Transition from allopathic to integrated practice


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This lecture was the fifth and concluding lecture for Dr. Cady at the IMMH Conference in Santa Fe, NM. In it, he discusses crossing the divide separating us - with our new knowledge and ideas - from the opportunity and privilege of offering it to our patients.

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  • Beneficiaries going up; workers going down to support them.
  • First thing politicians have to do is serve their constiuents – to “maintain the current perceived benefit of the structure.” Next priority is taxes – “You will protect your constituency.” Republicans want tax cuts for everybody. Democrats – protecting their constituency. “Tax the rich” Both see the same problems. Their solution is different. Next, doctors will fight with the hospitals and organizations for reimbursements.
  • This represents a disconnect between the AMA and physicians.
  • In the 1960 ’s and 1970’s – when it was known that someone’s child was becoming a doctor, it was viewed as a great accomplishment.
  • Transition from allopathic to integrated practice

    1. 1. How to Transition from Traditional AllopathicPractice to a Holistic and Integrated Medical Model Louis B. Cady, MD – CEO & Founder – Cady Wellness Institute Adjunct Professor – University of Southern Indiana Adjunct Clinical Lecturer – Indiana University School of Medicine Department of Psychiatry Child, Adolescent, Adult & Forensic Psychiatry – Evansville, Indiana This presentation is © Louis B. Cady M.D. and may not be reproduced or used without permission.
    2. 2. 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.
    3. 3. Background
    4. 4. “Wellness Traditional Optimal Health [integrated] No Disease = Health Medicine Medicine” Forestall and Diagnose and PREVENT Disease – Treat DiseaseDeath Optimize Function New Drugs Hormone New Surgical Modulation Techniques Diet, Exercise Nutritional Supplementation
    5. 5. Health is a state of completephysical, mental and socialwell-being, and not merelythe absence of disease orinfirmity.- World Health Organization
    6. 6. American Journal of Health Promotion; November/December, 2002 66% 19% of those 18.8% “Incompletely healthy” surveyed completely were unhealthy, completely defined as healthy with having low high levels of levels of health both physical with high Two-thirds of the adults and mental levels of reported some health and a illness. degree of mental low level of or physical illness that kept them illness. from being completely healthy. “Incompletely healthy.”DEAD HEALTH continuum O
    7. 7. The “Survival Curve” – Where Are You?
    8. 8. 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….
    9. 9. 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)
    10. 10. May 2002: 9th Annual IFM Conference
    11. 11. The Functional Medicine component Dead Doctors Don’t Lie - Joel Wallach, DVM, ND
    12. 12. Current socioeconomic state andallopathic (“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)
    13. 13. Medicare–Workers per Beneficiary Millions YearSOURCE: Kaiser Family Foundation based on the 2009 Annual Report of the Boards of Trustees of the Federal Hospital Insuranceand Federal Supplementary Medical Insurance Trust Funds. Accessed April 3, 2010. Slide courtesy of John Adams, MBA – CEO, Cenegenics
    14. 14. 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 Accessed April 3, 2010. Slide courtesy of John Adams, MBA – CEO, Cenegenics
    15. 15. SOURCE: Mary Meeker, Partner – Kleiner, Perkins Caulfield & Byers –“Internet Trends” Slide deck – D10 conference, released 5/31/2012
    16. 16. SOURCE: Mary Meeker, Partner – Kleiner, Perkins Caulfield & Byers –“Internet Trends” Slide deck – D10 conference, released 5/31/2012
    17. 17. Healthcare Reform–Physicians Perception of Medicine Over the Next Few Years Accessed April 3, 2010. Slide courtesy of John Adams, MBA – CEO, Cenegenics
    18. 18. Are the Best and Brightest Staying in Medicine? “60% of physicians would not recommend medicine as a career to their children.” • – The Physicians’ content/uploads/2009/05/merritt-hawkins-survey.pdf. Accessed April 3, 2010. Foundation Slide courtesy of John Adams, MBA – CEO, Cenegenics
    19. 19. Note: new slide
    20. 20. Is there hope for medicine?
    21. 21. “The Great Crossover” – the microchipcf: Dan Sullivan
    22. 22. Accessed 1 21 2012
    23. 23. A change from the allopathicmodel?
    24. 24. Socioeconomic/disruptive forces with two models Allopathic Wellness/ fxnl med• Disease and CHANGE AGENTS • Integrated and whole sickness focused person model• Short appointments • Microchip/intern • Bill for time• Commoditized et • Non-commoditized• Compartmentalized • Increase in • Collaborative• Doctor as priest chronic disease • Informed patients• Uninformed patient • “boomers” willing to “pay for• Sicker patients • Job/socio- expertise”• Either practice economic • Practice per peer- ignorantly or with reviewed literature; pressures No crises (pl) of guilty conscience• Worry/poor conscience satisfaction • INTENSE satisfaction
    25. 25. Divergence of focus of two models Wellness/ fxnl med;Allopathic “complementary/alternative”• Relief of symptoms • CAUSE of symptoms, prevention• Organ specific • SYSTEMS focused• Aggressive. “magic bullet” • Gentle, methodical.• Rules, practice guidelines • Creative. What works?• Patient as uninformed • Patient as integral part of team. protoplasm. Questions/participation encouraged.• Tied to medico-pharmaco- • Focused on health and optimization industrial complex with natural, bio-identical methods• Use of synthetic, patented, • Use of PROVEN botanicals and not-from-nature substances 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 accessed 1 21 2012
    26. 26. Some interesting thoughts:• “The war situation has developed not necessarily to Japan’s advantage..”- Japanese Emperor Hirohito after the atomic bombing of Hiroshima and Nagasaki, announcing Japan’s surrender to the Allies• “A naïve analysis of stability is derived from the absence of past variations” (or “The Turkey Problem”) – Nicholas Taleb, author of The Black Swan
    27. 27. What does integrated, holistic medicine “look like?” A quick dip in the literature
    28. 28. % U.S. Women with inadequate quantities of nutrientsArab L, Carriquiry A, Steck-Scott S, Gaudet MM. Ethnic differences in thenutrient intake adequacy of premenopausal US women: results from the ThirdNational Health Examination Survey. J Am Diet Assoc 2003; 103:1008-14.
    29. 29. = 2 apples (fruits) & 3 - 4 vegetables– per CDC
    30. 30. 4 – 13 servings of fruits andvegetables per day, depending onenergy needs
    31. 31. Cf:
    32. 32. % Mineral depletion from the soilduring the past 100 years, by continent North America 85% South America 76% Asia 76% Africa 74% Europe 72% Australia 55% Source: UN Earth Summit Report 1992
    33. 33. If we know all of this stuff…. Why don’t we DO anything about it (with our careers, or practices, and our patients lives)?
    34. 34. 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. (Alcoa story)
    35. 35. Beating the FUDD Factor ™• F ear• U ncertainty• D oubt• D ESPAIR: – 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.
    36. 36. 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
    37. 37. 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. (Chris Lord example).• Give CME talks and paper over their objecting mouths with references.• Spiritual and ethical clarity.
    38. 38. “You can have everything in life you want, if you just help enough other people get what they want.” - Zig ZiglarWhat do patients want?•To be treated withrespect•To not have to wait!•To FEEL BETTER•To HAVE HOPE.•To not be doped up.•To NOT have theirmoney wasted.
    39. 39. $5,000 worth of wisdom on one page – from Jay Abraham• Risk reversal• “USP” – unique selling Focus: “Be able to proposition treat your clients• Defining the buying (or patients) as criteria dear and valued• Three ways for more friends.” profit: - Jay Abraham – Higher price – More frequency – Additional items (supplements, etc.)
    40. 40. Jay Abraham References (recommended)
    41. 41. Evansville Courier & Press: May 29, 2006References: ;;Dr. Oz show on YouTube:
    42. 42. My position on supplements• “The needs of the patient come first.” – W Mayo• Unique and/or patented. (Otherwise GNC is fine).• Guaranteed (risk reversal).• Measurable changes (functional testing good!)• Be a doctor and not a stock boy/girl or inventory clerk.
    43. 43. 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.
    44. 44. Be Awesome!NEW reference. Grab it.
    45. 45. MARKETING – what has and hasn’t workedWorked Hasn’t worked• Word of mouth • Paid advertising (TV,• Public seminars print, magazines)• Web site• • What I HAVEN’T tried: Going to MD’s/DO’s – Marketing consultants offices PERSONALLY – Radio ads• Free stuff – PR opportunities New initiatives:• Going to places and •Proprietary, paid websites NETWORKING •“SEO” – search engine optimization (Willie Sutton principle)
    46. 46. Additional resources – handouts available at end of lecture• “The 10 Commandments of Marketing a Medical Practice” – Cady (handout, free)
    47. 47. From Chet Holmes - Grow Your Business 10X web presentation
    48. 48. Try our app (also “mobile optimized”) Office: 812-429-0772 E-mail: 4727 Rosebud Lane – Suite F Interstate Office Park Newburgh, IN 47630 (USA) Download fromiTunes or Android App store now!
    49. 49. A personal close:How do YOU want to age?
    50. 50. 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.
    51. 51. "If you have knowledge, let otherslight their candles in it."- Margaret Fuller (May 23, 1810 - July 19, 1850)(American journalist, critic, andwomen’s rights advocate.)I wish you allthe best!Good luck!
    52. 52. Contact information: Louis B. Cady, M.D. Office: 812-429-0772 E-mail: 4727 Rosebud Lane – Suite F Interstate Office Park Newburgh, IN 47630 (USA) Download fromiTunes or Android App store now!