Concierge Medicine and a Comprehensive Approach

There are many ways to diagnose and treat a disease. A comprehensive approach informs you of all your options, and is essential to make optimal medical decisions. (A comprehensive approach is sometimes called "holistic," but due to its ambiguous nature, I prefer not to use that term.)

There of several areas doctors fail to provide a comprehensive approach, these include:

• Treatment of chronic medical conditions - Arthritis, autoimmune disease, obesity)

• Lifestyle medicine - Exercise, nutrition, sleep, stress management)

• Supplements

• Preventive medicine and longevity

• Optimal health and Wellness - Improving performance beyond average

• Alternative medicine - Traditional Chinese Medicine, Homeopathy.

For example, a patient with chronic insomnia is typically offered a prescription sleeping pill. However, there are several treatment options for insomnia that do not rely on pharmaceuticals . A partial list includes: supplements, meditation, exercise, sleep hygiene, stimulus control, sleep restriction, progressive muscle relaxation, and cognitive behavioral therapy. Some of these can be as effective as a sleeping pill.

Primary Care fails to provide a Comprehensive Approach

Your primary care doctor is the person best suited to providing you with a comprehensive approach. She is a good communicator and knows you the best. She also lacks the bias of the specialist who may to tied to these options and protect you from misinformation. Unfortunately, she often fails to provide you a comprehensive approach, and here are the reasons why:

• Incomplete training - Doctors finish training with a significant knowledge gap. Although medical school is exceptional at teaching the pharmaceutical and surgical approaches to acute medical problems, it is notoriously weak at everything else.

• Just out of training - Due to incomplete training, a new, inexperienced doctor is ill-equipped to provide a comprehensive approach.

• Obsolete knowledge - To provide a comprehensive approach one's knowledge must be current. However, with knowledge growing at an exponential rate, and a lack of time, it's almost impossible for most doctors to keep up.

• Lack of counseling time - Most medical problems have many options; a comprehensive approach takes time to communicate. The more options, the more difficult the decision making; another time consuming process. Finally, it takes time to implement the options (especially non-pharmacologic options). For example, it takes time to help set-up an exercise program, or teach meditation. The current fifteen-minute office visit does not allow for any of this - it's easier to prescribe a pill.

• Inexperience with weak claims - Many, if not all the options for longevity, optimal health, and alternative medicine are speculative. Weak claims based on weak evidence. Some are pseudoscientific, and some even fall outside the realm of science entirely. Most doctors are either uncomfortable or lack the time and critical thinking skills to evaluate these claims.

Concierge Medicine and a Comprehensive Approach

The Concierge Medicine model, characterized by its low patient volume, serves as an ideal platform for offering a comprehensive approach to my patients. Here are the features of my practice that enable me to provide this:

• Completion of training - I have had over three decades to complete the training not provided in medical school.

• Continually updating knowledge - I have devoted myself to lifelong learning and case-based learning. Each case I see launches a thorough investigation to update my knowledge.

• Ample counseling time - Concierge Medicine gives me time to review all of your options, help you decide which options are best for you, and implement the options that require instruction and follow-up.

• Experience with weak evidence - Learning how to evaluate weak or pseudoscientific claims is quite challenging indeed. I've had the chance to evaluate thousands of such claims over the last 30 years (see here, here, and here). To read more about how to evaluate medical claims, click here.

Offering a comprehensive approach to my patients is one of the most important task of my practice. It not only empowers you to make the best medical decision, it also protects you from misinformation.