Are doctors not bringing up the risks of type 2 diabetes because they feel powerless to act until the patient is already pre-diabetic and getting worse? Or maybe because they know their cliched advice to lose weight and eat healthier will go in one ear and out the other? Or maybe patients are selectively tuning out the warnings because they haven’t experienced any symptoms yet? Or maybe they are in denial because they’ve tried every fad diet and the pounds they manage to lose not only come back afterwards, but bring friends?
In any case, the answer is knowledge that empowers Doctors and patients alike to be proactive. There is a solution that Doctors can prescribe right out of the Physician’s Desk Reference that addresses high A1c levels (more than 15% improvement by itself), metabolic syndrome, dyslipidemia (reduces LDL as effectively as top dose statins, and is 3 times more effective at increasing HDL), hyper-tension, and obesity (backed by 20 years of multiple double-blind, placebo controlled studies at universities and clinics in the US and around the world). It is so safe that it can used by anyone, even children and pregnant or nursing mothers. And because of what it is made with and how it is used, the prescription actually creates the diet and lifestyle change that patients have so much trouble accomplishing on their own.
It’s time to stop leaving patients ignorant of their risks, or helpless to make the changes that would reduce them.
Un-doctoring could save lives
As I read an article by Rob Lamberts on who is his target demographic, I thought about cardiologists. Could they prevent more heart attacks if patients visited sooner, and followed advice better when they left? If so, then being an un-doctor like Dr. Lamberts is about more than just being popular with patients. It could actually be saving lives. So what keeps your patients from visiting as soon as they start to feel something wrong? What can you do to make your practice more welcoming to them?
They work the same hours your office is open and can’t risk taking time off for something that may turn out to be nothing. By the time the symptoms are pronounced enough for them to be sure, it is too late for prevention. What are some of the things you could do to help them see you sooner?
- Give them a guideline sheet what they should do for some common symptoms. For example, if you’re feeling generally more fatigued, schedule a regular appointment and I will give you a doctor’s note. If you are also experiencing nausea and dizziness, come visit me ASAP and I will fit you in. If you experiencing sharp chest pains, go straight to the ER.
- Schedule on late-in/late-out office day per week or month when people who work 8am-5pm can come in at 6pm to 8pm. It would also give your staff the chance to schedule their business day errands for that morning instead of cramming them into lunchtime.
- Let your patients know you are available by phone or e-mail if they need help deciding to come in for a visit.
They are embarrassed about being overweight and out of shape, and they are tired of being given the same lecture about losing weight and eating better when they feel powerless to overcome bad habits because of weak will-power, inflexible schedules, and limited meal options during their work days. How could you show them that they don’t need feel ashamed or hopeless?
- Proactively send them a letter telling them that there is an option that would help them to balance their bad cholesterol, raises good cholesterol, lowers high blood sugars, and reduces abdominal fat. And it doesn’t even require dieting or completely re-arranging their life, and accommodates any work schedule.
- Let them know your practice wants to help them achieve their fitness goals, and will help by regularly measuring their weight, vitals, and lipid panels if that will help them stay motivated.
- Set a good example at your clinic. Few things are more discouraging to a patient’s hope for getting heart-healthy than Doctors, Nurses, and clinic staff who are out of shape. After all, if you can’t keep in shape with all of your knowledge and prescriptions, what chance does a normal working stiff have?
Is there an easier way to make practicing medicine not suck?
For Dr. Bob Lamberts, author of the article “A year into direct pay: It doesn’t suck to be a doctor anymore“, it took starting a new practice, giving up all his patients (although many patients chose to follow him because of his passion for their health), and risking a business strategy that doesn’t work for all doctors. I’m delighted to hear that he is starting to reach financial success by providing better medical service than ever to his patients, and wish him the best in the years to come.
I believe that direct pay primary-care provides the best future for health-care in America, but I also realize that not all Doctors are ready, willing, or wanting to transition to that business model right now. So let’s look at some of the frustrations doctors face with their current model, and see if we can improve any or most of them without making a Doctor change everything.
- Too much 3rd-party interference. The federal government, state governments, and the insurance companies all want to tell you exactly what you can and can’t do in your own exam room, how much you can charge, who you can discounts too, etc.
- Everything in your practice revolves around reimbursements, because you are operating on little to no profit margin.
- You spend more time during a patients visit trying to determine the right procedure code (so you don’t get stiffed by the insurance company) than you do talking with the patient about their health.
- For many patients, you can only treat the symptoms because they won’t/can’t make the lifestyle changes that would actually reduce their health risks.
- For newer Doctors, the stress of student loans, and for older Doctors, the question of ever being able to afford to retire.
Luckily, there is a step you can take now that will help you to start enjoying your medical practice more without revamping your whole business.
It can help reduce the stress from a practice’s finances by increasing profit margins (some health-care practitioners have said it has more than doubled their incomes).
Create an ongoing income that can work towards student loans or retirement funds, and that isn’t subject to the vagaries of byzantine government regulations or every changing insurance reimbursement procedures.
It will help more of your patients become healthy instead of merely not sick (especially those with diabetes or heart disease risk factors). The doctors who have been using it rave about the positive impact it’s had on their patients’ health.
And like direct pay business model, you get still get paid for healthy patients even if they aren’t needing to visit the office.
The Nobility of Medicine as a Business
Business at its core is two people voluntarily exchanging something of less value to each of them for something of more value to each of them. For example, let’s say my home is very cold in January and I have more food in my pantry than I need, while my neighbor has lots of extra firewood but no money to buy groceries. If I keep all my food to myself, I will have a cold, miserable month, and my neighbor will have a hungry, miserable month. But I offer to trade half of my food for half of his firewood, and he voluntarily accepts, we have just conducted the simplest, most basic form of business, and both are better off for it (meaning both have profited).
All of economics is merely building on this concept, adding abstractions (like currency instead of barter, hiring employees to be able to create more things of value to trade, improving customer service to attract more people to trade with you, etc). All business is moral as long as it is voluntary and honest.
Medicine practiced as a business is moral because there are few things of more value to a patient than having their health. After all, if you are dying, what earthly possession is worth more than your life? And it is moral because a Doctor is worth their wages. If you deny that a Doctor should be making a profit, you are demanding that he not be paid back for his investment of time and money in medical school. Essentionally, you are forcing him to work those years for free, and when force enters the equation, you are no longer talking about business, but theft or slavery.
The most noble kind of medical business is where a Doctor gets paid for helping his patients get all the way healthy AND stay that way. Why? Because when a Doctor only gets paid for sick patients, it creates a perverse incentive (in the economic sense meaning a motivation that leads to undesirable results) to only manage a patient’s health problems instead of solve them. A doctor who gets paid for healthy patients has no perverse incentives, and only the positive incentive of healthier patients needing less of his time so he can help others or enjoy some well earned vacation time with his family.
If All Your Doc Has is a Hammer, Then You Might Feel Like a Nail
Let me step out on a limb and ask, if you wore a tool pouch and all that was in it was a hammer… wouldn’t every problem look like a nail to you?
There is an article by Zackary Berger, MD, titled “How to talk to your doctor about cholesterol“ which every patient with high cholesterol should read. However, since you are most likely a healthcare professional reading this, then a better title for you might be, “How doctors should talk to their patients about cholesterol solutions,” because discussions of better cholesterol solutions are what is needed most, not the philosophical question of which is better for a patient… having a 15% chance of dying from a heart attack or a 15% chance of dying from a statin medication.
We all know that carpenters have and use many other tools. In fact, hammers are rarely used by them now-a-days, because they’ve become archaic. Doctors too have lots of tools, but you might not know that based on the dicussions they are having with their patients. It is as if doctors have not modernized and still seem intent on driving in a screw with their trusty old statin hardened hammer. Can be done? Yes it can, but clearly it is no longer the best tool for the job.
Here is an exerpt from the article which seems to illustrate that point.
…even if your risk lies at one of these two extremes, and your doctor is confident in telling you that your risk of heart disease is high (or low), there is one essential point to keep in mind which is underemphasized in all the media coverage of the new cholesterol guidelines: Whether to take such a medication is still, and always, your decision.This is not “your decision” in the sense of: go play in traffic, see if I care. Rather, your decision-making must take into account a whole variety of factors, which can be clarified by thinking about the following questions, or discussing them with your doctor.
Cholesterol medications can reduce the rate of heart disease, but there’s a difference between absolute rate reduction and relative rate reduction. If a cholesterol medicine reduces your rate of heart disease by 50%, that sounds great, but it’s less impressive if your 10-year chance of developing heart disease was only 5% to start with. Maybe you can live with a 10-year chance of developing heart disease that’s 5 in 100. So you might ask: “What is my baseline risk of developing heart disease, without a cholesterol medication?”
Cholesterol medications can cause side effects not uncommonly. Some studies cite a rate of 10% for the rate of muscle-related symptoms (this is probably the upper range of the rate, including everything from muscle aches all the way to significant muscle inflammation). You are really the only one who can weigh the chance of side effects to the benefits of the medication. But you might ask, “How would you compare the risks and benefits of this cholesterol medication?”
Dr. Berger, like many others, severely limits the cholesterol solution discussion to statin medications. However, if you make a careful read of the new AHA and ACC guidelines about cholesterol management, you will see that two-thirds of the guidelines are providing other methods and tools that can be used for cholesterol management. Doctors now have other tools in their bag of solutions… but, do they know about them and will they use them remains to be seen.
Based on this article and others published in the media, we might assume that cholesterol management discussions still need to be limited to pharmaceutical solutions that create the following moral dilemma for doctors… will I do less harm if I leave a patient with high cholesterol untreated knowing they have a greater risk of heart disease, or will I do less harm if I prescribe pharmaceutical drugs that are known to harm the liver, muscles, the brain, raise the blood sugar levels, and increase the likelihood of type 2 diabetes in a certain percentage of the population. I believe that most doctors are aware of the fact that if they prescibe statins to enough patients, it is virtually guaranteed that they will in fact cause harm to some of them. Hiding behind the legal skirts of the FDA might be okay for them, but morally its very questionable.
It used to be, according to the old guidelines, that doctors didn’t have much of choice. According to the guide, the statin hardened hammer was pretty much the only solution for lowering the risk of heart attack due to an imbalance of lipids. Although safer and more natural solutions were available, they were not recommended as a solution.
However, with the new AHA and ACC guidelines out, things are different. There are safer and more natural solutions that can be recommended and even prescribed by doctors. And most of the natural solutions are preferred, because when patients are asked, natural is what they want most. In fact, unofficial surveys conducted by myself and members of my team show that 60-80% of patients desire safer and more natural solutions for managing their cholesterol and blood pressure. In most patient’s minds, Natural is Safer and Safer is Better.
I personally had blood pressure problems for 21 years and not a single doctor ever offered me a better solution than a pharmaceutical. I tried a couple of them, but although they all lowered my BP pressure to a certain extent, all of them had mild adverse side-effects… but none of them ever actually fixed my health problems. Instead of getting healthier, I continued on a downward trend healthwise. Eventually my LDL Cholesterol levels rose and my doctor at the time nearly demanded that I get on a statin. However, because I also developed a liver problem while serving in the military, I was warned by my doctor upon retirement to be very careful of anything that might harm my liver further.
Fortunately I’m a researcher… and I discovered a natural remedy that lowered my blood pressure back to normal (so I’m off all meds) and at the same time it solved my Cholesterol problems, because it lowered my LDL (bad) Cholesterol, raised my HDL (good) Cholesterol, and lowered my Triglycerides. This same remedy also has my blood glucose levels completely under control and it caused me to lose 70 pounds without having to change my diet. I’m back to my trim military weight and feeling 20 years younger. And to top it all off, my liver is completely normal again.
Of course my doctor was pleased at my health progress… although he appeared a bit confused as to how it happened. He seemed happier when I showed him that what I took was in the Physicians’ Desk Reference and it also had multiple double-blind studies performed at leading clinics, universities and research hospitals. I also pointed out to him that the natural remedy had been developed by Rexall Drugs over 20 years ago and had no reports of any adverse side-effects or any known drug interactions, so it was being used adjunctively and as first-line treatment for cholesterol and type 2 diabetes by many doctors across the USA. I think he would have begun recommending it to other patients, except he retired early due to Obamacare reasons.
Given the above, it is my strong opinion that with the advent of the new, more comprehensive AHA and ACC guidelines, and with natural alternatives being available in the PDR, that healthcare providers no longer need to limit their cholesterol discussions with patients to the two alternatives of doing nothing or taking a statin which might pose a greater risk. I believe that the discussions can (and should) cover a wider spectrum of natural and safe alternatives for managing cholesterol, which will lower the risk of heart disease and the risk of doing harm to the patients at the same time.
