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Episode 53: Dr. Omar Akhter (He/Him) of Madina Medicine - Austin, TX

DPC Doctor



Dr. Omar Akhter owns Madina Medicine in Austin, TX
Dr. Omar Akhter

Dr. Omar Akhter grew up in Pakistan and had exposures to medicine at an early age as he was born into a family of physicians. He followed the same path as the other physicians in his family and graduated from Aga Khan Medical School in Pakistan before going on to complete residency in Internal Medicine in New York City at Presbyterian Queens. He has been board-certified in Internal medicine since 2017.


He practiced hospital medicine for a few years in a large hospital system in New Jersey before eventually settling in Austin, Texas with his wife and children. Working in that system made it clear to him that he wanted to work with patients in a more meaningful and holistic way. That is why when he moved to Austin, he started a Direct Primary Care practice. He opened Madina Medicine in Jan 2020.

In toady's episode, Dr. Akter shares his passion for functional medicine and how he is able to bring his expertise to the community of Austin, TX. Hear how he transitioned from his medical training in Pakistan to New York and how this transition opened his eyes to his love for primary care and preventative medicine!


Get Out & Stay Out: starting a cash based medical practice - a presentation by AAPS President Juliette Madrigal-Dersch, MD at AAPS Feb 1, 2013 meeting in Austin, TX




Resources Recommended by Dr. Akter:


- Loom (video recording platform for video messaging)


PODCASTS:

- Doctors Pharmacy by Dr. Mark Hyman

- Dr. Ruscio Radio by Dr. Michael Ruscio

- The Drive by Dr. Peter Attia

- Solving the Puzzle by Dr. Datis Kharrazian


BOOKS:

- Food Fix by Dr. Mark Hyman

- Why Do I Still Have Thyroid Symptoms by Dr. Datis Kharrazian



CONTACT:

phone: (512) 601-8952

fax: (512) 382-7270

info@madinamedicine.com



TRANSCRIPT*

Welcome to the podcast, Dr. Akhter thanks for having me. I'm excited to speak. I think the Texans are really dominating the podcasts because, we have people from Wichita falls and Burford nuts and Houston and Austin, and this has been fantastic.


So I'm really excited to speak with yet. Another Texan in terms of you guys are really proving that DPC can thrive in a large state and in large communities. Yeah, definitely. And in Austin, there's quite a few of them and, it's so great to see how they help each other out, despite being literally in the same town.


And for those who aren't aware, what is the population size of Austin and its suburbs? Austin is about 2 million people, roughly. And ever-growing now I want to start, with your roots because as was mentioned in your bio and your credentials. You are originally from Pakistan. And I wanted to ask how is the medical system there in Pakistan compared to the U S So the medical system is quite different there.


The primary way is that you really have you go into medical school after high school. So essentially after 13 years of schooling, you go directly into a five-year medical program. So there's no real undergrad the way that they have here. So people are really making the decision to go into medicine at the age of about 18 or 19.


And then that's when they get into medical school. So it's very different in that way. Versus people here who are generally starting medical school later in life and they're much older. And then the other thing is that, we're still dealing with a lot of third world illnesses and diseases in Pakistan.


And so you're going to get a whole different way of practicing with much fewer resources. So the clinician over there really has to be a very astute clinician in terms of diagnosing and treating because you really don't have all the resources you have available here. And I think that it makes for great clinicians because you have to often diagnose pneumonias and abdominal issues without the luxury of imaging and a whole lot of blood tests.


I think that the emphasis on making it an accurate clinical diagnosis and using affordable medicine is definitely huge there. And then obviously we're dealing with different illnesses in general.


When you were in your training, having gone from high school to medical school, basically how was that emotionally for you? Because like you're saying you're younger when you go into medicine versus having, the four or five plus whatever years a person takes to go to undergrad.


How was that emotionally when you were seeing things like. Death and severe illness, especially how you described, you're dealing with serious medical illness, serious medical diagnoses with limited resources. Yeah. It's very, eye-opening for someone who's literally finishing their teenage years and then going into this type of environment especially the ER and those types of places, which are very different from the way they are here because of the nature of where you are.


In that sense, it's very different. I think, emotionally you get into the role of the physician after you get into medical school. I think here because of how difficult it is to get into medical school and all the prerequisites you have to do before.


The people who get into medical school are the ones that are generally very determined to go down this path. Whereas sometimes in, in medical school, over there, you end up, you enroll them there, you get in there. And sometimes then you're lost and it takes some time to grow into that role.


Just given the age you are and stuff. So I find that it's something that, you get into medical school first and then you soon realize what that means, what your role is and stuff. Very different. And for you, what did that journey look like before you made your transition to the states?


Just going back to my family, I think it'll make a lot of sense. So both my parents are physicians and my father has three sisters. My aunts were all, three of them are physicians and all three married physicians. So growing up really medicine is just what I saw, what I knew I was the eldest child.


And I really didn't have any exposure to anything else. And so when it came time to that age of 17, 18 I really, felt very acutely that medicine was my destiny and and I excelled at the sciences required for it. And so I entered medical school in that way. And, I think the transition was tough in some ways, because in, in some ways I didn't feel like it was my own decision.


If you know what I'm saying it was like, it's your destiny and you felt that it wasn't, it was a choice. But it was sometimes it felt like it was made for you, and so it took me a while to grow into that. And just realize how I can still carve my way in doing it the way that I want to despite having all a family that was very involved in medicine,


did you have any particular experiences that, made you realize?


Wow, this is not just my destiny, this is my calling as well. Yes. I had a number of experiences throughout medical school, it's hard to pinpoint necessarily which I think there were different feelings that you get at different times. And I think that it was.


No, it was a gradual process. It wasn't that overnight type of thing that, this is my calling. It was that gradual learning the medical system and learning myself more and more, and then getting to that point eventually. And I don't think that point came until I got late into residency, to be honest with you.


Cause you know, you go through the motions a little bit and you go through medical school, then you go to your residency and sometimes it feels like you're just doing the next step, which you're meant to do. And it may not be your calling. So that kind of came later in my career.


I, I feel and the other thing to know in Pakistan is that there's a heavy emphasis on specialty care. If you think about a primary care physician over there, you're essentially thinking about the person who is really treating poor people with lack of resources. And so they get that little clinic in the side of the hospital.


Not as fancy as the specialists, the cardiologists and the surgeons and all of them yet. And so it gears your mind towards understanding that if I wanted to Excel in the chain of the hierarchy of medicine, then becoming a specialist, a board certified specialist is a prerequisite to that.


And so that always was in the back of my mind. It's not it wasn't like, am I going to specialize? It was like, what am I going to specialize in? And it was only later in my journey that I realized that I wanted to remain general, remain holistic and then not specialize. And that really was very strange.


When you talk about being in general practitioner, you know, I I just light up because I'm like, yes, family medicine You are an internal medicine doctor. So what was your transition like from Pakistan to an, a residency program in the states? And I asked a specifically, because if there is a foreign grad who is listening or somebody who is applying from a foreign medical school, I would love for you to share that part of your journey specifically for those people and all the other listeners as well.


Yeah. So medical school there, as I imagine it is here is fiercely competitive. And especially in the school that I went to, which is considered the best one over there. It, you start at an early time , in your in your schooling, starting to study for USM LEDs, and it's very different.


Then cause here U S Emilys are considered your final exam for your second year and your fourth. Over there. Us, Emily is a choice. And sometimes for people it's a privilege because the idea that you're going to be going to the U S after medical school is not necessarily something everyone can do because of DCIS status because of affordability and those types of things.


So automatically it becomes like that's the the goal to achieve almost, so you have a lot of competition, you have a lot of people wanting to do like they Excel and do better than others. And there was a little bit of peer pressure, I think, to to get into a good residency program here in the U S and that really you know, you kind of made it if you did that as a graduate from there.


And I think that while it's a great thing. And I did that myself. I think that. Foreign grads should also realize that not everyone needs to leave their country of origin and go to the us and there's such a high need for because over there's such a brain drain where you have the brightest minds that are, physicians and others that are leaving the country for looking for other places.


And so there is that need for physicians to stay there. So I think that if I could tell a medical student right now, like in their fourth or fifth year it's like just try to carve out your own journey and not necessarily get sucked into that peer pressure of, I have to do things a certain way.


Cause I kept doing that. Throughout my entire career that, oh, this is what I have to do. I have to go into residency. I have to go into fellowship. I have to do, so it was just that pressure that kind of kept me going. But when I finally broke away from it, that's when I felt that liberation of, I don't really need to do this.


I can just carve my own weight in a way that I feel comfortable. So that's really my advice that I try to give, not only to foreign grads, but to grads here, that just try to carve your own path question, the things that you learn in medical school, because you're not necessarily learning, everything in the right way.


You're learning a model of care, just like we do DPC. We, we consider rebels in the society. And and that's. You're just taught one way, whether it's a way of practice or whether it's a way of the way medicine is just one model. And so I think that's what I, and I wish someone could teach me that at that time, but you learn in your own journey.


And so I tried to tell all medical students and pre-med students right now that just be aware that there's more out there than, you may be exposed to. Yeah it's so true. And I'm really glad that for all the reasons that the number of people who are choosing to do DPC out of residency is just amazing.


With you sharing what you did, that you never know, somebody will listen to this podcast, the week it comes out or two years from now, and that your words will sit in their mind to mull over and potentially impact their journey. One of the things that is present on your website in terms of your, why was the fact that you. Saw in New York and New Jersey, the type of medicine that you did not want to practice. So can you flush that out for us and share what happened in those states where you saw the medicine that you did not want to practice?


When I was going through medical school, there was this real sense of your helping people and the community. Especially those folks that can't really afford care and that really poor. And you may do something to save their lives or, better their lives, something like that, that I could do everyday in Pakistan.


You really can, whether it's medical related or otherwise. When I got to the U S I felt that lack of authenticity in the hospital system where the system does not allow you to have that kind of. That pure physician humanity that we all start off with because of just various things related to documentation and EMR and systems and, metrics and all of those things.


It just devoids that physician of that pure reason that they got into this field. And so as I started here I, it w it was a lot of hard work, a lot of hours, just a lot of the grind, but with very little, or that feeling that I used to get back home that in which I really felt that I was helping someone making impact in lives.


And at some point it just felt like I was going through the motions. And so there were multiple times during my residency, admittedly, that I did not want to do medicine anymore. Because you put all that effort into it and you really don't feel that, that satisfaction at the end of it. And that was really a, a point of reflection for me. And that's, I think definitely an impacted what I wanted to do later. And after residency, you chose a very different locale for your practice. So how did you go from where you practiced in the east coast to moving to Austin?


So I first I moved from New York to New Jersey after my residency. And it was following my wife because she was doing her psychiatry residency in New Jersey. And so I was working in the hospital system over there as a hospitalist carrying on that residency type of practice in the hospital system.


And when I was in that big system, I, it was just more and more chance to burn out basically. And finally my wife got a fellowship, a position in child psychiatry in Austin, and she happened to match here and that's what brought us here. And we were very happy to be here now we consider it home.


Definitely. But that's really how we came here. I just want to say, I love to be the toddler in the background cause that's it. Was that your kid or was that my kid? I like that's awesome. No, I love it. That's this is legit parenting in 2021, so I absolutely love it. now how did you come to learn about DPC?


I came to learn about DPC from Josh umber in one of his videos, as well as Dr. Magical. I think in marble falls or was there, and I saw one of her videos on YouTube, which was just talking about cash pay practice, and, the concept of DPC.


Wasn't really something that I had heard. And I really didn't think about a cash pay practice, really that much as just because, I never really thought about primary care. Because as I mentioned, we, when you go from medicine to residency was always internal medicine. And even when we did internal medicine, we did Three weeks in the hospital.


And then we did one week in the clinic. And so everyone felt that clinic week was just like their little break that they'd get, see a few patients much lighter, less shift work and all that stuff. It was, it never crossed my mind that, Hey, this could actually be a career, even though I really enjoyed speaking with patients and interacting in that way.


But when I was in that kind of hospitalists system and going through the grind and finally starting to wake up, then I started doing my research and that's how I came across these videos. And then it was like this whole world opened up and it was just direct primary care and functional medicine and just holistic.


And I'm like, wow, this is definitely something that now I can start understanding my calling. But you have to go through that to get to that, that, to that. when you moved to Austin, because as you mentioned, Austin is DPC rich in terms of numbers of practices, did you find the transition easier because there were existing practices who you could commiserate with and who could guide you as you opened your own?


I would say it's been a great help, I've chosen a very central Austin location, so there isn't a ton of DPC practices around me. They're more scattered around Austin, but I think that feeling of like everyone is connected, everyone who genuinely wants to help each other out that's been fantastic.


And so I've learned many things along the way. I've learned many things on my own but it's definitely helped to have people doing it.


when you chose your central location, what was your mindset when you went after the location that you chose? To be very honest it's not a profound answer.


I just wanted it to be close to home and not have a big commute. So that was really it. I may not have known all of where the DPC practices were when I got to know about them. I realized I'm in this catchment area that really other physicians aren't. , but it was really just to be close to home.


That's not a bad reason whatsoever though, especially in a city, you know, I can imagine because you have two little ones and your twins are a week younger than my son and my youngest son. And then you have a toddler who's also. Correct. Three and a half. Yeah, literally we had kids at the same time.


So I think that was a great way to plan your practice around your family because that at the end of the day we all have to balance with our work now, how did you choose the name Medina medicine?


So that's a great question. So when I went through medical school and residency, the institutions that I went to had a religious foundation, both in Pakistan and in New York, I went to New York Presbyterian hospital. So a very Christian foundation and a lot of the hospitals.


That I was exposed to have that solid kind of Judeo-Christian foundation. Not Sinai in New York. My monities you St. Mary's St. David's St. Joseph's. I've literally every hospital I've worked at, has had these names and these, these foundations in being someone of faith. I wanted, you know, Muslims in the U S I think are very sometimes because of social political, economic, or social political reasons tend to keep their religious lives and their public lives very separate, and so they're like the, they're the physician and then they go home and they're like the Muslim. I wanted to not do that. I wanted to merge the two and have. My practice have a component of my faith mixed with it. And so that people know that not just that they're going to a physician or a good physician, but they're going to a Muslim physician and, have that presence in the community that reflects the faith and hopefully, advances people's Muslim peoples lives here in the U S.


And so it's really just a way of me incorporating my faith in the past. That's so wonderful. I just really loved that. And I did not know that at all before our interviews. So that's so special. And I think that it goes back to you developed your own practice and


you get to name it, what you want to name it. You get to practice the way you want to practice. When you opened Medina medicine, how did you get the word out that you were ready to accept patients? There was a couple of ways. I think that I basically I try to do a lot of networking, it was a very strange time to open the practice right before the pandemic hit.


And so there were a couple of different, I put myself on different maps, know, like DPC frontier and so on. I also was on some platforms like SOC doc, that in which it wasn't DPC specific, but you could patients book appointments with you, you call them, and then you say, Hey, by the way I do a different practice model.


And nine times out of 10, they actually were very impressed with that. And then they ended up signing up to the practice. And so that was the initial part of it. Then the pandemic hit and, I was, I would say I was pretty sick stunned for the first month or so. I just did not know what to do.


I mean, Here I was starting a new practice and. It was like, okay, that's hard in and of itself. And then now the pandemic hits, I can't even go to people, visit people, tell people I'm not tech savvy or media savvy. That was like it wasn't something I could just pivot to and go online.


So it was a real challenge, but then I think that as soon as I was able to physically see patients back in the office, I got back there and and then that's when I started to, join the Austin wellness collaborative. That's something we could talk about later and start the real networking process and, get to know people in my area.


Once I did that, it was a lot of Word of mouth and just people that I got to know that would recommend me, whether it was a nutritionist chiropractor and so on. And so I think those, the strength of those relationships were key. And they remain key. So those were some of the ways that I started off.


Great. And now you mentioned the Austin wellness collective. So can you explain to the listeners what that is and how do you and other DPC practices function within that culture? Yes. So the Austin wellness, collective or collaborative is basically a group that was formed in 2017 here in Austin that is really just bringing practitioners of different spheres together.


So that there's a collaboration rather than competition. There's a Facebook group and there's a website. And a small, monthly membership type of thing where you could put your information on the website and there's a very active Facebook group. And so someone who says, Hey, I'm looking for a new primary care physician, can you point me in the right direction?


And so you get a lot of comments regarding that, and that's how whatever someone's looking for, they're able to find in that way through a robust Facebook group, I think it's very beneficial. And I think that different cities can really replicate that model and have that type of a collaborative because just when people, come together and work together, it's so much better than working separately.


And when you mentioned different spheres of providers, those who do chiropractic care, those who do primary care, et cetera, et cetera. Does that include physicians who are doing fee for service as well? Or are the physicians specifically involved in the collective independent practitioners?


DPC docs? Yeah, I think that there's generally not necessarily. A one or the other meaning that, it's not exclusive for DPC and physicians but you tend to see less fee for service providers in the group. And I think that's because when you're fee for service you don't necessarily have a lot of trouble, attracting patients in the same way that we do because of the educational roadblock that's there.


And so I think that the fee for service folks are generally getting people by saying, Hey, we take all these insurances and if you have this insurance and come see us very easy, the whole public really knows that. for us. It's Hey, we have this different model that first we have to tell you about and educate you about, then we have to convince you about, and that's when you sign up.


And so I think the pool of patients that were there's a high potential pool of patients, but really the pool of patients we're dealing with are, lesser because of that. , when you were talking about the, there were less fee for service doctors in the that they don't tend to be the dominant number of physicians it doesn't surprise me at all because it also speaks to the culture of our country in terms of the questions. What does my insurance cover? Does my insurance cover this practice? Not what kind of doctor do I need to fit my health needs. With that said, I had seen posts on your Facebook page, where the two posts that I'd seen, those people who had posted about your practice were also saying things like he practices a model called direct primary care and their own explanation of it. So it's very interesting that, not only are you getting word of mouth recommendations of your practice, but also of the model itself.


So I want to ask, since 2017, as you guys have continued with DPC practices involved in the collaborative, has it been. An easier jump between fee for service care and to DPC for patients because there's more word of mouth on the street. I definitely do think so.


And now, interestingly, I'm seeing a trend where a lot of people do know about it. Whether you're talking about DPC or functional medicine, I tend to tell people, like I ask people, have you heard of this? And they say, yes, even if they say direct care as opposed to DPC. So there is that awareness that has begun and has definitely spreading.


And to your point, I think that it makes it much easier for patients to jump. And then when we had the pen down. You know, A lot of people, it was just so much easier because here you lost your job, you lost your insurance. And now in searching for a physician you see this different thing where you don't need health insurance at least to see your primary care physician, that was a no brainer for people.


And so that also made it much easier to jump to that model. And so I think that is definitely a very good point. The one thing I will point out that would be interesting for people listening is when you are a DPC physician and you're trying to market yourself and you're trying to get more patients.


I think that the DPC model in and of itself is a. Is an attraction, it's just a model. And then there's the physician who's the other attraction. And so sometimes I actually find myself at a crossroads of kind of what to lead with. And I'd be curious to hear your thoughts on this as well, that, sometimes do you want to just maybe talk about yourself, what you do, which diseases you see most of and what you really do, but you also end up talking about DPC and letting that take the lead.


And I think that's something that I'm also working through that what's the best approach where you can, not necessarily, you sell the model, but you also need to sell yourself. And so w the interaction of those two is very interesting to me. And yeah, I'd love to hear your thoughts on that.


I think about your community and how many different DPC docs there are in Austin in particular. And, you know, I definitely would say everybody probably approaches it differently in my community. I definitely tend to lean towards asking people or approaching them from their pressure points specifically on the nextdoor platform? Very frequently in my community. People are, asking the question. Is there anybody that I can see after hours? Do I have to go to urgent care? How come there's no other doctors, I still don't have a primary.


I've been in practice for five plus years in my community before making the jump to DPC. So I feel that in a town of 4,000 people, I do have some name recognition. So I will use that to my advantage


but I will say that in general, when I'm talking to, for instance, the lady at the bank who opened my bank account for the business and, to the to the group or to the barber cutting your hair. Exactly. Whenever somebody, and I feel like a constant sales person, because whenever somebody says anything about frustration with anything related to health, I immediately start , oh my goodness, that sounds terrible.


Tell me more. And there, everybody has their own elevator pitch, but I think for me, I approach it organically based on what I'm hearing. And I expect it to usually be from those pressure points in our community where there's really limited access to care. Yeah. Yeah. And that's a fantastic point.


I think that there's those folks that are just fed up of the system and want something different. And so they love DPC the, for the model. And then there's those folks that. Maybe have been to multiple other physicians, whether a fee for service or whatever, but they just haven't received the care that they need holistically and that way.


And so they don't care about the model. They don't care about what the cost is. They are coming to see you. And I think that's really a great distinction. And and I think that we could really go to sell to both, which is very absolutely. Yeah, absolutely. And when I think about and reflect on the way that people buy into listening to another person, talk about stuff like DPC,


I almost like the general and then selling yourself as a doctor because it's oh yeah, this isn't, like fairytale medicine, this actually exists. And you know what? I actually provide that. So yeah, I think it's it's like a one-two punch, you're like, oh, this medicine exists and the person you're talking to doesn't have medicine.


Yeah. Yeah, for sure. So I want to highlight the fact that you are on the board of directors for the American holistic association. So I would love if you can share with the listeners what that is, and because we're talking about, selling DPC as a model, selling you as a doctor, how do patients okay.


Let me re-ask that. I want to highlight that you are on the board of directors for the American holistic association. So I'd love if you could share with the listeners, what does what is that association and how did you become part of that? Yeah, so the American holistic health association, or H a is basically a, an association that's been around for around 30, 31 years now.


And they're really a online resource to basically provide impartial, holistic information to the wider community. And that's really the goal through newsletters and through different different ways essentially to basically, give that information which has now unfortunately become very.


Politicized and partial and so on. So that's really the goal. It focuses it functions with a board and we, meet regularly virtually now and, there's board members from different parts of the country. And it's really just brainstorming ways in which we can get more outreach in the community, better information and just better ways to get that information.


I think that I applied to be on the board when they had an opening and, they just interviewed me and they brought me on board. And I think that there's a different types of people on the board there's MDs and then there's nutritionists and so on. So they're just looking for a range of people.


And so I think it just it, it aligns so well with my philosophy that I really wanted to be part of it. And and happy to contribute. And what is your philosophy , at Medina medicine? Yeah. And so that is a, that's the million dollar question. My way of practicing medicine is really reflected by my entire journey from the starting medical school into residency and and afterwards in the hospital system and what I realized as so many others have realized and continue to realize is that we really have, we have two, two types of care.


We have acute care and we have chronic care. We have developed resources for acute care excellently. So every time you have an accident or a traumatic event and you have to go to the ER, a heart attack stroke or something like that, we have. The best resources to be able to deal with those situations in an acute way, which is pharmaceutical agents and procedures, surgical procedures and where we Excel at that, what we've done, unfortunately or what we've been made to do, let's say is to take that same model and take it to chronic care and just apply it as a copy paste and to expect the same outcomes, so if you have a broken bone, you fix it and you're healed, but if you have diabetes or cardiovascular disease or, auto immune disease, and then you apply the same, pharmaceutical model or the same procedural model, you are not going to get the same results by the nature of the illness that is there.


And and it just reflects on our numbers. We are, we're getting we're getting more chronic disease as a nation children it's just really rampant. And so if we were doing things right, you should see those rates going down, you should see people getting better.


You should see people fixing their ailments. But we're not seeing that. And so I think that, that acute realization, and I often say that when I was in the hospital and I would talk to patients with these chronic issues, I would often stop believing myself when I was speaking to them because I was coming to them.


And I was saying that within that conventional model, look, you have really you have. Two options. One is this pill or when is this procedure? And w I knew at the end, at the back of my mind that really there's more there's more options. There's a better approach. I would see a patient who had a cardiac catheterization who was found to have triple vessel disease.


He would be scheduled for the bypass surgery in a day. I would have one conversation to have with him, if that if I ever saw him again in the hospital to be able to tell him like, Hey, maybe there's that option of you radically changing your diet and lifestyle before they saw your chest open.


Just a thought. And it just doesn't, it just doesn't exist. And then the time factor is the other thing, when you're in the hospital, you're seeing patients 20 patients. You literally do not have the ability to time to sit with a patient and just discuss these very complex things.


And all of that drove me towards a model in which I felt that I was being true to myself, being true to my patients and practicing a holistic form of care, which, if you're depressed, if you're anxious, let's sit and talk about it. Tell me why you're depressed, why you're anxious.


And if it's something that I'm not able to understand, if it's something that is not related to circumstances and all that, okay, we can go towards pharmaceutical approaches to fix it fine. But have we looked into your diet? Have we looked into your lifestyle? Have we looked into your relationships, your stress and so on?


And so it's just a way that it just makes sense to me. And I just like practicing that way. And so I just encourage anyone to just start realizing. Chronic disease needs to be treated. These are lifestyle diseases and, they, if they're if they come about because of lifestyle, they should get fixed by correct lifestyle.


And so that's really the gist of it. And it's so true though, especially for those patients who have been successful at making lifestyle changes for particular chronic illnesses, they just cannot believe that, oh my gosh, I don't have to take 16 medications anymore. Oh my gosh.


My body feels so wonderful and I have all this energy, it's amazing. I have been recently listening to the podcast, the cost of care. It's a 10 part series about the healthcare in America. And episode seven is basically around the case study of kidney disease in this country and how people very frequently are already at end stage renal disease. And then all of a sudden to them, it's a shock that they have to do dialysis as the only option versus no treatment. And two doctors, we sit here and we're like, yeah that's what we're seeing too. And so what this podcast is talking about, there's a specialist who is just talking about how, the way that they're fixing it is having time with patients to talk about the dietary portion, the psychological portion, impacting food choice, et cetera, et cetera.


And it's so true. It's. It goes back to the relationship that we build with patients as direct primary care physicians. One person had made a comment on the Instagram for my DPC story about if everybody, went into DPC, who's in primary care as a physician in pediatrics, internal medicine and family medicine, we'd have this big shortage and that's, another issue for another day, but the idea that, but look at the quality of care and look at the prevention that can happen.


This is where I sit every day and I'm sure you do as well. There is no other way. Yeah. Yeah. And I think two points on that one is that if you take my example to debunk this kind of shortage, if I wouldn't be practicing DPC or kind of this cash-based practice, I probably would be in the hospital.


And so here, you have someone who is either not going to be a primary care physician or he's, or he's going to be in this cafe practice and be seeing so many more patients. So that's one. And then just to you mentioned kidney disease and stuff. I think it's so interesting if you even take a step further back than that, which is that we know what's the most common cause of patients being on dialysis in the U S and it's, diabetes and high blood pressure.


And nobody ever told me through my medical school and residency that diabetes and high blood pressure can be reversed, can be, Improved with diet and lifestyle to the point that you can get off of your medications. These, this isn't just a one-off miracle or something. This is researched stuff.


And so I think that when we have a cost issue, especially when it comes to diabetes, the amount we spend, kidney disease, dialysis the amount we spend there, there's also this argument put aside our healthcare spending in general. But if we just took a smarter approach to these chronic diseases, we can save money in that respect.


And and not just save money, but prevent people's serious illness and death as a result of these things. So I think that there is. There's just so much potential to heal chronic disease that is just not being pursued enough. And again, I just encouragement to everyone to just look into that so that we can, start addressing that more


Because you are doing functional and holistic medicine, one of the things that is mentioned, on your website that I found this, but that you're doing things like integrative cardiology.


What I really like about functional medicine and integrative medicine, because you're really saying that when you develop diabetes and cardiovascular disease and everything on the metabolic syndrome, spectrum that arises from obesity and those types of things you're saying that's all connected.


So with intent, and I want to just take a step back and just talk a little bit about my biggest issue. And this is what kind of really opened me up to functional medicine. And that type of practice is when, w the way that we're doing conventional medicine is very black and white.


And, you see this with your patients the lab says I don't have diabetes, but diabetes doesn't happen overnight. It's not, you don't have diabetes means you're perfectly healthy. And then you have diabetes means you have the disease. It's a spectrum. So you start it over years, insulin resistance, and then you get to a point where you have diabetes.


And so it's very frustrating that the conventional system doesn't do anything about that 5.7 A1C that is gonna, say to that person we need to address this now, and we need to address this in a very holistic way. The other thing is, adrenals, and that's another aspect of it.


Everyone is under stress these days. And but again, conventional medicine just realizes that you either have Addison's disease, so complete autoimmune adrenal insufficiency, or you have Cushings on the other hand, which is just in a tumor or something else causing that which are very rare things in medicine.


So it's about that being in the middle of that spectrum. And I just don't, I like that aspect that addresses that. And then the other point that's very important to make is that I think that conventionally, we are not up to date with the amount of research that is out there, which means that we are practicing old antiquated models of care.


So when you look at lipids, for instance, We now have the ability to measure the LDL particle number, the LDL particle size the density we have that ability. And I ha I have that ability in my practice to do that. And when you do it at a cash rate it's very affordable, so it's not like it's like this.


Wow. Like this hundreds of dollars of testing it's very affordable. So to that point, I think that conventional practice has often lags behind the research for years, for example, We now know that there's about 45 steps, at least in the process of atherosclerosis and not through a sclerotic disease.


So we know that's, you can intervene in multiple different times. And so given that all the nuance that we know, we yet, we still practice that typical, you have the LDL at a certain number, give them statins, and then, you try to get the LDL as low as possible.


So the point is that I think that, that nuance and that ability to go with the research and evolve as a clinician is what really draws me to that model. And that's what I try to practice, day in, day out.


And , in terms of practicing holistic medicine, one of the things that drives your care is the idea that food is medicine.


And, in other cultures, that's a really. Accepted way of thinking about food and an accepted fact of life in America. It's definitely not necessarily the first thing that people think of when they think of the word medicine. So when you are talking about food as medicine to somebody whose habits are not necessarily the healthiest for their body, how do you enter that discussion?


I think that, just, I think getting people to realize more and more that the illnesses that we now have, and we're that are growing in number in our society are primarily brought on by our lifestyle. So the way the, what we eat that way, we eat the the wit the lives that we live, the stress, the environmental toxins our relationships, all of that is really what's driving.


Disease and chronic disease. And so getting them to that awareness, first of all, that food is very likely what caused your disease. And so that kind of is a segue into changing the way you eat, the pattern, what you eat and so on is can be the catalyst for changing those diseases. And so I think that's how I try to enter it.


I think that a lot of people I see are actually people that have gone down that conventional route to to use medication, to use all sorts of things and not find as much benefit as they would have wanted. And then eventually coming to this realization, just like many physicians do that.


This is just not working and that's enter license.


And as you've transitioned to practicing in more of the holistic and functional space, what are resources that you like to use to help? Reinforce what you're telling patients that they can access from home.


So I would say that, there's a lot of handouts that I have. There's a lot of visuals that I tried. So that education is a big piece of it, when you're sitting there and you're explaining to people literally with the diagrams and stuff, that this is the cause this is what's going on inside.


I think that's, they're very appreciative because suddenly their eyes light up. They understand why they're having this rather than a physician, just telling them you have this disease and take this medication. And it's it, whether it be diet, dietary plans recipes plans for stress relief and stress reduction just a lot of those different things.


I try to accumulate and give to patients as they need. So they have that. in terms of. Patients in your clinic in terms of trends that you've seen, what are some examples of patients who have just completely new lease on life because of the care that they got from you as their doctor, I think that when I, lot of what I see is, auto-immunity and a lot of gut issues as well.


And there are these people that have just had their issues for just, months and years, and they're just really struggling and they just don't have the right answers. And so those are the patients that sometimes you make some small dietary changes, you make lifestyle changes, you use simply to sit and talk to them and you give them that internal, someone's listening, someone's telling you're not crazy.


And you don't have all these symptoms aren't in your head. That is, I think the catalyst for change right there, and that kind of puts patients, really feel empowered by that? And, making those small changes can often Result in some major breakthroughs in their own illness.


And so I think that when patients feel that they found someone to partner with in their health journey, then they feel that empowerment to heal as opposed to, oh, I'm going to the doctor again, it's just going to adjust my medications a a little bit higher on the Synthroid and a little bit lower on this.


And, but when, if they see in your eyes that you genuinely care to make them better that's a whole different ball game. And going back to your practice, you are a solo practitioner right now. So given that you have this relationship with patients that you're there for them when they need there, what happens.


In terms of coverage. If have to go take your family on vacation, which I get it, it's not the easiest thing right now, but even if you're just taking a break or after hours, how do you manage your practice? Because more internal medicine and functional holistic I tend to do much less urgent care related stuff.


Just out of not having it in my training and not having those, a lot of those skills. And most of my patients know, to go to urgent care or something like that comes up. I just, I think that different DPC doctors have, different I would say just strengths.


And so I definitely consider that as something that I probably would use. One of my colleagues here in Austin, if it's a procedure that they need or, coverage, then probably someone pretty close to them. It's definitely a lot easier when there's multiple doctors, one in your area, but two in your state, because if you're licensed in Texas, you can always do telemedicine coverage for each other.


So that's wonderful. Yeah. Now one of the things that I found very interesting was the fact that you have a note at the bottom of your website that says that it was designed by the free website guys. So I would love if you can share, because I know that there's a pressure point for some DPC doctors about designing their own website.


Like for me, that's my jam. I absolutely love it, but for like you, it, like you shared, you don't consider yourself that the tech person, how did you find out about the free website guys and what is their. The free website guys it was through a Facebook post in which they they're posted and I responded to that it their model is essentially that they take on a certain, 15 to 20% of their clients as free to set up their website, you know, a basic website for them.


And so it was at a time when I designed my own website, it was pretty bad. And I saw this and I was like, don't have necessarily the revenue to hire someone to do it for three or $4,000. And this sounded interesting. And it was a lot of back and forth emails how do you want this to be and what you want here.


So ultimately you're. You are designing it in that you're putting in your content and your, how you want it and everything. But what they do is they, set you up with a website, WordPress and all of that stuff on the backend, and then they hand it to you. Here you go.


Here's the website. If you want to make changes, this is how you do it. But this is a website set up for you. So I think it's great for people who just want a website to start off with, they don't have necessarily a lot of revenue to to go with. Definitely something to look into and I'm definitely a Wix person or a dragon drop person myself.


So when you say WordPress, my next question to you is what is the maintenance looking like for that? So once they. Their selling point really is that once you've worked with them and you liked them, then you rehire them for a different job or add ons and stuff. I haven't done that, as they've, I've just been figuring things out on my own, adding things by myself.


And so the maintenance to the extent that there is just basically by myself, basically just doing it. That's wonderful. You got me so impressed there because I don't even want to touch word press on the backup. So that's fantastic. Now, one of the things you also have on your website is this mind map where you basically do a visual of what the care is like with you as the doctor and at your clinic.


So when you were developing your website, what was the story behind putting that mind map on your website? I think that I'm definitely a very visual person when it comes to either learning or just seeing information.


And so I think that I just tried to replicate that for patients where they just have that one central thing where, because we keep talking about one low monthly fee is covering all this. So instead of putting it in a text format, a paragraph format, I was just wanting to do something a little different.


And so that it came up with just, all of the different things that can come from one central low monthly fee. So that's where it came from. And another piece of tech that you, that I noticed that you use as loom. And so I would love if you can share your case use for loom. Because I'm a huge tech person and wherever tech can help us out, especially, we don't know what the future holds in terms of future mass mandates, but I love that you're using that as a way to communicate your emotion and your face with people who might not be able to see that in-person in clinic.


Yeah. Loom is something that is, was relatively new to me and I am experimenting more with it and seeing, how to use it. So my thought of in using it was to use it to essentially just put out educational content out there for people so that they almost know you before they come in to see you.


I've I know other people who use it for lab interpretation. You see a patient, you do labs, you can record a quick five minute loom, send it to them and say, Hey, this is what your CBC show. This is what everything means. And that patient just has that. So it's great for efficiency in that regard.


And so I'm really just experimenting with how to use it and what's the best approach. But something I came across more recently, I think that use cases genius. I had not given a thought because I'm, I'm using some spark and similar idea and that, there's the ability to communicate.


And there's the ability for the patient to leave you a video voicemail back, so in terms of your usage for things like laboratory results, do you have your patients sign a statement that, you know, this might not be HIPAA compliant, but it allows me to, communicate with you in this special space,


so generally speaking, the patient agreement at the beginning includes that where there's an understanding that email and texts and other forms of tech communication may have the situations where it's not compliant. So patients are aware that whether I'm emailing them something or texting them something.


So generally speaking, they're they're aware that specifically for video, I don't send that, but again, the labs part is not necessarily something that I use too often. It's something that I've heard other people use. For me it's more of right now it's more of a call to the patient afterwards.


In a previous interview, somebody had mentioned the idea of. It's really not hard to make DPC shine when you're comparing it to something that's really crappy. And just the idea of being able to do that in fee for service.


I'm like, oh, heck no. There's no more time because There's no way to quickly record, you know, two second video saying something like you're describing your lab results or just saying, Hey, sing, happy birthday. I mean, Basic communication forms that are so easily achievable with things like loom and video messaging.


That's just amazing. Now I want to go back to the fact that you and I literally had kids at the same time. How are you balancing life as a dad with your practice? And also with this pandemic? Yeah, that's a very challenging to do, with three kids now and trying to grow your practice and, when you have a family and you want to do anything really, it comes at, you have to sacrifice something.


So if you're going to go gung-ho in this practice, then you're, you will sacrifice time with your kids or whatever job it might be. If you want to spend more time with your kids, it will come at a cost to your business, your income, , so there's, it's a trade-off. And so you prioritize what's most important.


And in which order, and you your kind of schedule your time that way. And so I think that what I try my best to do is try my best to have situations in which you're able to spend quality time with your family and, separately, each family member, the toddler requires different attention, the spouse infants.


And so it's like that, that you have to do that very in a quality way. And when you do that, then I think that that certainly helps, but there's no doubt that there's that constant pressure. It's not the same as just being able to do it without that's tuition. So that, and then the depend DEMEC, I think it's something that arguably is easier for me than the family part, because I think with the pandemic, there's the aspect of you, you can't control it.


And I think from a from a point of view of faith, it's this is something that's meant to happen and, we just, we have to be patient and go through it. And and so that's really, it comes from there. And so I just try to, tend to try to be strong about that.


When you talk about the kids needing different attention amounts during the day, I definitely, I hear you on that. And I feel that in my bones, I.


It's very easy to get into a place of guilt because you're not spending the time you wish you could spend, but I will say that when you are able to spend time and focus on quality, I think that's amazing. So now with that said, I want to ask about you being a solo provider right now. do you continue to envision yourself as a solo provider in the future?


Or do you think that you would add on another practitioner in your office? That's a great question. That is a question that I don't have a great answer to right now, but because, and primarily because I'm thinking about so many different ways to do it, in terms of having someone you partner with who's maybe either a mid-level and you're separating.


Kind of chronic disease versus acute care, someone you can partner with or an additional provider. It's definitely something I want to envision and go grow towards. Right now I will probably be staying a solo provider for the next year or so. And I do have a very small office, so right now there's no office space for that person, but hopefully within the next couple of years, for sure.


And for those who are listening I know you, you mentioned resources that you have for your patients, but resources for others to learn about functional medicine, holistic medicine, what resources would you recommend them to. So the Institute for functional medicine has a lot of resources in their website, ifm.org.


That's a place. People can go to get training and to get information find practitioners. There's a ton of podcasts and videos and different types of things. A lot of books written by excellent practitioners.


Um, you know, I could send you a list of them and, you know, a lot of which are behind me. there's just a lot out there that sometimes I see those books and I'm like, I did not know that this was out there. And there's just so much being done and so much being researched and so many new aspects in medicine that we just should really, inform ourselves about.


And so I think that. The main thing I think for physicians is just to let down their ego and just be open to that. I think one of the best quotes I heard recently was that I completed my medical school and then I became a student of medicine. And that is, that is really just, how I'm going about things.


I feel like I'm learning constantly every single day and just growing. And I do feel like a student right now and in a good way. That's awesome. And I'm totally going to take you up on that offer to send a list and we'll include that on the blog accompany your podcast.


So what is the best way for others to reach out to you after this podcast? You can email me@infoatmedinamedicine.com. That's mad ina medicine.com, or you can call 5 1 2 9 6 0 2 5 2 2. And that's the best way to reach me. Perfect. Thank you so much for joining us today. Doctor, doctor, thanks for having me.


It was great speaking to you.


* Transcript generated by AI so please forgive errors.


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