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Integrating Wellness Into A Primary Care Practice

I often am asked how I incorporate wellness in our family medical practice, and I must admit that I’ve mixed feelings when it comes to the question because it implies that I’m not already trying to practice wellness simply by practicing medicine. I feel that the two are synonymous.

To those who want to know more about wellness and primary care, here’s my approach:

• I never try to sell anyone on a “wellness” program.
• I follow specific guidelines on certain chronic illnesses, mostly adhering to evidence-based guidelines and not expert opinion or opinion by committee.
• I offer the best advice I can to patients and try to guide them in the right direction when I feel they are taking pathways that worry me and that could be harmful (e.g. like using megavitamin and nutrient therapies or colonics, to name a few). 
• I try to be as cost effective as possible when it comes to treatment.
• I see our patients once a year to comply with the legal definition of “face-to-face visits,” but not because scientific evidence substantiates this time honored ritual as “wellness.”
• I use calendar reminders in our electronic health record, MD-HQ to set up needed labs like cholesterol or Hgba1C or to schedule flu shots based on guidelines.

A few times a year I’ll use the data mining capacity of the MD-HQ system to write letters to people on relevant questions like:

• I see that you’re over 50 and there’s no evidence that you’ve had a colonoscopy. If have not, then this means you should and here is why…
• Our records show that it’s been two years since your last mammogram. If you haven’t had one in that time you should and here is why…
• PAP smears in women over 25 years of age with three consecutive normal PAP smears and who have a single, long-term partner means you don’t need to get a PAP smear for three years and here is why.
• Avandia really is in trouble and our records show you might be too since you may still be using it; please call …
• Zetia and Vytorin make your cholesterol look awesome, but guess what, we just found out through studies that the medicine doesn’t save anyone’s life so it’s expensive, probably useless, and even has side effects. We need to talk…

I encourage my patients to get exercise, maintain a proper weight, stop smoking, sleep eight hours a day, monitor their BP regularly at home, take charge of their health decisions, and try to steer them away from magical belief systems, including some that are promoted by the medical industrial complex (like bioidentical hormones, human growth hormone, or botox). I try to be a cheerleader, hopefully not judgmental, since I see my story in my patients’ journey too, and know that I too can be mislead, scammed or lead to water but often lack the persistent daily discipline required to drink or to drink just the right amount.

If a patient wants a lot of extra “wellness” and I don’t have evidence to the contrary, then I lean forward and listen. After all, he or she is my boss.

That’s how I incorporate wellness into my practice, with the simple tenet that the patient is at the center of medicine and wellness both. Isn’t that what’s at the heart of it all?

It’s time for some exercise, so I better get to it and hope you will, too.

Until next week, I remain yours in primary care,

Alan Dappen, M.D.

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