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. 

Victory for Patient Empowerment

Consumers Could Get Test Results Themselves...

Patients may soon be universally able to view their lab results thanks to a new rule proposed by the Department of Health and Human Services. This means getting access without permission or release by their providers. This is a victory toward patient empowerment and a step in the right direction.

Classically patients do not see their lab results. The busy primary doctors are often left with nothing more than a "no news is good news" approach to reviewing labs with patients. Or they stamp the lab report "normal" as long as they do not fall outside of the gigantic reference ranges the labs have set. So patients do not get to see how "normal" they are or how things have trended in the past. This means that patients who are not contacted are left to assume things are "fine". The data shows that 20% of labs are lost and not reviewed by physicians and so patients sit at home believing things to be okay when that may be far from the truth.

The blame should not be placed fully on physicians. Often, they are overburdened by having to maintain a busy day of patient visits in order to generate revenue for the practice and keep the doors open, and still need to spend a significant part of their day doing things that do not pay the bills or bring in revenue to pay their staff: reviewing patient messages and questions, reviewing consult notes on their patients, and the expectation to review every lab, test and procedure on their patients. With this much on their plates, things are bound to be overlooked or just flat missed. This is a system issue, not a physician issue. A healthcare system that only rewards patient visits means one of three things happen with labs: either you meet face to face with your doctor, you get the "everything looks fine" from their staff, or they just get flat ignored.

Enter the patient, who is starting to understand the vital role they must play in their health. It's up to them to navigate their path. Now, they're helping to play a role in determining which therapies or lifestyle roads are taken, interacting with their provider to maintain a regular relationship, staying on top of regular monitoring and screening and now controlling their data to ensure things are on track.

There are few systems and practices that are supporting the enabled and empowered patient well. More and more physicians are realizing that the empowered patient is actually a relief for their practice and not a burden. Their questions are more focused and appropriate, they stay on top of their labs and screening so you don't have to, and generally they are making better lifestyle choices to increase the health of themselves and subsequently your practice. It's time to truly embrace them and provide them with tools to connect with you and attract more of them. Take a look at the Hello Health platform, built to empower patients and take some of the daily burden off of physicians. We'll all be a little healthier.

Patients with a story of how they have become a more empowered patient? Enjoying the Hello Health platform with GladdMD? A physician trying to create your ideal practice? Leave a comment below...

Raising a future designer/creator

I am fascinated by technology and the people and companies that are creating amazing things on a daily basis.

While I love taking care of patients and helping figure out ways to improve health, I also love creating things and am itching to be a part of a technology startup. The kind with bean bag chairs, white boards and lots of creativity flowing daily. It's why I created GladdMD, to free myself some to work on other projects. We're working on a new site, going to be doing some video blogging with the goal of delivering medical school to the people. It's imperative that people learn to take care of themselves and knowledge is empowering. I am also getting ready to start working on Mytavin.com, a tool to help people figure out which supplements, if any, they should be taking.

I have been recently been exposed to guys like Aza Raskin, who was the creative behind Firefox and recently started Massive Health (hope to meet with you soon in SF), Gary Vaynerchuk of Wine Library TV and now the Daily Grape and recently heard Zach Klein speak in Fort Wayne (he's from here). Zach was cofounder of Collegehumor.com and vimeo.com.

Learning the stories of success from these pioneers and hearing Zach talk about how much creating is still left to do, the future is wide open for progressive, out-of-the-box thinkers that have ideas and ways of improving just about anything. In a way, that's all of us. Unfortunately, so many of us remain cozy in our day to day lives and never creep outside the box. We all have ideas, all the time. Technology and and the tools available to today allow anyone to bring that idea to the public and make a reality.

So I was thinking about my kids and the future that is being laid out for them. The worksheet my son brings home that is created by the state of Indiana to do nothing but help him pass standardized tests. How do you stimulate creativity? How do you start building a future Zach Klein? It started yesterday with this discussion:

My 7 year old asked when we were going to start his free range eggs business that we talked about last year. We talked for awhile about what it would entail: purchase chickens, buy the materials and spend the time to build a coop, buy feed, research the how-to's and how we would market it. Then I asked him, "What happens when we go to the lake, or out of town?" He smartly replied that he would have to hire someone. He made the connection that this would cost money and eat into revenues. I was trying to imprint the lesson of scalability and also creating a lifestyle to balance with your work. He can see that there are some real limitations to the egg business now (not that it isn't an amazing lesson and experience for a child). So then I presented another option. "Sam, what if instead you learned about computers and were able to create something really helpful and cool that people used. What if it made money because people paid to use it or simply because a lot of people liked it?" I asked what happens now if he goes out of town. He answered that the business still makes money, and he could take his computer with him and check on things from lake. Atta boy.

Enter Scratch. So, motivated by the idea that there are greater opportunities for my son in the future if he learns to channel his creativity in technology versus learning how to throw a curveball (not to say I won't still promote sports, just give up early and realistically on professional aspirations), I searched for ways that kids can start to learn coding and programming. MIT built Scratch to do just that. It's a basic tool that let's kids program different cartoons or games with simple language and tools. He loves it. Talked about it for two day and finally tonight we logged in and set up his profile. He spent 90 minutes creating sounds, pictures and animations with a huge smile. I am happy and proud to present Sam's first project: Funny Show. The future is bright!

Sam's Funny Show

Enlightening Young Minds

I was invited to the Ft. Wayne Family Medicine Residency today to give the noon conference talk on Integrative Medicine. I love talking to medical students and residents as they generally seem so hungry for changing medicine. To me it's important to show them some light in what often seems like a gloomy future within the hamster wheel of a busy primary care doctor (at least in my eyes in today's sickcare system).

I sadly forgot how much the drug companies have infiltrated medical education. Prior to my speaking, the drug rep, after providing a fancy buffet of heavy restaurant food and 10 2-liters of pop,  brought in a local psychiatrist to revel in the amazing healing properties of Lexapro. That ate into 12 minutes of my talk and was shocking to hear him speak of how great it is and how a single nerve study in a Petri dish in a lab shows how Lexapro may be better than its cheaper and equally weak-evidence-based cousin. Then he said if patients on it suffer from muscle cramps and pain, it must be generalized anxiety disorder (not a side effect of the medicine, or some other symptom related to the driving force originally behind the blues)! So...then just add another 2-3 drugs for that one. Here I am in the front of the room trying not drop my Macbook. Then the drug rep takes up more of my time to tell all the residents that their Medicaid patients can get it for the low, low price of $3.

Residents get this every day. Free, heavily processed restaurant food and a bunch of industry-created drivel. Never a mention about how lifestyle has a tremendous impact on health or lack thereof, just day after day on how to provide sickcare. What I presented today was novel, new and refreshing. Their eyes brightened to the ideas of using vitamin D, living and learning whole foods nutrition and spending time with patients to partner with them rather than simply whipping out the prescription pad pretending to heal all ills. For the most part they really get integrative medicine, many of them came to medical school to do just the things I get to do every day. They are just not presented any opportunity to think or learn about it during their 7 year stint within the confines of "Camp Conventional". Many asked to come shadow me and want to know more.

I also discussed the career freedom offered by disruptive healthcare technology like the Hello Health platform. Get out of the outdated, boggy frankensystem (thanks Gordon!) interfaces that surrounds you everywhere within the system and jump on today's technology that everyone else is playing on. Again, lots of interest in ways to live the dream they entered medical school with, lifestyle freedom, empowering patients and promoting health and healing, the candle quickly burned out the moment that short white coat was donned.

We need to get the concept of health promotion into medical education. We need companies like Hello Health to show students/residents that they can be a part of a major disruptive innovation for the good of their personal lives and the lives of their patients. No longer is it acceptable to keep the herd shuffling along the same old machine, producing America's next generation of prescription pad warriors. Time to mesh health promoting care with access to patients and partner with them to optimize their health.