Wednesday, April 07, 2004

Back home

Back from the California Academy of Family Physician's Annual Symposium over the weekend. Met some new people, saw some people from the past. Some of them had heard of the "solo-solo" practice model, others had not but thought it was an interesting idea. Actually, Gordon Moore, father of the "solo-solo" model was there on Thursday night giving a presentation on this very topic. Unfortunately, I couldn't make it, as I was tending to a sick 5th grader at Outdoor Science School at the time. But I'd already heard most of what he talked about already, I think.

I learned some new things at the Symposium. One speaker, Dr. Michelle May, had an interesting concept regarding obesity treatment. Basically, our approach has been all wrong, and diets and exercise and drugs don't work (and she's right, they haven't). Her approach is to retrain people to recognize the physical signs of hunger and to only eat when they are hungry, and to stop when they are no longer hungry. She also teaches them to recognize the other reasons why they may be eating, and to learn to deal with these triggers in more productive ways. She has a website detailing her approach. I'm one of those naturally skinny people she talked about, who eats pretty much whatever I want without gaining weight. But I've noticed that it doesn't take a whole lot of food to fill me up, and I will in fact start to feel ill if I overeat. That is one of the cues that some overweight people have lost the ability to recognize, Dr. May argues.

My own take is that this approach would probably be very helpful to some people, but not everybody. Since overweight and obesity are multifactorial, it makes sense that one treatment would not fit all, and that different people will do better on individually tailored obesity treatments. I wonder if anyone has ever tried to categorize obese patients by type (eg. psychotrauma-related like child abuse/rape, stress-reducing, binge-type, carbohydrate-craving, familial, etc.)?

Another memorable speaker was Dr. Kenneth Moritsugu, assistant surgeon general, who spoke on behalf of organ donation. He related his own touching story about how he lost both his wife (in 1992) and daughter (in 1996) in separate car accidents, but donated their organs thereby giving life to over a dozen people in need of organs. He pointed out a website with more information, and how the Department of Health and Human Services will be making a push to publicize becoming an organ donor with green ribbon pins. He told us to expect them in the mail soon.

On the listserv, there has been some discussions about what our group of "neo-solo" physicians should call themselves, and how difficult it is to describe what we do. "Boutique" or "concierge medicine" has a name for their concept of high-quality, extra-service medical care that comes with an extra retainer fee. As far as I'm concerned, I do most of what concierge medicine physicians do, but without the extra cost (and expense).

Some names that have been suggested for our concept of a low overhead, barrier-free, highly personal medical practice has been called solo-solo (referring to a doctor with no staff/employees), minimalist, cutting-edge, neotraditionalist. But the best suggestion I've heard so far is that of "Personal Medicine". Same day appointments, no waiting, extended length office visits, house calls, email and cellphone access to me at any time of day. Personal medicine. It fits.

However, I don't offer "vigil service" like these personal physicians. But then again, I don't charge $400 an hour either.