Transition into an integrative medicine practice.
Return to practicing medicine the way you always dreamt it could be.
The United States spends the most health-care dollars per person in the world. Yet we are a sick, fat, and tired nation. Both patients and health-care providers are dissatisfied with our health-care system.
We have a diseased management system masquerading as a health-care system.
This system is broken!
Integrative medicine is a solution to heal our broken system. The Integrative Medicine Solution is a practical guidebook for physician assistants, supervising physicians, nurse practitioners, and other health-care providers who want to transition from treating symptoms to the root causes.
• Patients are healthier, happier, and less dependent on drugs.
• Providers are rewarded for spending more time with their patients.
• It will restore balance and joy in your practice and life.
"This book is a great introduction and practical guide for PAs or any other health-care providers who are wanting to start their own integrative practice."
-Jana Pratt, PA-C, Women's Integrative Health Specialist
"This is an awesome read and a great education piece for all health care providers to read. I think it is a must read."
-Nathan S. Bryant, PhD, author of The Nitric Oxide (NO) Solution
"Excellent job . . . your book will shed light on what patients need to know."
-Mark Starr, MD, author of Hypothyroidism Type 2: The Epidemic
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Read an Excerpt
The Integrative Medicine Solution
Go Beyond Wellness to Heal Your Patients and Your Practice
By Cathy Ochs
AuthorHouseCopyright © 2015 Cathy Ochs PA-C
All rights reserved.
Our Broken Healthcare System
How did we get here?
You are in a very small minority living in a bubble if you think everything is fine with the healthcare system in the United States today. There are indicators all around us, and numerous studies to confirm what we are all feeling. There is growing dissatisfaction with our system from patients and healthcare providers alike. The United States spends the most on health care than any other nation, however higher expenditures don't translate into better care. The World Health Organization (WHO) was one of the first to reveal on a global scale the severity of our country's failing healthcare system. In 2000 WHO released the first ever analysis of the world's health systems. Comparing the 191 member countries using five performance indicators, the report ranked the United States 37th behind Costa Rica and just ahead of Slovenia. France was number one with Italy ranked second and San Marino third. Interestingly, in this report the biggest difference between the U.S. and the other industrialized countries in this ranking is the absence of universal health care.
The Commonwealth Fund, a private foundation committed to promoting high performance health care systems, fulfills their mission through independent research. Their 2014 Executive Summary update titled "Mirror, Mirror On The Wall" continues to find the United States overall ranking last among 11 nations studied including Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland and the United Kingdom. The United Kingdom is ranked first followed by Switzerland and Sweden. The report shows the U.S. spends the most of all 11 countries at $8,508 per capita, whereas the number one ranked United Kingdom spends less than half at $3,405. Seventh ranked Norway comes closest to the U.S. in health expenditures spending $5,669 per capita. Similar to the WHO report in 2000, the Commonwealth Fund report points out the U.S. differs the most from the other industrialized counties in the absence of universal health insurance coverage. Again, spending more does not confer better healthcare and we must focus on getting better value for the dollars spent.
An independent study published in February 2014 by PartnerMD, a national membership-based medical provider, states 69% of the 1,000 people surveyed expressed worry about the future of the traditional primary care model. 93% of Americans spend less than 30 minutes with their doctor, and nearly one-third see them for less than 10 minutes. Physician dissatisfaction and burnout rates are at an all-time high with many leaving their private practice to become employed by larger hospital groups or moving to concierge style medicine. Primary care physicians are tired of working longer hours doing more "computer work" for declining pay. Trying to see more patients to make up this pay cut creates more stress and job dissatisfaction. This has created a shortage of primary care physicians just as the biggest transformation of our healthcare system rolls out with the Affordable Care Act. Millions of Americans are entering the insurance pool seeking care now faced with the difficult task of finding a physician who is accepting new patients.
Physician assistants and nurse practitioners are being called upon to help bridge that gap. Job satisfaction and career outlooks for midlevel practitioners have historically been very positive and optimistic. However, as the demand grows to see more patients and work longer hours, PAs and NPs are now starting to feel the same pressures their physician counterparts have been wrestling with for the past several years. Jackson Healthcare is one institution that surveys and tracks trends with midlevel practitioners. Their report "Advanced Practice Trends 2012-2013" states that "PAs and NPs are critical players in addressing and caring for the flood of additional medical consumers". Overall PAs and NPs are satisfied with their jobs, however half of those surveyed reported their patient load increased in the prior year (2012-2013) while their duties increased by 49%. Now that we are into the second year of the Affordable Care Act, job satisfaction scores are starting to decline reflecting these increased demands. Clearly, our system is broken and needs a dramatic change in approach.
Myself and other providers who have been in health care for over 30+ years have experienced and witnessed these changes first hand. The healthcare system I am part of today is vastly different from the one in 1980 when I graduated from PA school. One entered medicine then more as a calling than as a "career". I truly felt that being a PA was my life mission, the driving force that has kept me so committed to continue practicing over the past 10 frustrating years. Today, I find it sad to read how there are a growing number of physicians who discourage their children from going into medicine, and, if they had to do it all over again, they would not have gone into medicine themselves.
For those of you who are relatively new to the medical world, let me share how it "was" on a day to day basis. A big part of how changes can be made is knowing the history of the problem. In family practice, we were given 30 – 60 minute appointments with a focus more on educating patients about diet, exercise, and lifestyle changes. A short 15 minute visit would be for a wound check or to remove stitches. Education was always part of the visit. The PA profession was born out of the need to assist the physician in spending time educating their patients while the "busy physician" was focusing on more complicated duties such as time consuming procedures and complicated patients.
At that time, health insurance was reserved for covering major health expenses such as hospital costs - similar to fire insurance for our house today. People hoped they would never have to use their health insurance, but knew it was prudent to have "just in case". Most people did not use health insurance for the smaller costs like office visits, rather they would pay for their visits themselves. We had one to two front office staff and a nurse for the back. The front office would do everything including billing the few insurances (mainly Medicare, Medicaid and workman's comp) that were available at the time. Now most offices have a separate billing company or one person that just does billing in the office. We would make a few check marks on a one page billing form and write the diagnosis name at the bottom (no complicated codes). Billing for insurances was faxed in and payment was prompt. The ICD-9 codes were few in number and easy to remember.
Many patients left the office without a prescription, but with a plan of what they would change in their diet or lifestyle. There were a handful of medications we prescribed that were easily committed to memory. I thought the PDR then was large spanning a thickness of one inch. Today, most people use drug computer programs such as Epocrates Online rather than weight lifting the 4 inch thick 2 volume PDR book (left over PDRs have been relegated to serve as a laptop platform to obtain an ergonomic visual of the screen). Most of the medications we used are still in use today and found on the generics list of drug formularies. Very few medications from my early years had to be recalled. The physician and PA "hotlist" of providers with suspended licenses was not yet born.
Personal computers were just a twinkle in Steve Job's eye. The closest we came to a computer was the fancy EKG machine that was interpreted by a cardiologist over a phone transmission. Our patient notes were usually a one page hand written SOAP note that we used for our own use and were never seen by an insurance company or outside nonmedical party. My biggest stress was the self-imposed desire to be sure my patients were getting the very best health care I had to give. Time restraints, paper work demands, codes and typing were not part of my early years in medicine. My patients were like my family, getting to know them while following two and three generations in the family over time. It would be unthinkable that a patient would stop coming to see me because my name wasn't listed on a "preferred provider" list with an insurance company. Patients changing providers based on these lists are common occurrences today. How can anyone give the best care to someone they just met and talked to for ten hurried minutes?
Fast forward to the past ten years. The number one complaint I hear from my patients who see another provider or go to a walk-in clinic is feeling rushed through their appointment and not getting enough time with the provider. I heard this same complaint several years ago from my Mother who noted a sign posted on her doctor's waiting room wall limiting visits to one problem only. Due to this time squeeze, patients and providers are feeling rushed. When I refer a patient to a specialist, I ask them how the appointment went and what they recall was the outcome from their visit. Very often they will tell me "he didn't even examine or touch me ... he had one hand on the door knob most of the visit ..." With the demand of switching to electronic medical records, patients feel ignored as the provider is more focused on typing during the visit than listening. I had one patient insist that the specialist she saw had his back to her throughout the visit while he typed away on the laptop. Patients are also concerned about medication side effects as well as the costs they sometimes have to pay themselves. Patients are feeling more distrustful, depersonalized, and wary of the healthcare system.
From the healthcare provider's standpoint, dissatisfaction is rising rapidly from physicians, to midlevel practitioners and nurses. We have less time to spend with the patient while spending more time documenting that short visit especially for insurance companies (health and malpractice companies). At the same time, physician pay has declined. Physician satisfaction in medicine as a profession is rapidly dropping with the "Burn Out" rate rising. In 2012, a national survey was published in the Archives of Internal Medicine reported that US physicians suffer more burnout than other American workers. Emergency physicians top the list at 52%, critical care physicians (50%) then family practice physicians (43%). MedScape conducted their own study and found 45.8% of physicians were experiencing at least 1 symptom of burnout that included either loss of enthusiasm for work, feelings of cynicism, and/or a low sense of personal accomplishment.
The practice of "defensive medicine" is another area of provider stress that also adds to rising costs. I recall around 1990 that malpractice companies began giving their insurers information how to properly document visits and code properly to avoid a lawsuit. With the perception of a growing distrustful and litigation prone public, defensive medicine was born and unfortunately fear of a lawsuit began to alter a healthcare provider's behavior. As a result, more laboratory tests and imaging studies are ordered and defensive referrals are made. Over time, these defensive behaviors become the standard of care which adds unnecessarily to already rising health care costs.
These continually rising costs stem primarily from the health insurance, device and pharmaceutical industries. The pharmaceutical industry has become the front and center pillar of modern medicine. This industry has become a big business with an $85 billion dollar net profit in 2012. As of December 2013, the FDA website lists 1,453 drugs that have obtained FDA approval. A research report issued by the Commonwealth Fund in June 2010 shows in 1995 the United States per person cost of pharmaceuticals was $397, followed by Canada at $342 per person. Ten years later, the United States was spending $790 per person with Canada the next highest spending $599. This did not happen by accident. With big business comes sophisticated marketing plans. In 1997, the FDA lifted the ban on direct to consumer advertising. New Zealand and the United States are the only countries in the world that permit pharmaceutical companies to advertise on TV. It is difficult to find a channel devoid of ads that instruct patients to "ask their doctor to see if xyz drug is right for you".
At the same time, the industry expanded their marketing plans to physicians and midlevel practitioners. In addition to the regular weekly pharmaceutical rep visits to the office, invitations for educational dinners and events exploded. I recall, for a while, that I was enjoying very nice dinners two and three nights a week. There are many books and publications that discuss if this profit motive is ruining the American healthcare system. My bottom line is this: we have moved far away from the medical model I was practicing where time, relationships, diet, and lifestyle education were the central focus. Instead, our healthcare system focuses on seeing people quickly, giving a diagnosis, and choosing a drug to treat a symptom.
This system is clearly not sustainable from a humanitarian or economic standpoint. This "profits over people" driven system must and is already changing. The Commonwealth Fund, established in 1918 with the mission to "enhance the common good" is among a growing field of independent research groups that are identifying and trying to address the causes and solutions to our broken healthcare system. Changes at the national level will take an enormous amount of discussion, research, bipartisan politics, and time. Our patients and our own health can't wait. At a grassroots level, we as healthcare providers can start this change. In the following chapters I will share with you the paradigm shifts and simple approaches I have learned that can dramatically change one's health and begin to heal our broken system one patient at a time.
Key Points to Remember:
The United States healthcare system is the most expensive in the world but fails in performance compared to other industrialized nations.
Physician job dissatisfaction and "burnout" is at an all-time high. Physician assistant and nurse practitioner surveys indicate job duties increasing and job satisfaction scores are starting to decline.
Patients are worried about the future of traditional primary care and lack of time with their health care providers.
Practice of defensive medicine adds to provider stress, workload, and rising health care costs.
The U.S. spends the most per person for pharmaceuticals than any other country.
The United States and New Zealand are the only countries in the world to permit pharmaceutical advertising on television.
Our healthcare system has wandered far from how medicine was practiced 30+ years ago. The medical system today has become less personal and focused on time restraints, symptom treatment with pharmaceuticals, and cost control.
Our current system is not sustainable from a humanitarian or economic standpoint. This big business "profits over people" system must and is changing. This change can start with us as healthcare providers in taking back the charge of medicine.CHAPTER 2
Integrate Or Disintegrate
Seven Principles to Repairing the Roots of Healthcare
"If you always do what you've always done, you'll always get what you've always gotten." This adage has been quoted by some of the greatest successful people in history first credited to Henry Ford, then Mark Twain, Albert Einstein, and most recently by Tony Robbins.
If we want to change this broken healthcare system, we have to change the way we do things. We as healthcare providers can be the change and integrate a new approach now rather than be forced to make changes by outside influences and continue onward with this slowly disintegrating system.
"Never doubt that a small group of committed people can change the world; indeed it is the only thing that ever has." Margaret Mead, anthropologist
In addition to the changes already forced upon us, as this book is being written, the new ICD-10 codes are rolling out which will require even more time in documentation and delays in reimbursement. Fee for service reimbursement will be a thing of the past as the payment for performance models are embraced by insurers. We are on a runaway train, forced to run faster on the same tracks seeing more patients in less time while trying to use the same basic philosophy that we are doing something "for or to" the patient. It is possible to jump off this track onto a new train of thought that returns the roots of healthcare back to the patient and provider.
Excerpted from The Integrative Medicine Solution by Cathy Ochs. Copyright © 2015 Cathy Ochs PA-C. Excerpted by permission of AuthorHouse.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of Contents
ContentsAdvance Praise for The Integrative Medicine Solution, vii,
Chapter 1 Our Broken Healthcare System - How did we get here?, 1,
Chapter 2 Integrate Or Disintegrate - Seven Principles to Repairing the Roots of Healthcare, 8,
Chapter 3 Detoxification - The Missing Piece in the "Wellness" Model, 19,
Chapter 4 Restore Blood Flow - Nitric Oxide - The Miracle Molecule, 33,
Chapter 5 Digestive Support - "All Disease Begins In The Gut", 45,
Chapter 6 Remove Barriers and Correct Deficiencies - Beware of Putting the "Cart Before the Horse", 61,
Chapter 7 Restore Hormonal Function - Last But Definitely Not Least, 87,
Chapter 8 Putting It All Together, 118,
Chapter 9 Go Beyond Wellness - Return To Practicing Medicine As It Was Meant To Be, 143,
About The Author, 169,
Author Contact Information, 171,
About Diana Hoppe M.D., F.A.C.O.G., 173,