how to transition from allopathic to integrated practice - imm brazil 2015
TRANSCRIPT
Transition from Allopathic to Integrated Practice of Medicine
Louis Cady, MDCEO, Founder – Cady Wellness Institute
Newburgh, Indiana (US)Indiana School of Medicine,
Dept. of Psychiatry
Brazil, 2015
Ethics and financial/logistical practicalities of these lectures
• Nothing is more important than taking care of the patient.
• “The needs of the patient come first.” (Dr. Will Mayo, MD)
• The current “medical model” is at variance with what is ethical, moral, and factual.
• If the physician is not stable and financially secure, the system implodes.– “No margin, no mission.” - Steven R. Covey
• If the system implodes, the patient suffers.
Background
Deat
hOptimal HealthTraditionalMedicine
Hormone Modulation
No
Dis
ease
= H
ealth
Diet, ExerciseNutritional Supplementation
“Wellness [integrated] Medicine”
Diagnose andTreat Disease
New DrugsNew Drugs New Surgical New Surgical TechniquesTechniques
Forestall and PREVENT Disease – Optimize Function
Health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity. - World Health Organization
American Journal of Health Promotion; November/December, 2002
19% of those surveyed
were completely healthy with high levels of both physical
and mental health and a low level of
illness.
18.8% completely unhealthy, defined as having low
levels of health with high levels of illness.
Two-thirds of the adults reported some degree
of mental or physical illness that kept them from
being completely healthy.
“Incompletely healthy.”
HEALTH continuum
DEA
D
OPT
IMA
L
66%“Incompletely healthy”
The “Survival Curve” – Where Are You?
Outline
• Overview of concepts• My bias – a practice model• Current state of allopathic medicine• Microchip as disruptor and disintermediator
– (“Change or die”)• Current state of patients and society• What’s your model? Chloraseptic or PCN?• How to start changing….
The evolution of my practice• Sidetracked in high school, two degrees in music (’77 and ’79)
and learned piano tuning• 1976 – 1989 – piano tuning (through pre-med and med
school). “fee for service”(Med School finished 1989)• 1989-1993 – conventional allopathic psychiatry residency at
Mayo Clinic• 1993 – start practice. 1995 – l-tyrosine and EFA’s• 2002 – first IFM conference• 2003 – Cenegenics training• 2005 – founded Cady Wellness Institute• 2010 – 2011 – Neil Rouzier, MD & WorldLink• 2012 – rTMS (Transcranial Magnetic Stimulation)
May 2002: 9th Annual IFM Conference
The Functional Medicine component
Dead Doctors Don’t Lie - Joel Wallach, DVM, ND
Current socioeconomic state and allopathic (“conventional”) medicine –
DISRUPTIVE NOTIONS• CONVENTIONAL Allopathic medicine = symptom
focused, reactive, “taught,” unthinking, uncreative, PRACTICALLY non-informed by peer-reviewed medical literature. – Commoditized. No variability. “Providers.”
• Integrated medicine: individualized. Can’t get it elsewhere. Not a commodity. Scientific. Informed by peer-reviewed literature.– Concept of “information brokering” (example: THYROID)
Medicare–Workers per Beneficiary
http://facts.kff.org/chart.aspx?ch=383. Accessed April 3, 2010.
Year
Millions
SOURCE: Kaiser Family Foundation based on the 2009 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds.
Slide courtesy of John Adams, MBA – CEO, Cenegenics
The Future of Medicare
“Medicare is going bankrupt. The Medicare Trustees estimate that the program will run short of money starting in 2017.”
•Rep. Bobby Scott, Senators Jim Webb and Mark Warner
http://www.congress.org/congressorg/bio/userletter/?id=3181&letter_id=4747883751. Accessed April 3, 2010.
Slide courtesy of John Adams, MBA – CEO, Cenegenics
Healthcare Reform–Physicians Perception of Medicine Over the Next Few Years
http://www.athenahealth.com/index.php?open=26. Accessed April 3, 2010. Slide courtesy of John Adams, MBA – CEO, Cenegenics
Are the Best and Brightest Staying in Medicine?
“60% of physicians would not recommend medicine as a career to their children.”
• – The Physicians’ Foundation
http://www.mayorswellnesscampaign.org/wp-content/uploads/2009/05/merritt-hawkins-survey.pdf. Accessed April 3, 2010.
Slide courtesy of John Adams, MBA – CEO, Cenegenics
Is there hope for medicine?
“The Great Crossover” – the microchipcf: Dan Sullivan www.strategiccoach.com
Accessed August 30, 2015
A change from the allopathic model?
Socioeconomic/disruptive forces with two models
Allopathic• Disease and sickness
focused• Short appointments• Commoditized• Compartmentalized• Doctor as priest• Uninformed patient• Sicker patients• Either practice
ignorantly or with guilty conscience
• Worry/poor satisfaction
Wellness/ fxnl med• Integrated and whole
person model• Bill for time• Non-commoditized• Collaborative• Informed patients willing
to “pay for expertise”• Practice per peer-
reviewed literature; No crises (pl) of conscience
• INTENSE satisfaction
CHANGE AGENTS
• Microchip/internet
• Increase in chronic disease
• “boomers”• Job/socio-economic pressures
Divergence of focus of two models
Allopathic• Relief of symptoms • Organ specific• Aggressive. “magic bullet”• Rules, practice guidelines• Patient as uninformed
protoplasm.
• Tied to medico-pharmaco-industrial complex
• Use of synthetic, patented, not-from-nature substances
Wellness/ fxnl med; “complementary/alternative”• CAUSE of symptoms, prevention• SYSTEMS focused• Gentle, methodical.• Creative. What works?• Patient as integral part of team.
Questions/participation encouraged. • Focused on health and optimization
with natural, bio-identical methods• Use of PROVEN botanicals and
natural hormones (as well as conventional RX).
Adatped from “Alternative Medicine: Why so popular? By Hans R. Larsen, MSc ChE. International Health News, Sept 1999, issue 93 http://www.yourhealthbase.com/alternative_medicine.htm accessed 1 21 2012
Some interesting thoughts:
•“A naïve analysis of stability is derived from the absence of past variations” (or “The Turkey Problem”)
– Nicholas Taleb, author of The Black Swan
What does integrated, holistic medicine “look like?”
A quick dip in the literature
% U.S. Women with inadequate quantities of nutrients
Arab L, Carriquiry A, Steck-Scott S, Gaudet MM. Ethnic differences in the nutrient intake adequacy of premenopausal US women: results from the Third National Health Examination Survey. J Am Diet Assoc 2003; 103:1008-14.
= 2 apples (fruits) & 3 - 4 vegetables – per CDC
4 – 13 servings of fruits and vegetables per day, depending on energy needs
Cf: http://www.veganforum.com/forums/showthread.php?t=3532
North America 85%South America 76%Asia 76%Africa 74%Europe 72%Australia 55%
% Mineral depletion from the soil during the past 100 years, by continent
Source: UN Earth Summit Report 1992
If we know all of this stuff….
Why don’t we DO anything about it (with our careers, or practices,
and our patients lives)?
Factors trapping physicians & HCP’s• “Doing it, doing it, doing it.” (Michael Gerber, The E-
Myth)• Already time-pressured –
– Minimal time to think or plan– PROBABLY ADRENALLY DEPLETED ALREADY, perhaps
with suboptimal thyroid and sex hormones• Tip – GET YOUR LABS CHECKED!!
• Must “make overhead.” • Can’t “take chances.”• Trapped by “provider panel” arrangements, including cut
rate fees
Beating the FUDD Factor ™
• F ear (medo)• U ncertainty (incerteza)• D oubt (duvida)• D ESPAIR: (despair)
– Don’t know where to start, don’t know how to test, don’t know how to interpret the labs, afraid of “hurting” the patient.
MAKING THE TRANSITION• Must DECIDE
– Must have INFO (e.g., this weekend)– Must INTROSPECT
• Must have something LEGITIMATE to offer• Start SMALL – both with interventions and testing
– E.g, ¼ grain Armour, or Cytomel 5 MICROgrams, or Cortef 5 mg twice daily, or FDA approved testosterone for guys
– E.g., OAT and IgG testing
• Get EDUCATION– IMMH Conferences – AAMG – American Age Management Medicine Group; Institute for
Functional Medicine. For hormones – Neal Rouzier & World Link Medical
• Find a mentor (s) – start here
Marketing & Practice Development• Maintain excellence in allopathy, osteopathy,
chiropractic or naturopathic medicine)– (knowledge base, prescribing, surgery)– (“Be able to debate the great issues.” – Jim Rohn)
• Know your [new] stuff!• Do not badmouth the competition. • Give CME talks and paper over their objecting
mouths with references. • Spiritual and ethical clarity.
“You can have everything in life you want, if you just help
enough other people get what they want.” - Zig Ziglar
What do patients want?•To be treated with respect•To not have to wait!•To FEEL BETTER•To HAVE HOPE.•To not be doped up.•To NOT have their money wasted.
$5,000 worth of wisdom on one page – from Jay Abraham
• Risk reversal• “USP” – unique selling
proposition• Defining the buying
criteria• Three ways for more
profit:– Higher price– More frequency– Additional services
Focus: “Be able to treat your clients (or patients) as dear and valued friends.” - Jay Abraham
Evansville Courier & Press: May 29, 2006
References: www.pharmanexmd.com ; www.slideshare.net/lcadymd;Dr. Oz show on YouTube: http://www.youtube.com/watch?v=rX4oxxGWi_8
Building CWI - what has worked• Being nice to patients
– (on time, polite, compliment on questions, don’t be a jerk or abrasive, put yourself into their shoes, etc.)
• Be good and get results. BE THE BEST!• Be TRANSPARENT – give’em their labs.
– Write on them. Draw pictures. Take time (and BILL FOR IT).
– Cenegenics model• Be appropriately self-protective of your time and
talents. “If they show up, bill’em.” – Dan Kennedy.
Be Awesome!
NEW reference. Grab it.
MARKETING – what has and hasn’t worked
Worked• Word of mouth• Public seminars• Web site• Going to MD’s/DO’s
offices PERSONALLY• Free stuff – PR
opportunities• Going to places and
NETWORKING
Hasn’t worked• Paid advertising (TV,
print, magazines)
• What I HAVEN’T tried:– Marketing consultants– Radio ads
New initiatives:•Proprietary, paid websites•“SEO” – search engine optimization (Willie Sutton principle)
Additional resources – handouts available at end of lecture
• “The 10 Commandments of Marketing a Medical Practice” – Cady (handout, free)
From Chet Holmes - Grow Your Business 10X web presentation
Success and Failure (Jim Rohn) What about you? You’ve only got one body.
• “Errors in judgement” - High glycemic eating, no exercise, poor nutrition, no labs and “flying blind”, lousy/no supplementation, high stress practice.
- “Good disciplines” – appropriate diet, labs, supplementation, exercise, hormones. Stress management. Decent practice and lifestyle.
"If you have knowledge, let others light their candles in it." - Margaret Fuller (May 23, 1810 - July 19, 1850)(American journalist, critic, and women’s rights advocate.)
I wish you all the best! Good luck!
Contact information:Louis B. Cady, M.D.
www.cadywellness.comwww.Facebook/cadywellness
www.TMS-relief.com
Escritório: 812-429-0772E-mail: [email protected]
4727 Rosebud Lane – Suite FInterstate Office Park
Newburgh, IN 47630 (USA)
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“slides”
A few extra references follow