Trust Me, I’m Your Doctor
We all hear about health care. Usually it’s through the microcosm of someone’s illness, or the macro-view of dueling pundits and politicians. Frequently it’s adversarial, or negative.
Thanks to long-time Trust Matters’ own trusted advisor Shaula Evans, I met Dr. Craig Koniver. He brings a fascinating perspective to the topic, as you’ll see.
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Charlie Green: Craig, you’re a doctor in South Carolina. Are you a native?
Craig Koniver: No. I grew up in Delaware, went to one year of undergrad at Johns Hopkins, hated it, and transferred to Brown. I then went on to medical school at Jefferson Medical College in Philadelphia. So I did end up being a doctor, mostly in Arizona, and recently moved here.
Charlie: You say you practice “organic medicine.” How did you come to that?
Craig: First of all, I am a “regular” doctor, board-certified and all that, but I also came to believe in a certain approach to medicine. The transformative event in my life was when our daughter was colicky.
The pediatrician said what I’d been trained to say, but since it was our daughter this time, we were wholly unsatisfied. We went out and found unconventional approaches to the issue. And once you’ve seen behind the curtain, it’s hard to stop.
Charlie: What is behind the curtain?
Craig: The standard routine is label, diagnose, prescribe medicine or surgery. Repeat, repeat, repeat. The paradigm of modern medicine is medicine-based, which is to say, pharmaceutical – pills and chemicals.
100 years ago this was not the case; the doctor had a relationship with the patient. But today, the doctor is trained to see the patient as a series of chemical pathologies.
Charlie: So, on a practical level, what do you do differently than other doctors?
Craig: I am interested in helping the patient reach optimal health through natural means. I am not against prescription medicine, but I think they are highly over-utilized by doctors not interested in pursuing alternative/ natural modalities.
So with my patients we look for the root cause of disease by running specialty lab tests and then use herbs and vitamins and nutrients to get their health back on track. I am a firm believer that there is a natural option for everything–we just have to look in the right place and be willing to try any different options.
Charlie: What’s the effect on patient health?
Craig: One telling study suggested that as many as 1/3 of prescriptions get tossed away on the patient’s way out of the doctor’s building. They want more than a prescription, they want a relationship and they want options.
Charlie: What did you do as this became apparent to you?
Craig: I finally decided to move to a holistic practice. That entailed moving away from insurance, and cutting my patient load from about 4,000 to about 400.
Charlie: Wow. Now, hang on a minute; that raises all kinds of interesting issues. What does that say for coverage?
Craig: It affects many people differently. First, there are a large number of people who are quite willing to pay for personalized, holistic healthcare. It is quite valuable to them!
In addition, remember that existing health insurance policies don’t generally cover doctors suggesting things like exercise and nutritional changes; as well, procedures like bypass surgery are reimbursed while time-tested acupuncture is not.
And I now get to spend real, quality time with my patients. I take as much time as I want and they want, and they leave satisfied feeling that I’m concerned about their whole life. Which I am! A lot of people find this hugely valuable.
Charlie: What about those who can’t afford it?
Craig: Before we get there, there are number of people who may or may not be able to afford it, but don’t see the value in it. They’re used to thinking that a doctor visit should cost the amount of a co-pay. They can’t get past a more cost-based model.
Are there those who are left out by this? Absolutely there are and it’s a real tragedy because they continue to get the acute-based, chemical-and-surgery, impersonal kind of medicine that doesn’t help them.
Charlie: Ah, interesting. You’re not a selfish doc going off to serve well-heeled patients, there really is no choice.
Craig: That’s true. I’m not abandoning poor people, I’m abandoning bad medicine. And the existing insurance system simply cannot support the kind of medicine I like to practice. Is it tragic? Yes, and a real shame.
You pretty much cannot have a holistic medicine practice that operates within the existing high-volume insurance-based delivery method we have today. The choice is not which clientele to go after – it’s which kind of medicine I want to practice.
Charlie: Does the patient-physician relationship of trust affect health?
Craig: Yes. Again, if the relationship is pill-based, then it’s not personal; that is not a good basis for trust. Before too long, patients will stop trusting a physician because there is only that basis for the relationship.
In a holistic practice, where by definition the doctor is concerned about the whole patient, you have the basis for a personal relationship. That means you have the basis for trust. And with trust, patients share more with you, they take your advice, and there is probably even the positive placebo effect.
Charlie: One implication of what you’re saying is that our existing approach, based on insurance reimbursement of pills and surgery, is basically built to minimize trust.
Craig: Yes, I think that’s an accurate statement of the current situation. The health care delivery system is tied to the doctor-patient trust level. And not in a good way just now.
Charlie: Well, this has been enlightening indeed; thanks so much for spending time with us.
Craig: Thank you, Charlie.
Charlie
This is a fascinating post. It is a great starting point for a discussion of trust in the health care system. However, there are a lot of questions this raises in my mind.
When he says 400 patients is that families or individuals?
At first glance, one would think that that much more involvement with a
patient makes him much more successful at preventative medicine, but
does his attention lead to lower levels of hospitalization or less
expensive treatment when his patients are ill?
What are the economic implications, both for the practice and the system (e.g the rest of us.). Simply by avoiding the administration of billing insurance companies, he can keep his overhead much lower, although I expect he still needs malpractice insurance, and his insurer probably wants extensive record keeping. But with fewer patients, that would be less burdensome as well. So how does this play out? How doe his charges compare to those of a physician under the standard model. Could this treatment paradigm, combined with the old style major medical policy be more cost effective?
Would this doctor be able to practice this way under a single payer
system? Will he be able to under the Affordable Care Act? How many
more doctors would we need than we currently have if most primary care
physicians worked this way?
I would love to see you follow this further.
Great questions Franklin! I will let the good doctor reply.
I will get a more detailed reply to you when I get back home, but for now, yes, there are many economical advantages for both patient and doctor.
This will not be a practical option for many doctors and patients who are unwilling to think outside the box and outside the traditional arena of health insurance care.
But for the growing number of us who do embrace the holistic/integrative style of medicine, health takes on new meaning filled with possibility and hope as opposed to negativity and doom.
My patients embrace their health and as a result are proactive about pursuing health for themselves. This does translate to lower disease rates and lower savings spent on health care.
Thanks for all of your questions, I will get back to you in a day or two with more detailed response….
Charlie:
I suspect that the answer to most of our economic and other concerns around health care are captured in this interview, if we just know how to put this thinking to work.
And please note, conventional medicine has literally saved my life through surgery.chemo and RXs, so I am all for it in the right circumstances!
I too am a beneficiary of ambidextrous docs. Yay for a full quiver of solutions
Charlie, thank you for searching out and interviewing Craig. To Craig I thank you for directing your lack of fulfillment with the mainstream to a positive and constructive practice. The matter of healthcare is not designed to be legislated, nor prescribed by deep pockets. The very idea of holistic defines the person; that we should be treated as a “whole person” is something that the ‘system’ will accept in time. For now, whether you are a patient, practitioner or insurer I hope more folks like you will step forward and enlighten the rest.
Thanks for your comments!
I do think that both patients are physicians are yearning for more meaning out of health and medicine.
I agree it will take time, but the more that word spreads about this practice style, the more momentum will build for holistic types of practices to be more popular and commonplace.
Great post. I practice Traditional Chinese Medicine. It is very holistic in nature. It just help people regain their health rather than swallowing pills forever. Charlie’s book has helped me tremendously. Because Chinese medicine is perceived as “less scientific” by most people, there are usually very little trust to start with. The book has really helped me see from the patients’ perspective.
Charlie and Dr. Koniver thank you for a great post. And as
mentioned by Sandy, there is a lot in here that could help us with the challenges
our country is facing right now with respect to healthcare.
Dr. K you identified early, the disincentives baked into the
system to provide good health. They system is biased to provide treatment, (not
mutually exclusive but not the same thing) as opposed to health by following
lifestyle recommendations and so on. The cost of smoking is a great example. We
have known for decades that smoking is bad and leads to increased consumption
of healthcare resources down the road. And yet many Dr.’s to this day won’t counsel
patients for 1) fear of driving away a patient and 2) it’s not a reimbursable
event under the current system.
I was at a conference recently where the CFOs were speaking
of population management. Education is key, but the one making money in the
model said it is more than that it is the physician provider relationship. If
the patient trusts the physician they will follow the advice.
Thanks again,