integrative medicine 2.0

Integrative medicine is in the unique position to take advantage of all of the healthcare technology solutions being released at record pace. The portals, tracking programs, and social networking interaction are all very exciting and give users lifestyle-changing experiences never before possible. Unfortunately, what's also happening rapidly is that technology is moving at a faster rate away from doctors. I received 15 minutes of nutrition during my 7 years of medical school and residency, and nearly zero exercise physiology that could be applied in the real world. How is the average physician able to carry the conversation around optimal nutrition tracking and other lifestyle change? In addition to lack of education is the hamster wheel of seeing 30 patients a day, reviewing their patients' labs and tests, renewing medications and answering messages in their workday allows them no time to interact with patients who desire guidance on their lifestyle and engagement with today's technologies.

So we have great tools for patients for empowerment, change, interaction but very little guidance from the health profession to interface this with prevention and/or management of health conditions. Patients are doing most of these things outside of their physician.

Enter integrative medicine. Healthcare providers who have been through the conventional training to understand disease management of conditions when it's needed, but who truly understand how lifestyle impacts health or lack thereof. There is no better captain for the healthcare team than the provider whose seen the light and dedicated their practice toward optimal health. Notice I use the word captain and not general or manager. Providers are still viewed as the head of the health care team, by both patients and payors (either employers or insurers). In order to accept and embrace this role, though, today's providers need to better understand whole foods nutrition, stress management and physical fitness. Whether they educate themselves or surround themselves with team members that do, it's a necessity. 

Integative providers taking a centrol role in our society's health is essential. Traditionally, their healthcare is based on spending time listening to patients and educating them. Largely done in one-on-one visits, the scalability of such a model will not allow this message to get very far. It's going to take technology and team members to branch out and reach more folks.

Integrative Medicine 2.0 is what I call it. It's the high-tech, high-touch approach that empowers the patients, keeps the cost low by utilizing technology and promoting true prevention. It represents the movement that will improve health on a larger scale. To change medicine for good. What technology tools can support and sustain this movement?  I have taken the principles of Integrative Medicine from its father, Dr. Weil and applied the technology that supersizes each one to reach more patients, for the good of us all.

Principle 1: Patient and practitioner are partners in the healing process
Technology: Today's technology allows a unique connection between practitioner and patient like never before. The relationship is enhanced with the ability to directly connect to practitioners via tools like email and video conferencing as well as stay connected via their online presence.

 Principle 2: All factors that influence health, wellness and disease are taken into consideration; including mind, spirit, and community as well as the body.
Technology: Using social networking and intelligently designed tools to promote health through lifestyle change, improvements in stress management as well as accountability and success, technology can be a major tool driven by providers to support patients’ path of health.

 Principle 3: Appropriate use of both conventional and alternative methods facilitate the body's innate healing response.
Technology: Allows providers to deliver evidence-based content to their patients either within a practice portal and/or social networks to keep them up to date and educated. They are also able to easily present content via their online presence and within the office visit about drug-nutrient depletion, drug-herb or drug-supplement interactions  

Principle 4: Effective interventions that are natural and less invasive should be used whenever possible.
Technology: Breeds a relationship that is built on connection and enabling lifestyle change. The providers able to interface these tools within the scope of care as well as the healthcare database (EMR) will be able to show patients their progress in the big picture and keep them engaged.

Principle 5: Good medicine is based in good science. It is inquiry-driven and open to new paradigms.
Technology: Technology has become a necessity for providers stay up with evidence-based protocols and new ideas for therapies. Allowing them to connect with other providers for educating and inspiring best practice as well as delivering this to their patient population easily both as content and as motivational/interactive tools.

Principle 6: Alongside the concept of treatment, the broader concepts of health promotion and the prevention of illness are paramount.
Technology: Enables the ability to create social networking and interactive features to inspire and guide health promotion through the most powerful means necessary: lifestyle change. Just as important is to be able to interface these features within a bigger portal that allows the patient and practitioner to see the bigger picture in regard to overall health and prevention.

Principle 7: Practitioners of integrative medicine should exemplify its principles and commit themselves to self-exploration and self-development.
Technology: Allows providers to interact with patients on a whole new level, which has value (should the provider desire and/or feel comfortable) in exposing certain aspects of the provider's lifestyle for their own accountability as well as their patients’ inspiration and education.

The best news? All of this technology is available today! Time to start changing the paradigm of the new paradigm. Welcome to Integrative Medicine 2.0. 

Local hospital's fraud shows health care system's ills

Just read an article (http://bit.ly/iv0JZX) about a local hospital and its parent company (a collection of mega-hospitals) being investigated for fraud. They allegedly have been overbilling Medicare, Medicaid and private insurance for millions of dollars more than the work that they did. What a shame. They will take a major financial hit and potentially loads of irreparable media exposure. Two questions come to me:

1. Do people really care?

2. Do we blame the hospital (sure), but what about the system?

Who Cares?

People largely will could care less about this case of fraud because they were not victims directly. When you create a cost-blind system, where neither the customer, nor the business have any clue what things cost, no one really gets "hurt". Sure, we all lost on this deal because we ultimately bare the burden of escalating healthcare costs and taxes, but no one personally feels cheated by Lutheran Hospital. We need to bring a much greater awareness to the cost of healthcare. People, on both sides need to realize how much money these medicines, surgeries, interventions (too many of which are unnecessary and quite harmful) cost.

I left the insurance world when I started GladdMD. I did that because insurance reimburses the better physicians for seeing a high volume of patients per day (around 30 on average to make the average wage, but the number needed to see is rising) and doing procedures. I do not do either of these things. I sit with patients for an hour, sometimes longer if they need it, so when I was with a hospital in an insurance-based practice it was in the red every month. In order to practice the type of medicine I wanted, I needed to work more like a lawyer, being paid for my time. I charge what I believe is fair and what allows me to spend time with my family and make a decent wage like the average family physician (the wage part that is, I spend a lot more time with my family then they do). Because I practice this way, some view us as expensive care. The truth of the matter is, if you knew how much your care really cost dollar-wise, we're the best bargain in town. A one-hour visit with our integrative practitioner to truly promote your health and empower you to feeling and being well is cheaper than the average 10 minute fast-paced, prescription-receiving visit your getting now.

Who's to Blame?

Blame both. There is no excuse for intentionally billing an insurance company for work that was not done. I suspect the punishment will be severe. But don't forget about the system that has been created. This disease-care system we have is very expensive, partly because your rewarded for using expensive testing and doing expensive procedures, and partly because the malpractice landscape has raised a bunch of physicians to practice defensive medicine. We are taught from medical school on that instead of, "Do no harm", we also need to "Get no sued". The expense of this care is not sustainable. The answer? Cut reimbursement across the board. The reimbursement from Medicare is pennies on the dollar. It is extremely sad, but we are in a time where caring for our nation's elderly is essentially charity work and good business practice would suggest you should not do it.

I am not sure what the ultimate cure is, but I can assure it starts with investing, from both the payer's (Medicare, Medicaid, insurance) and customer's (patient) side in true healthcare. Helping people connect their conditions and concerns to their lifestyle and providing the tools and resources to do such. I can assure you that the majority of folks that come to see us and other integrative providers and make this investment, cost both their own and their insurers significantly less money over within a year. And to spend time with patients and survive we bill the patient directly. Just good, honest business. Isn't that what this country is supposed to be about?

Find a physician, not a general

"Superior doctors prevent the disease.
Mediocre doctors treat the disease before evident.
Inferior doctors treat the full-blown disease."
Huang Dee Nai-Chan 2600 BC; 1st Chinese Medical Text.

Not only does my work in integrative medicine have me on the front lines of big pharma-created "syndromes", like chronic fatigue, fibromyalgia and irritable bowel (these are real for patients, but are not formal syndromes), but I get to see the worst of our sickcare system. I continue to see patients who are not only suffering from frustrating and often debilitating chronic symptoms, but they have largely been disrespected and pushed away by physicians they put trust in.

See most patients still believe that physicians still provide what the ethics of medicine requires us to: "consideration, compassion and benevolence for our patients". They come to the doctor with the expectation that they will get to tell their story and be heard. That they will enter into a discussion with their doctor about the risks and benefits of certain tests, therapies and alternatives. That their physician will help them, as a patient, make their own best decision for themselves and be comfortable making that decision.

Unfortunately the healthcare experience for many is quite the opposite. The doctor gives a patient an order that is expected to be followed or else. Patients that don't follow these orders are branded non-compliant and often excused from the practice. Is this the way this partnership was meant to be? A dictatorship that takes no account as to the desires or means or belief systems of the patients we are to care for? The natives are getting restless with this approach and they should. I often apologize to my patients for my profession and hope to show them a new way, a team approach where the patient, armed with the evidence and my experience can make the best decision for themselves.

I believe healthcare was meant to be a partnership with patients where providers use their talents and knowledge to help them make the best decision to promote their health often in the face of disease. They don't give orders, they give advice. They provide patients with a toolbag of ideas and options for bettering their health and well-being. They never give them a guilt trip if they made a different decision than the provider would, or sought a second opinion.

There are many reasons why our current system has become this frustrating, dictatorship experience, but it is no excuse. There are models of care being developed and good practitioners willing to partner with patients to help them make the best decisions, and actually take the time to hear them and provide this guidance. You should go find one.