Islon Woolf MD
Concierge Medicine and a comprehensive approach
Updated: Jun 21, 2020
There are many ways to diagnose and treat a disease in medicine. A comprehensive approach informs you of all your potential options. This is essential in order to make good decisions for your health. If you are not informed of all your options, how can you be expected to make an informed decision?
A comprehensive approach informs you of all your potential options.
Failure to provide a comprehensive approach
Your primary care doctor is the person most suited to provide a comprehensive approach. She is a good communicator, knows you the best, and lacks the bias of the specialist. Yet, it is often the case that patients are not offered a comprehensive approach by their primary care doctor. This is especially true when it comes to chronic medical conditions, and optimal health - aka "wellness"- the science of living better, stronger, happier, and smarter.
A patient with a chronic condition like insomnia, for example, is typically offered a prescription sleeping pill. Yet, there are several treatment options for insomnia that do not rely on pharmaceuticals . A partial list of these non-pharmaceutical options include: 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.
The same can be said for optimal health and wellness. There are many options for optimal health, such as: hormones to stay youthful, supplements to boost memory, foods to prevent disease, etc. Yet, they are often neglecting by primary care doctors.
Why primary care fails to provide a comprehensive approach
There are several obstacles preventing primary care doctors from providing patients with a comprehensive approach; they include:
1. Incomplete training - Doctors finish training with a significant knowledge gap. Although medical school is exceptional at teaching doctors the pharmaceutical and surgical approaches to acute medical problems, it is notoriously weak at teaching the management of chronic conditions, the pursuit of optimal health, and the use of non-pharmaceutical options for medical conditions.
2. Obsolete knowledge - A comprehensive approach in medicine must include what is current and what is effective in medicine, and discard what is old and what is obsolete. Knowledge grows at an exponential rate, and concepts become obsolete at an exponential rate. Keeping up with medical knowledge is a full time job. Most doctors lack the time to update their knowledge after medical school.
3. Lack of counseling time - A comprehensive approach takes time. Time to communicate the options, time to help make decisions, and time to implement. First, it takes time to communicate all your options; even simple problems may have many solutions. The more solutions you are faced with, the more decisions you have to make. Helping with decisions making takes time. Finally, it takes time to implement these decisions, especially non-pharmacologic options. For example, it takes time to help you set-up an exercise program, or teach you how to meditate. The current fifteen-minute office visit does not allow this - it's easier to prescribe a pill.
4. Inexperience dealing with weak evidence - Many of the options for chronic conditions and optimal health are based on weak to no evidence. Some are pseudoscientific, and some fall outside the realm of science entirely. For example, the claim is made that a supplement increases longevity. What evidence is this based on? What kind of evidence would be required to recommend using this supplement? There are no sources readily available that perform reliable reviews of these claims. Sorting out weak evidence requires time, effort, experience, and critical thinking. It is not something stressed in medical school. Most doctors are uncomfortable, ill-equipped, or simply lack time to address these issues.
Patients find biased information
Primary care doctors that do not provide a comprehensive approach are disconnected from their patients needs. The modern patient wants to be involved with their healthcare; they want to be informed of all of their options. They are interested in non-pharmaceutical options, and living "optimally". In the absence of a primary care doctor that can provide this, patients will seek out other sources of information. Access to information is easy in our Information Age; however, access to good information is not. It is becoming increasingly difficult to tell good information from bad. Most of the infromation comes from biased sources with conflict of interest. (To read more about bias in specialists, click here. To read more about conflict of interest in medicine, click here.) Consequently, a patient not provided with a comprehensive approach from their primary care doctor, can be lead down the wrong path.
A patient not provided with a comprehensive approach from their primary care doctor, can be lead down the wrong path.
Concierge Medicine and a comprehensive approach
I realized very quickly that my patients wanted to be involved with their healthcare; informed of all their options, interested in non-pharmaceutical approaches, and living optimally. Providing them with a comprehensive approach is one of the most important goals of my practice. The Concierge Medicine model, with the low volume of patients, with gives me time and freedom. With this, I have designed and built my practice to provide a truly comprehensive approach:
1. Completed training - I have had over two decades to complete the training not provided in medical school. This includes learning the proper management of chronic conditions, learning the approaches to optimal health, and learning non-pharmacologic options for medical conditions.
2. Continually updated knowledge base - I have devoted myself to lifelong learning. I use each case I see throughout the day as an opportunity to learn. I spend approximately one third of each day learning in this manner. Both of us benefit from this; I get to update my knowledge, and you receive the most precise and current approach for each and every problem you see me for. Click here to read more about lifelong learning and my practice.
3. Ample counseling time - Concierge Medicine gives me ample time for counseling. There is time to review all of your options. There is time to help you decide which options are best for you (to read more about making difficult decision in medicine with your doctor, read here.) There is time to implement the options that require instruction; such as mediation, exercise, and other non-pharmacologic treatments.
4. Experience with weak evidence - Learning how to evaluate pseudoscientific claims, or claims based on weak evidence, is quite challenging indeed. Over the past twenty-five years I have had the chance to evaluate thousands of such claims. (see here, here, and here). I apply critical thinking, which involves: understanding cognitive error, clarifying claims, systematic review, determination of plausibility, ranking of evidence, and considering prior success rates. To read more about critical thinking in medicine, click here.
Provided with a comprehensive approach, you are empowered to make good medical decisions.