident in only their own medical ability, the physician does not – CANNOT – deliver truly excellent care. If the patient is suspicious of the physician and does not have confidence in the physician’s ability or motivation (even when the physician believes in the patient and their integrity), the delivery of care could well be “dead on arrival.” What is the saying? “You can lead a horse to water, but you can’t make it drink.”

This relationship-essential atmosphere of mutual trust has been assaulted by a number of outside sources, which I may touch on in a separate rambling. The concept of restoring this precious thing – mutual trust – is part of our Mission. The relationship has been broken, and building it back together like Humpty Dumpty is exacting and can be tiring. It takes effort, and must be done one person, one interaction at a time. Because it is time-consuming, it cannot be realistically accomplished in 10-15 minute intervals with 40 people a day. When you take into account time for administrative grunt work, not to mention the time required for personal relationship-building, you begin to see that time is the primary obstruction standing in the way of restored mutual trust. This is also why Direct Primary Care (DPC) is the best model for rebuilding that relationship – because we have adjusted our time around building relationships, instead of adjusting our relationship-building to fit the time.

By keeping our patient panel – the number of patients for whom we care – purposefully low, we can spend more time with each individual, provide better communication tools for our patients, and work on restoring mutual trust. Our Mission Statement posted in the DPC waiting room. It’s the first thing you see when you walk through the door and – hopefully – it will be the first thing you notice during your interactions with our DPC Clinics team.

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Deer Me!

HALvsdeer

It was bound to happen sooner or later, with the abundant amount of deer roaming loose in the Ozarks.  These gals and guys don’t bother to look both ways when crossing a street, I’ve noted, and when you drive a quiet hybrid car, they must tend to think that the headlights are a large lightning bug approaching.

I was driving home one evening, just me and the little dog in her seatbelt-strapped-in carrier, minding my own business, on a winding wooded country road.  We were only going about 40-45 miles per hour, since we’d just turned left at a near 90-degree turn and were gathering up a little speed to head up a hill.  Out of Nowhere – which apparently is my name for the wooded area just at the bottom of the hill on the driver’s side heading home – out of my peripheral vision came barreling toward me the largest un-antlered deer I’ve ever seen. It may have been a small elk for all I know.  At any rate, no time to stop, I realized it was going to hit me. I instinctively swerved as I stomped on the brake pedal, and braced myself as the deer slammed into me.  “I am going into the ditch,” was my thought, and so I held on, steering the car so that the passenger side wheels would not go into the ravine part of the ditch.  I did not want to roll the car. Slowed to a crawl now, I drove forward for a few feet, thinking I might be able to drive out of the ditch, but as I heard the undercarriage of HAL (my Prius) being scraped and smelled a hot car I thought best to stop.  (Yes, I named my Prius after the computer on 2001: A Space Odyssey. http://www.imdb.com/title/tt0062622/ )

I sat for a moment, reasoning; I can’t drive this car out of this ditch, the ravine is too deep, and I can’t back up because there are large rocks in the ditch that have already scraped the undercarriage.  I looked at the space between my driver’s side door and the road.  I could probably open the door about 5 inches, and I’m no slender girl.  So I unbuckled myself, and my little dog’s carrier, put her in the back seat and crawled over to get out on the passenger side. I looked back down the road and, sure enough, there lay the deer – in the opposite lane of traffic, lying right across it like he/she was taking a nap and hogging the entire lane to him/herself. Along came a fella in a pickup truck who pulled over and got out to make sure I was okay.  I assured him I was fine, but I wasn’t so sure about either my car (I didn’t want to confuse him by referring to HAL) or the poor deer.  He looked back down the road and then offered to go move the deer.  I agreed that would be helpful for others who may be traversing the road that evening.

My Good Samaritan walked down to the deer and was standing near it, to judge – I suppose – how he was going to move this large animal.  Then, surprising both of us, it suddenly sprang up and ran back into the wooded area from whence it came.

The next day my right trapezius started to ache, like I’d lifted something heavy.  By the time I got to the office I considered either seeing if I could get a same-day massage from Infinite Touch Integrative Therapies (https://www.facebook.com/InfiniteTouchLLC/?fref=ts) or get trigger point injections into the shoulder.  But then Rebekah Anglin walked into our office.

 

Rebekah is the Wellness Coach who works out of our office on Thursdays and Fridays.  Her business is multi-faceted, but among other things, Rebekah uses essential oils and does auriculotherapy.  Now, I don’t know the physiology of essential oils, nor homeopathy, nor of acupuncture, reflexology or auriculotherapy.  But I know that if I can avoid leaving the office during a busy scheduled day, and I don’t have to have a needle shoved into my muscles, I am all for trying it.

First she concocted a muscle rub using a couple different essential oils mixed with carrier oil and it was rubbed into the aching muscle.  After about 15-20 minutes, I didn’t really notice the muscle as much.  A couple hours later I lay down on her table and she touched my ears.  Weird, but so cool.  There was one spot on the ear that – as soon as she touched it – I felt a lightning bolt go into my right shoulder.  There was another place that when she touched both ears, I felt an aching in my neck. Then, using a cotton-tipped applicator, she applied essential oil(s?) to those areas.  After asking my feet a couple of questions (don’t ask!), I got off the table and resumed work.  I felt terrific, until about 4:00 that afternoon when the aching in the shoulder resumed.  I took the oil combination she’d given me and rubbed more of it on the spot.  That night, before bed, I rubbed some more on, just for good measure, though I could longer feel the aching.

The next morning, it was as if the accident had never happened.

Now, I’m not about to stop taking Edarbi, which I take for my hypertension.  But if I have any further problems with this right shoulder, I’m making an appointment with Rebekah Anglin.  You can too, simply by calling her at (573)836-1197 or emailing: rebekah.a02@gmail.com.  She not only can work miracles (in my opinion) with essential oils and auriculotherapy, she can help you manage what ails you using nutrition.

I’m betting that deer could use her services!

Repeal and Replace the ACA?

I have been reading a lot lately about the challenges the 115th United States Congress is having with a “Repeal and Replace” strategy for the Patient Protection and Affordable Care Act (the PPACA, commonly referred to as the ACA or “Obamacare”) law. Given the new administration’s struggle to even grasp the scope of the ACA, I can only imagine that it’s like climbing Everest or rowing across a small ocean.

Partisanship is the tendency for representatives and senators to vote on legislative measures as dictated by the letter that designates them as (R) or (D). However, I don’t think that party affiliation is the true nature of Congressional difficulties with the ACA, regardless how much their members may protest it. The lines are well-drawn between the aisle on many fundamental issues, and despite the fact that the ACA was the darling of the former President and his party, there can be no denying that it has proven disastrous for middle-class Americans.

I also don’t believe the complexity of the law itself (its rules and regulations written by the Secretary of Health & Human Services with virtual carte blanche control over its content) is the cause of the difficulties – despite containing over 2,000 original bill-signed-into-law pages and its thousands of subsequent pages of regulations. It is very easy to say, “This thing is far more complex than a simple repeal and replace”, and place the blame on the self-imposed vastness of the law.

I have only a few acquaintances who have benefited from the passage of the ACA, based on the fact that they now have “affordable” health insurance. However, most of the people with whom I have come in contact have experienced negative effects, including;

  • Loss of their working policies, as employers were forced to cut coverage
  • Prices that escalated quickly to unaffordable levels, and/or
  • Penalty taxes imposed for being unable to afford an “acceptable” (i.e., federally-approved) policy.

There is very little that is Affordable about the Affordable Care Act. I must also point out that in addition to not being affordable, the ACA is not (as no law could ever be) Care. Care is provided by medical personnel, not by insurance and not by laws. So the only true-to-its-nature aspect of the law’s name is Act. And I believe that therein is where the difficulty arises.

In March of 2015, I traveled to Washington DC to be a part of a Healthcare Coalition composed of practicing physicians of all specialties from across the nation. We came together to design and present to Congress a one-page proposal of “How practicing physicians would ‘fix’ the healthcare system in this country.” It only took us less than one morning to compose the proposal – three hours, tops. Since it is near-impossible to get even two or three physicians to agree on much of anything, that mere three hours it took to gain consensus between the 30 of us in the room is nothing less than miraculous. But the point is this: were able to do in one morning what Congress has failed to do during numerous sessions, across multiple years.

We printed our one-page proposal and set out that same day, to present our historic proposal to Congress via their legislative assistants. Across our two days of meetings, these staffers were – for the most part – kind and silently attentive, offering very few questions. Feeling great and patting ourselves on the backs, we left with high hopes for progress.

Little did we know that – at the same exact moments we gathered around conference tables and in hallways (and even getting kicked out of South Carolina congressman Trey Gowdy’s office) – those same elected representatives were quietly and quickly passing MACRA, the Medicare Access and CHIP Reauthorization Act.

Touted by the major physician organizations as the “Doc Fix,” MACRA is the completion of the ACA. It is the How the ACA will complete the Single Payer System that the architects of the ACA envisioned. It is also a tool to force independent physicians and other healthcare providers into the big systems, while driving private insurance companies into oblivion. It’s no wonder the legislative assistants were being so polite and listening so intently. “Let’s keep these doofus physicians who think their opinions matter busy so they don’t find out what our bosses are doing.” Their courtesy was just a smokescsreen.

I came back from our nation’s capital with a single message to my friends, colleagues, patients and family: Washington, DC is not about to give up any control. While they handed over responsibility to the Secretary of HHS to define the language of the ACA and MACRA, the control still lies in Federal hands, and they are NOT going to relinquish willingly that power over their constituents. They are NOT going to put control back in the hands of the individual sovereign States, nor into the hands of the People themselves. They may not even fully understand their own reasoning, but control – once locked in federal hands – is hard to wrench away.

Keep this truth in your mind when you hear of the difficulties they are having on Capitol Hill. If they so willfully disregard an educated recommendation from practicing American physicians to pragmatically shift responsibility and control of patient decisions to the patients themselves, just imagine the derision and contention if they were asked to repeal control of those decisions altogether. Our leaders clearly feel that you and I are not equipped to govern ourselves, much less make big decisions about our own health, safety and wellbeing.

Why I Am Firing My Family Medicine Board

I am firing my family medicine board, the American Board of Family Medicine, through which I have held certification for a long time.

First of all, some clarification: board certification is not required for state licensing. Once upon a time it was little more than a nice fancy title one could put after their name: “Diplomate, Board of Specialty Medicine.” It was a status symbol at one time, much like being named in “Who’s Who in America.”

Physician licensure is maintained by the State, and has nothing to do with board certification. All physicians must must renew their licenses yearly and attest that we have achieved a required amount of continuing medical education. Board certification is generally more related to what kind of original medical education a physician received: were they taught to research and study on their own, or just spoon-fed facts and taught to regurgitate them and take multiple choice exams? Can a physician think on their feet and outside the box?

The problem with many board certifications is that someone along the way decided they are schemes to remove physicians from their money.

Over the years, medicine boards have moved from a one-time passage of board exams to requiring reexamination every few years, and these exams are very costly. Many boards have implemented “maintenance of certification” programs with annual fees. Board exams have been made increasingly difficult in order to sell expensive Board Exam Review Courses prior to the exams themselves, and revenue from the study guides goes directly to the boards. Legislation has also been passed making it difficult, and potentially illegal, for physicians who have recently passed the exams to pass useful information to other physicians about to take them. And there is no recourse for addressing grievances.

In short, the board certification process has, in my opinion, become completely untenable. At least for the American Board of Family Medicine.

Back when my employer expected board certification, and when the insurance companies they billed required the same, I spent the money and was reimbursed at least a portion of it. But when I walked away from hospital employment and opened my own practice, I began working for patients. This forces me to look at those dollars quite differently. Is it truly a good investment for my patients to spend their money for my board examinations, or the costly yearly maintenance of certification programs? Sure, I get continuing medical education credit, but how much of what I am learning (i.e., to pass a multiple-choice exam) can be put into practice and actually benefit my patients?

As it turns out, I believe my patients—my employers—receive very little tangible result from my effort in maintaining that board certification. I can obtain just as much education and updates on treatment from far less expensive forums.

So, there you are: that’s why I am firing my family medicine board. The expense does not provide sufficient benefit for my patients. It is a bad investment. The return simply is not there.

I did get certification through the National Board of Physicians and Surgeons https://nbpas.org/. I did this mostly to support this board in hopes that it will be become recognized where board certification is required (primarily through hospitals and insurance programs, which I don’t play with anyway).

I just want everyone to understand that since I now work solely for my members—not a hospital system, not any insurance companies, not any governmental bodies—I have to consider every payment and every obligation, weighing whether it is worthwhile and beneficial for my “employers.” And I’m willing to bet not one of them cares at all whether I have that ongoing American Board of Family Medicine certification or not.

But they DO care whether I would end up having to increase my fees in order to continue to dance to that music.

So, you will no longer see the words “Diplomate, American Board of Family Medicine” below my name on my business cards. I will be taking down the framed paper that states I have re-certified through 2016. And I won’t have to increase membership fees.

I hope that you all, as my employers, agree with my decision