OUR PHILOSOPHY

Why do we do what we do, the way we do it?  

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I was trained as a physician in the conventional medicine model on which the American healthcare industry is based.  It is the family trade.  My father was a pediatrician and my mother was a NICU nurse.  I began my career as a medical assistant with an Indian Health Services clinic and since completing my training have practiced in a variety of settings.  I served in the military where I cared for military members and veterans.  I have been in rural settings where I was the only OBGYN for 100 miles in any direction.  And I have worked as a OB hospitalist at a busy regional care center where I dealt with highly complex cases. I’ve experienced first hand the variety of ways in which conventional healthcare is delivered in this country and I assumed that was just how it was done.  Sure, I had heard whispers of a more holistic approach, but dismissed it out of ignorance.  I am board certified after all.  I read the journals.  I search Pub Med.  It’s also not what my patients want.  They want to walk in with a complaint and walk out with a prescription.  They want me to schedule the surgery that will make all their problems go away.  

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Or so I thought.  What broke me from that spell was a little book called “Good Energy” by Dr. Casey Means, a Stanford trained Ear, Nose, and Throat Surgeon who abandoned her conventional career to pursue functional medicine and who has since become one of its most well known advocates.  If anything, the book was the crack in the dam that was holding me back from a different approach to medicine.  I came away from the book thinking that maybe I was wrong.  Maybe patients do really want to take control of their health and are willing to make the effort, but we as physicians are failing them by not giving them the tools to do so.  It's easier for everyone involved, including the physician, to write that prescription or send her down the hall to the surgery scheduler.  It takes two to tango and I was ignoring my part in the equation entirely.  I had to take responsibility for my own role in this dysfunctional health relationship.  

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So I began training with the Institute of Functional Medicine and learned about a different approach to medicine.  I learned of these success stories that were fantastical, too good to be true, works of fiction.  I couldn't really be this effective, could it?  So I began to incorporate it into my practice.  Fortunately, I was in a rural setting where my patient load and supportive administration afforded me the opportunity to take more time with a handful of patients.  What resulted was nothing short of transformative.  One of the first patients I took this approach with was a woman in her fifties who was struggling with obesity, referred to me for menopausal symptoms that her primary care doctor was not comfortable managing due to her thromboembolism risk.  In addressing this, we also had a lengthy conversation about what her weight meant for her health.  We did extensive labs to show her that although her Hemoglobin A1C was normal, her fasting insulin was markedly elevated indicating that type 2 Diabetes was all but inevitable.  We discussed how this related to cardiovascular risk.  And we tied it all back together by coming around to its relevance to the reason why she was referred to me in the first place: menopausal symptoms.  Then we developed a plan to tackle her health in its entirety, not just playing whack-a-mole with her individual symptoms.  She had tried numerous diets in the past, so we explored what barriers she encountered which led to her being unsuccessful with those attempts.  We addressed activity levels and brainstormed different ways of incorporating activity taking into account her various limitations.  We started the Cardiometabolic Diet and tailored it to her caloric requirements.  We developed a plan for blood glucose monitoring to help her understand her body’s response to the foods she was eating.  We had frequent check-ins to monitor progress.

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Two months later, we had our check in.  She had lost 30 pounds.  She had tears in her eyes as she explained to me that no doctor had ever taken the time that I had to really explore her health with her.  She told me it was the best experience she ever had in her long life of frequent interactions with the medical industry.  I saw first hand a patient discover the power she had over her own health and it was as if I could see the future change before my eyes.  Insulin pens and chronic pain replaced by energy and vitality.  We had done more in those few visits than a decade of Ozempic or Metformin prescriptions could have ever done.  I was hooked.  This is what I imagined being a doctor was like when I showed up that first day of med school, only for it to be drained out of me drop by drop through the ceaseless grind of an industry that was not only shaped by patient interests, but administrative and corporate interests as well.  More patients, shorter visits, more procedures, more mid-level providers, more insurance premiums, more denials… more, more, more!  All while providing less care, having less time with patients, having less good outcomes, with less reimbursement… less, less, less!

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The system is broken.  The system doesn’t work for patients or providers.  So what did Gandhi say?  Be the change you want to see in the world. By participating in this system, we are complicit.  Our solution: to no longer be complicit, we must exit the system.  That’s why we have structured the practice the way we have.  We don’t want to be beholden to insurance companies.  We want to do what we believe is right for the patient, not what will just get reimbursed.  We want to spend our time nurturing health, not playing whack-a-mole with illnesses as they pop up.  We want to repair a foundation of health for our patients in a world where every single thing seems to be an attack on that very foundation.  It is an act of resistance against a damaged system.  It is an act of rebellion against the forces, intentional or otherwise, that seek to keep us sick.  Because when we are sick, we are dependent.  When we are dependent, we can be controlled.  

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We have named our clinic Little Medicine Ranch with this philosophy in mind.  Ranch, because the freedom of the West reflects the freedom we can achieve when we take control of our health in our own hands.  And Little Medicine, because although we recognize the importance of medication and will utilize them in the appropriate circumstances, we explore all non-medication interventions first.  Welcome to Little Medicine Ranch.