PCPM Performance Lab
Why You Need a Doctor to Be Your Independent Advocate
“You can imagine them using a different sort of model, where everyone gets a concierge to help them with their health care, to have a primary care doctor be an independent advocate that helps patients navigate the system, not as an agent of the hospital where they have to feed the beast. And then if you need lab tests, an M.R.I., an elective service in the hospital, you would have a health savings account and a marketplace with transparent pricing. And then, if something really bad happens — you get leukemia, you get hit by a bus — the high-deductible insurance kicks in. That’s the way the market is moving anyway, so I bet this is where these companies are likely going.”
There is no doubt that health care is broken and it is a great sign that Amazon, JP Morgan and Berkshire Hathaway are joining forces to finally change the mold. In fact, most are hoping they just shatter the old mold and start from scratch. They are starting with their own employees and if it works out they will roll it out for the rest of us to follow the model and who knows, one day soon we may even buy our healthcare through Amazon. Until that time, however, we are stuck with what we have and need to find work arounds so that our own personal healthcare is safe, affordable and adequate.
This real distills down to the need for advocacy. Without an advocate, the system will not only swallow you up financially, but it could physically harm you or even kill you. I can't tell you how many stories of close calls and poor care I have heard just over the past couple years. In fact, just today I suffered an experience that was almost surreal and clearly illustrates the need for advocacy. Here's what happened.
My friend is in town this week with his wife for an Orthopedic conference. On our second ski run of the day, his wife who is also a physician got clobbered by an out-of-control snowboarder and suffered a mild concussion. We tried to get her to ski down to the base, but after 100 yards her symptoms were getting worse so we bit the bullet and called ski patrol. Multiple patrollers arrived in minutes and were just amazing. They were all young enthusiastic people in there 20s, one was an EMT, another was pre-nursing and couple were still deciding on what to do with their lives. The experience down the hill to the patrol clinic was second to none.
Now for healthcare reality in 2018. The ski patrol clinic at the base of the resort used to be a couple-room double wide trailer, but has since evolved over the years to an actual building resembling a real clinic. Unfortunately, a couple years back, the big gorilla hospital system in town bought out everything and everybody and now the patrol hut is essentially a for-profit instacare owned and run as such.
“The second we arrived in the clinic we were hit with the mindless protocol driven attitude of employees working for the man that often leads to poor care in all but the simplest of scenarios. A friendly clerk and nice nurse did greet us initially but when we asked to just chat with the doc for a minute prior to check in all the walls went up.”
Well, you can probably guess what's coming next in the story. The second we arrived in the clinic we were hit with the mindless protocol driven attitude of employees working for the man that often leads to poor care in all but the simplest of scenarios. A friendly clerk and nice nurse did greet us initially but when we asked to just chat with the doc for a minute prior to check-in all the walls went up. Being three doctors with 75+ years experience and my buddies wife having a rare medical condition that is ongoing, we wanted to get a quick sense if we'd be better off just heading straight to the hospital 2 miles down the road. We were really just trying to get an idea of what drugs and resources were available in the clinic in case we needed a little more advanced care then the typical instacare can provide. We were not asking for a medical evaluation or a professional assessment. What happened next was the first straw.
A young ER doctor came out to the waiting room and gave us the line that he wasn't even allowed to speak to us until she was checked in and that he was risking his medical license and malpractice just by having this waiting room conversation. That was bullshit line number one. I told him to forget he was wearing the hospital coat of arms on his jacket for a second and just have a simple conversation with us, two surgeons who have 50 years of trauma and sports medical experience, so we could expedite the care of my friend's wife. We were just trying to avoid sitting 3 hours in an instacare only to be told we needed to go to the hospital anyway, all the while rolling the dice with a serious pre-existing condition. Fortunately, my friend's wife was stable at this point so we decided to just check in and stay. The ER doctor was quite rude and just walked away. What happened next illustrates how not having an advocate can kill you.
So, without violating HIPAA, I can tell you that my friend's wife has a rare pre-existing condition in which those that are not trained and familiar with could lead to life-threatening hypotension and illness if not promptly recognized. The onset of this condition, which is induced by stress, can be rapid, and if overlooked, a downward spiral can quickly ensue. So, all three of us physicians, my friend, his wife and myself attempted to explain to this young arrogant ER doctor her history and its implication for her treatment today. All he could do was perseverate on the fact that he sees tons of head injuries and repeatedly tell us that concussion is responsible for all her signs and symptoms. Bullshit line number 2.
Yes, she had a concussion, but the constellation of other signs and symptoms were so clearly related to her pre-existing condition that most doctors once alerted, would have been happy to have been pointed in the right direction. I politely said to the ER doc, you don't see this everyday and he immediately cut me off and said actually I see head injuries all the time. Next, I said that I was actually referring to her pre-existing condition, at which point he put up his hand toward my face, turned his back on me and left the exam room, shutting the door behind him.
Never in my entire career have I been shown less respect by another physician. I was furious. He just ignored a vital conversation with seasoned physician regarding the most important part of his patient's care. At this point, my friend decided to call his wife's specialist back home to see if she would speak to this ER doctor and convince him to administer the correct meds to combat her body's lack of stress response that was clearly now making her quite ill. Thank god, the specialist promptly called us back and was adamant that we were correct in our assessment and she subsequently educated the ER doc about what he needed to do for her.
With a collective sigh of relief, we got my friend's wife the treatment she needed, which was exactly the treatment we tried to tell the ER doc about when we first walked in the clinic but he refused to entertain. Fortunately, 10 minutes after receiving the appropriate medication my friend's wife was feeling much better, with just routine mild concussive symptoms. We packed in my truck and went back to the hotel where she was feeling much better and continued to do fine.
“...find an informed doctor that you trust and build a relationship where you both know each other well enough so that in times of crisis you truly have a medical advocate by your side. ”
So, the moral of the story here is that without an advocate, in this case 3 doctors in-person and one specialist on a cell phone, my friend's wife would have gotten inappropriate care and we would probably still be in the ER right now with my friend's wife being admitted for a constellation of symptoms that many of today's cookbook doctors don't understand. Even worse, if this situation had been left unrecognized it could absolutely have become lethal.
My advice today in this state of haphazard quality healthcare is that your best defense is to find an informed doctor that you trust and build a relationship where you both know each other well enough so that in times of crisis you truly have a medical advocate by your side. With today's big hospital systems owning the vast majority of physicians, this may take some effort, but the pendulum is actually swinging back and if you look hard you can find a competent doctor that does really care.
More Validation for Performance Medicine: Exercise May Reverse Negative Cardiac Effects of Sedentary Life
More validation of what we have suspected all along. "Downstream" is too late. At 70 years of age after a sedentary lifestyle the heart is small and stiff and a done deal for the most part. What we do "Upstream," between 40 and 60 makes all the difference in the world.
Read about Dr. Benjamin Levine's latest study from University of Texas Southwestern Medical Center in Dallas.
https://www.medscape.com/viewarticle/891145?nlid=120031_3922#vp_2
A Note from Shawn, a True Champion
I lost a very good friend today. He was a selfless man who gave to others as if he was an endless well of faith and encouragement. He taught me that a simple life is the best way to live and that the only thing that really mattered was "family". In his eyes, we were all family, and through our relationships we were put on this earth to care for each other regardless of race or creed. As a physician and friend I had helped him in various capacities over the years and he had recently discovered the vitality of healthy living and the value of living every day to the fullest. Shawn helped me in return by being a constant source of positivity and on my lesser days, continually reminding me that it really "ain't all that bad." "Life is good, Doctor Reiss," is how he would always and endearingly phrase it.
Below is an email Shawn wrote to our team a month before he was suddenly taken from us in a tragic car accident. This was his recently adopted philosophy and I believe it was truly working for him. I am incredibly grateful that he was compelled to share it with all of us and our children.
Hello Parents,
I wanted to share a letter with you that I will be sharing with the boys today. It was given to me by Pete Kaligis, DL Coach from the Univeristy Of Wyoming, whom I met while doing G.O.A.T. Camp 3 years ago. It’s a letter that has changed my life, my attitude, and its something I try and strive for every day. What makes it great, is that it doesn’t just apply to football, you can apply it to anything you want in life. We’re not just teaching football, we’re teaching life. Thank you for taking the time to read….
There are a lot of average people walking around who have Champion buried inside them, but are not trained or are not willing to do the work needed. Being average is a choice. You were created to be a Champion. You have the seeds of greatness inside you. However, you have to do the work to grow the seeds. It takes work to be a Champion. You have to do the work and the training to bring it out. It is hard work, takes sacrifice and discipline. Do not take the easy way out. Do what you need to do to be great. It is truly disappointing knowing that so many people go to their graves with never bringing out the relentless Champion. It's not too hard. You have what it takes. You can do this. There are people around you that will be there to help you. Then in time you will be able to help those around you too. Take the time to do the work to be unstoppable. No more excuses. No more whining. Are you doing the work to be a Champion today?
Best regards,
Shawn Long
To my amazing friend, and a true Champion, may you speed to heaven on eagle's wings and forever rest in peace my brother.
Smoky Sunset Over the Wasatch Back the day we lost Shawn
Should a Simple Fitness Check Be Part of Your Checkup?
The New York Times article and YouTube video you and your doctor must review. At Park City Performance Medicine we've known about these data for years and have built our whole practice around the premise that activity and exercise are your keys to great health, longevity and a better life.
LIFE UPSTREAM
There’s an old parable about a professor and his medical student walking together along a river. As they walk, they discover a drowning man. The student immediately jumps in to save him. Farther along, a woman is drowning. Again, the student jumps in while the professor stands and watches. They continue walking, and encounter two more people drowning in the river. Once again, the student dives in to save the two, and barely survives with her own life. The professor just continues walking along the river. Exhausted and infuriated, the student confronts her professor. “Why didn’t you help me? Those people were dying, and I barely made it out alive!” The professor just keeps walking and says, “I’m going upstream to see why all these people are falling in the river.” Soon enough, the professor and student come across a bridge with a hole in it. Person after person is slipping through the hole and falling into the river. The professor and the student get to quick work repairing the bridge.
Much like the medical professor in the story, I decided a while back that I wanted to confront people’s medical problems upstream. As a cardiac surgeon, I'm tired of bypassing many of the long standing medical issues in my patients that result from years of poor health and poor lifestyle choices.
In our mid to late twenties almost everyone is at their peak of health and performance, however, at some point between 30 and 50, life begins to catch up with us. Our health starts to decline. Some of this decline is a factor of age, but in most adults health begins to dip as a function of stress at work, family obligations, and the challenges of life that make us too busy to care about our long term state of wellbeing. The problem is, if we don’t put in the time and effort to maintain good health as we get older, we are at risk of ending up way downstream where it’s too late to get effective treatment.
It is highly unlikely for anyone to go through their entire life without experiencing a major setback or needing some kind of major medical treatment. A good example is open-heart surgery. It takes an incredible toll on even the healthiest of patients. It will wipe out a teenager for weeks. A 65 year old will be under the weather for up to 6 months or more after such an invasive procedure, especially when they haven’t been taking care of themself for the last 30 years. Even worse yet, some patients have become too high risk to undergo surgery because of decades of poor lifestyle choices and we must resort to other, less-effective and often compromising treatments.
Life is a marathon, do you want to run it cold or do you want to train for it? Everyone has the opportunity to change their long term health trajectory. The choices we make upstream in the decades following our 20’s determine whether we stay fit and maintain a high level of health and happiness and if we can successfully face life’s most difficult challenges as we age. Or alternatively, we end up downstream in a world of hurt, as a high-risk patient for most medical procedures and continually self-inflicting medical issues and sadness upon ourselves as a result of bad living.
My goal in starting Park City Performance Medicine was simply to treat patients upstream, and show everyone how to change their trajectory early before it’s too late.
The Pen is Mightier than the Sword (Scalpel)
“The pen is mightier than the sword “- Edward Buller-Lytton
Bulwer-Lytton made his famous statement in 1839 regarding the communications and power of the independent press, which if used correctly could be a more effective weapon than taking up arms in direct violence. It can also be interpreted that one can reach many more people with a pen than with a sword. In today's world this is particularly true with the number of PDAs and social media outlets that are available allowing one to reach huge numbers of people.
In my career as a surgeon, I've often wondered if this could be the case with the scalpel. Stated differently, can the pen become mightier than the scalpel? Can a surgeon actually reach out to and help more people outside the operating room and thus limit the pain and suffering in this world merely through his writings? I believe the answer is yes, and because of that I've begun my written crusade to make a bigger impact.
Knowing that I have helped thousands of people over the years as a cardiac surgeon has been incredibly rewarding for me personally and I do believe that along with my patients there are countless friends and family members out there that are incredibly grateful for my work. Saving a life with your own two hands or adding more years someone's life because of a rare skill set that you possess is a daunting feeling and one only known to those in our field. However, throughout my career I've been continually haunted, almost from day one, about the utility of being the one to pick up the pieces at the end of the line and never doing much to prevent the crash.
Early on, I believed it was the highest of callings to be that last hope and the one who actually knows what to do in order to turn that last hope into a second chance on life. Unfortunately, the same questions have continued to arise over and over again throughout my entire career, which are, "Isn't there a better way?" and "What would it take?"
Isn't there a better way help people then to meet them when they are desperate and in dire straits, way downstream and suffering from decades of poor lifestyle choices? Is the only way to help them to take them to an operating room, crack open their chest, and put them through hell and back with a three month recovery, if they're lucky? What would it take to truly help thousands of people or more avoid the perils of cardiac surgery?
As the years rolled on it became clear that in today's healthcare system I got paid a lot of money to ignore those questions. In fact, hospitals are completely conflicted on this topic. Although they say they are in the business of healthcare, they're really in the business is sick care. So by definition, if one of your products is open heart surgery you need to have a steady supply of sick heart patients in order for your business to thrive. So, it makes no sense to incentivize heart surgeons to help people avoid heart surgery. Does it?
I wish this was not true but if you examine the incentivization of today's specialists, it's very clear that volume of procedural work is king not prevention of disease and suffering. Bottom line, the system just wants sick people entering the hospital for heart surgery and mine, as the surgeon, is not to reason why.
Yes, these words are heresy and sacrilege and, within the hospital executive boardroom, they are considered the speakings of another disruptive physician iconoclast. I prefer to call it speaking truth to the currently deaf ears of authority. Thus we have designed an innovative clinic to break the current mold for those wanting to take control of their health and live a better, higher quality life.
THE HEART ROOM
Welcome to the Heart Room, the official blog of Park City Performance Medicine. Herein lies thoughts and words pertaining to all matters of the heart. From anatomy and physiology to raising children and finding time to squeeze in a mountain bike ride before dinner. We also discuss topics like preparing for and recovering from heart surgery, dealing with cancer and illness and helping people successfully fight the hardest battles of their lives, it's all discussed here.