In researching your diabetes care, you may have heard people say they have “a touch of diabetes” or that their “sugar is a little high.” These words suggest that diabetes is not a serious disease. That is not correct. Diabetes is serious, but you can learn to manage it. Most of the steps needed to take care of diabetes are things you do yourself. I will help outline some of these steps in this blog post.

Progression of Diabetes

Keeping your blood sugar (glucose) in your target range can delay the health problems caused by the progression of diabetes. Yes, you read that correctly, diabetes is a progressive condition. Pancreatic Beta Cells (These cells produce, store, and release insulin) function will typically decrease over time. All the strategies listed here and discussed by your health care provider can help delay/prolong this progression.

Exercise & Nutrition

The doctor’s axiom of ‘eat less and move more’ is quite possibly the worst advice any doctor can give, especially if done in a rushed/ inconsiderate manner. Yet, regular movement and diet modification has been shown to improve insulin resistance–the main issue in those with type II diabetes. Moving your body and diet modification can improve A1C levels alone by as much as 4 points! This is far better than any single diabetic medication.

Cholesterol Counts

Diabetics have a higher risk of heart attack and stroke. That’s why doctors treat cholesterol levels more aggressively in those with diabetes

Pay Attention to Blood Pressure

The blood pressure goal of the diabetic person is below 140/80, just like the general non-diabetic population. A side-effect of elevated blood pressure and diabetes is the risk for kidney disease. Damaged filters don’t do a good job.

Get Your Vaccines

Diabetics also have a higher risk of infection. That is likely because bacteria love to live in high sugar environments. For that reason, doctors recommend diabetics get an annual flu shot, in addition to the pneumonia shot once before age 65 and once after age 65 (with at least 5 years in between).

Eye Doctors Aren’t Just For People With Glasses

Every diabetic should also get a yearly eye check that includes being examined by an ophthalmologist (eye specialist) who takes a look at the retina, or the back of the eye, for changes produced by diabetes.

Hello and thank you reading my blog at Beyond Primary Care and trying the BPC Good Eats recipes. This featured recipe is a Tuna Harvest Salad. These recipes are my attempt, in a way, to bridge that Doctor’s adage of “Eat Better & Exercise More.” In this post, I will showcase a healthy meal made on a budget, my pictures are pretty decent, and that is how I got into this food endeavor.

Tuna Harvest Salad
Prep Time: 15 minutes
Total Time: 20 minutes
Adapted from: Damn Delicious

Ingredients:
4 (2 oz) cans tuna in water, drained
1 cup greek yogurt
2 teaspoons lemon juice
2 teaspoons dijon mustard
½ cup carrots, diced
½ cup green onions, diced
½ teaspoon garlic powder
Salt and Pepper
4 leaves Bibb lettuce
2 apples, sliced
1 cucumber, sliced
1 (16 oz) package baby carrots
1 (16 oz) package raw almonds
1 lb red grapes, seedless

Instructions:
1) In a medium bowl, combine tuna, yogurt, lemon juice, dijon mustard, carrots, green onions, and garlic powder. Season with salt and pepper to taste.
2) Place lettuce leaves into meal prep container. Top with tuna mixture.
3) Arrange apples, cucumbers, baby carrots, almonds, and grapes around tuna mixture.

I recently met a doctor and self-proclaimed underserved medicine wonk who bellowed that DPC doctors ‘cherry pick’ healthier and wealthier patients, leaving the the vast majority of individuals without care and fewer doctors to choose from. Nothing is farther from the truth- Direct Primary Care is not concierge medicine. I wanted to scream (I didn’t) that this perception whereby accepting a patient’s insurance somehow improves access to health care. I wanted to point out how the health care services this doctor was providing relies so heavily on third-party reimbursement systems, costs for their medical care have likely gone up. But in the end, the before-mentioned doctor was so entrenched in the health care insurance matrix, I could only use their misconceptions to help educate others.

Direct Primary Care Doesn’t Cherry Pick Patients

Direct Primary Care doctors run their own business so that we can do what is right for a change in health care; Treat individuals the way everyone wants to be treated by giving patients the time and peace of mind they deserve. We have transparent pricing on the care for our memberships, and do not charge more for complicated patients, or management of difficult or chronic medical conditions that require more frequent trips to see the doctor. Our plans work great for anyone at any level of insurance or for individuals at any level of savings and income.

• No insurance? Whether you have a family, or are a single working mother whose employer doesn’t offer insurance, Direct Primary Care is a great option. We provide the vast amount of medical services needed, there are no surprise bills, and contacting or seeing your doctor doesn’t mean you will have to miss work or school.
• You have insurance but a high-deductible? Direct Primary care does offer excellent and affordable healthcare that can compliment a person’s insurance. I talked about a better plan- Direct Primary Care with Insurance earlier. Direct Primary Care focuses on decreasing their patient’s need for specialty care, ER visits, and hospitalizations by focusing on health and prevention. Doing so can (and does) reduce the need.
• Have good, or even great insurance? Direct Primary Care universally recommends all patients have insurance. But having insurance does not mean access or longitudinal care. Having insurance without proper access is tantamount to rationing. With Direct Primary Care, we will exceed your office expectations in getting you in for your appointment with the same provider who knows you and your health- every visit.

Direct Primary Care wants to work for you. 

Opening My Clinic, Beyond Primary Care

My goal with opening a direct primary care practice was to make healthcare more affordable and accessible to everyone in the community. I have worked in the fee-for-service system, up-billing every visit to maximize insurance reimbursement (remember, costs are passed down- ultimately to the patient). I remember the conversations about patient’s prescribed blood pressure medications that cost $100 a month, and how I felt powerless to offer alternative ways of obtaining more affordable medications. I know the gut-wrenching decisions I had to make in cutting short a conversation about a patient’s knee pain because I was already a half-hour behind, offering them to return for a subsequent visit two weeks away.

At some point, my job as a family doctor in the fee-for-service system felt more like just a title and salary. After spending the better part of a decade in medical school and post-graduate training, I wanted my role as a doctor to have value. Value for providing my patients with unparalleled access to care. Value for providing my patients with transparent pricing on health care services and helping them navigate the system when needed. Value for sitting down with my patients, spending the time with them that is needed, and being there. That is the value in Beyond Primary Care.

Hello and thank you reading my blog at Beyond Primary Care and trying the BPC Good Eats recipes. This featured recipe is a Ropa Vieja. These recipes are my attempt, in a way, to bridge that Doctor’s adage of “Eat Better & Exercise More.” In this post, I will showcase a healthy meal made on a budget, my pictures are pretty decent, and that is how I got into this food endeavor.

Slow Cooker Ropa Vieja
Prep Time: 20 minutes
Total Time: 25 minutes (including 8-10 hr slow cooking)
Adapted from: Food Network

Ingredients:
1 (15 oz) can crushed tomato
3 tbsp ketchup
1 tbsp apple cider vinegar
4 cloves garlic, minced
1 ½ tsp ground cumin
2 jalapeno pepper (with seeds), thinly sliced
2 bell peppers (1 red, 1 green), sliced ½ inch thick
1 ½ lbs skirt steak or flank steak
1 onion, thinly sliced
3 tbsp chopped pimiento-stuffed green olives, plus 1 tbsp brine from the jar
2 cups white rice, for serving
Salt and Pepper to Taste

Instructions:
1) Combine the tomatoes, ketchup, vinegar, garlic, cumin, jalapeno, and ¾ tsp salt in a slow cooker.
2) Add the steak, bell peppers, and onion and toss to coat.
3) Place cover on and cook for 8 to 10 hours
4) Coarsely shred the meat with 2 forks, then stir in olives and olive brine. Serve over rice.

Dr. Jeff O’Boyle will host a Meet and Greet at Beyond Primary Care Thursday, December 6th from 5:30 pm until 8 pm. 

Meet Dr. Jeff O’Boyle, check out the personal and all-in-one clinic, and learn what Direct Primary Care offers.

Topics include:

• How Direct Primary Care works with health insurance
• What kind of insurance works best with Direct Primary Care
• How obtaining your medications works with Direct Primary Care
• How obtaining labs and imaging works with Direct Primary Care
• How hospitalization works with Direct Primary Care
• How referrals work with Direct Primary Care
• Comparing the actual costs of services and products in a fee-for-service system versus Direct Primary Care
• Dr. O’Boyle will answer any questions you have

Hello and thank you reading my blog at Beyond Primary Care and trying the BPC Good Eats recipes. This featured recipe is a Turkey Cobb Salad. These recipes are my attempt, in a way, to bridge that Doctor’s adage of “Eat Better & Exercise More.” In this post, I will showcase a healthy meal made on a budget, my pictures are pretty decent, and that is how I got into this food endeavor.

Turkey Cobb Salad
Adapted from: Skinny Taste
Prep Time: 40 minutes
Total Time: 40 minutes

Ingredients for Vinaigrette Dressing
1 tsp dijon mustard
3 tablespoons olive oil
3 teaspoons red wine vinegar
1 teaspoon maple syrup
½ teaspoon salt
¼ teaspoon pepper

Ingredients for Turkey Cobb Salad
4 cups spring mix (or other greens of choice)
4 slices bacon
2 cups butternut squash, cubed and cut into ¾ inch pieces
1 cups dried cherries
4 ounces crumbled blue cheese
1/2 cup pecans
1 cup grape tomatoes, halved
2 tablespoons butter
1 tablespoon sugar
2 eggs
6 oz cooked turkey breast, cut into cubed ½ pieces
Pepper to Taste

Instructions:
1) Preheat the oven to 425F.
2) Spray a large cookie sheet with oil, place on top of a large nonstick baking sheet. Arrange the bacon on top, place in oven and bake for 20 minutes or until crispy.
3) Place the butternut squash on a large nonstick baking sheet, spray with oil, season with salt and pepper. Once bacon is finish cooking, add the butternut squash to the oven, baking for 20 minutes or until tender. Turn butternut about half-way through.
4) In a large skillet over medium-low heat, add the butter. Once melted, add the pecans and coat with the butter. Once butter begins to caramelize- but not burn- add the sugar and stir into pecans for 2 minutes. Remove pecans from skillet, set aside.
5) Add the eggs to a small pot, cover with water, set on stove over medium-high heat and bring to a boil. Cook until egg hard-boiled. Remove pot from stove and place under streaming cold water from sink. Remove shells and slice thinly.
6) Combine the ingredients for the dressing, whisk together.
7) Divide the lettuce, arrange with the bacon, butternut, tomatoes, blue cheese, dried cherries, pecans, turkey,  and eggs. Drizzle with dressing. Enjoy.

It is fairly easy in exceeding office expectations for the area of customer service, as people have an increasingly low expectation for the service they get at the doctor’s office. It’s normal in fee-for-service office systems to have to wait an hour or more to be seen, and then get only a few minutes of the doctor’s time (if a doctor is seen at all). Many patients often find they half-day off or work or activities, just to be seen. This has left people seeking alternative facilities, such as urgent-care type setting for their ailments. 

What Your Office Visit Looks Like In A Fee-For-Service Office

You likely scheduled a 15-minute time slot. When the doctor’s medical assistant calls you back, you are on the clock. 15 minutes includes everything: time to walk back from the waiting room to the exam room, time for the medical assistant to take vitals (eg- blood pressure, temperature), time for the medical assistant to do the office intake questions. All this, even with the best and fastest medical assistant takes 7 minutes at a minimum. That leaves 8 minutes. 8 minutes for the doctor to do any courtesy conversation (eg- how have things been, what have you been up to since we last spoke), time for the history of illness questions, time for the physical exam, time for discussing what the possible diagnosis is, and time to wrap up the visit by either dispensing medications, ordering laboratory studies, or helping to coordinate your care. By the way, the doctor is going to want to document that visit in your electronic health record. 8 minutes is NOT enough to discuss acute or chronic illness, let alone anything. This results in, at best, frustration. At worst, people avoid care they should be getting.

At Beyond Primary Care, the patient has a much different experience:

• All days begin with multiple slots open for same-day urgent visits.
• Patients seldom have to wait more than 10 minutes to be seen.
• Appointments are 30 minutes per patient but can be extended to meet the needs of the patient.
• More than one concern can be address at your visit. Come in to talk about your anxiety, but want to discuss that mysterious new rash? That is what we do.
• Care is often done via text message or phone, reducing the need for coming to the office at all.
• Late/early office days because health issues don’t always arrive between 9 am – 5 pm and you shouldn’t have to miss work/school/etc to be seen.

With Beyond Primary Care, a premium is placed on exceeding office expectations, and again this is done because it’s in the best interest of our clinic, but returning health care to what it once was- focused on patient care. 

Hello and thank you reading my blog at Beyond Primary Care and trying the BPC Good Eats recipes. This featured recipe is a Turkey Soup. These recipes are my attempt, in a way, to bridge that Doctor’s adage of “Eat Better & Exercise More.” In this post, I will showcase a healthy meal made on a budget, my pictures are pretty decent, and that is how I got into this food endeavor.

Turkey Soup
Prep Time: 25 min
Total Time: 3 hours
Adapted from: Elsie’s Good Cookin

Ingredients
1 whole Turkey breast
6 cups vegetable broth
4 cups water
½ cup green onions, chopped
1 cup celery, finely chopped
2 cups carrots, diced
2 cups zucchini, diced
1 tbsp vegetable oil
1 tbsp sugar
1 (15 oz) can tomato sauce
1 cup rice
1 tbsp Dill weed
Salt and Cracked Pepper to taste
Fresh Parsley, chopped

Instructions
1) Place whole turkey in a large pot, fill with water and vegetable broth, add salt and pepper.
2) Place pot on stove and bring to boil, reduce to simmer, and let simmer for 2 hours.
3) Meanwhile place sauce pan on stove over medium heat
4) Prep onions, celery, carrots, and zucchini. Set onions and celery aside in a bowl.
5) Place oil in pan, saute carrots and zucchini until softened but not browned, add to bowl.
6) After turkey has simmered for 2 hours, add all vegetables, dill, and sugar and continue to simmer vegetables for 20 minutes.
7) Remove turkey from pot, bring to cutting board and using two forks, pull turkey apart into strips.
8) While turkey is out, add rice and simmer until done, about 15 minutes.
9) Return shredded turkey to pot, add one can tomato sauce to vegetable rice broth. Allow to simmer 5 minutes.
10) Garnish with fresh parsley, serve

If you are in the process of open-enrollment, consider a better plan- Direct Primary Care (DPC) with Health Insurance. This post is the second of a two-part blog post where I detail how anyone, regardless of their coverage of insurance, would potentially stand to benefit from direct primary care services. Check my earlier blog postings for the first part (and other cool things too… like the recipe for a yummy Chicken Noodle Soup).

You read my first post and have looked at your own insurance or enrollment options, and say “I am paying a lot of money for health insurance.” Maybe you are left wondering how direct primary care can fit in or rather “What kind of health insurance should I purchase with DPC?” I went on a health insurance exchange to give everyone a better idea of what pairing insurance and a membership to Beyond Primary Care would be like.

Practical & Affordable
The following slide features a hypothetical family of four, that lives in Ann Arbor, MI. Let’s say the parents are in their 40s and they have two young children. Their household income is $65,600/year, which is the median. This family has a number of things happen in the course of their hypothetical 2017, listed in the left column.  A somewhat busy year medically, but not catastrophic.The family purchases either a gold (high premium, low deductible) plan, a bronze (low premium, high deductible) plan, or a bronze plan paired with Beyond Primary Care ($130 a month for family membership). Then let’s see what each of these occurrences “costs” out-of-pocket under each of the three scenarios, and then add up the total out-of-pocket expenses for 2019 in the last row.

Notice that in the last column, the family paid their bronze plan premium ($10,908 for the year) AND the monthly fee for Beyond Primary Care ($130/month, or $1,560 for the year). Despite the extra expense of Beyond Primary Care, they still came out way ahead compared to the gold and bronze plans. This is because Beyond Primary Care offers many types of out-of-pocket savings, including: no visit copays, no additional fee for stitches, and substantial discounts on labwork, medications, and radiology.  These savings help to hedge against using that high deductible.  

Tolerance & Values

At some point in your research of health insurance, it no longer becomes analytical but needs to revolve around a conversation about tolerances and values.

What is your risk tolerance? As example, if you pick plan ‘B,’ what monetary hit can your family afford to take if you get ‘run over by the bus?’ Health care in the US, is a service, and it is expensive. What do you value in your healthcare? As example, do you care about longitudinal care? This is where a doctor really knows you and your family. Do you value access to your doctor, or appointments that run on-time?

With Direct Primary Care, patients are paying the practice, so we are very conscious of trying to give a patient their money’s worth. If DPC can give them value (a concept that has become foreign to healthcare) and patients are happy with our care, they will continue to stay in the practice. It’s in DPC’s best interest to do this, so we do a number of things to save patients’ money:

• DPC offers very low-cost lab testing (using “client billing”), saving people 75 percent or more on labs.
• DPC clinics dispense medications in the office (legal in most states), also saving people 75 percent or more, and offering a huge convenience to the patient.
• DPC will find the lowest cost for procedures, X-rays, and specialist services. While many of these are covered by insurance, most people have higher deductibles. So the lower cash prices are very valuable to them (not to mention the value to the uninsured). 

Health Insurance can be Expensive.
Insurance is a hedge against financial disaster, not a prepaid healthcare. DPC is not meant to replace insurance, nor does the model in any way encourage patients to drop their insurance. People need a way to pay for the high-cost areas of care, such as surgery and hospitalizations. DPC doesn’t try to address paying those costs.

Direct Primary care does offer excellent and affordable healthcare that can compliment a person’s insurance. DPC focuses on decreasing their patient’s need for specialty care, ER visits, and hospitalizations by focusing on health and prevention. Doing so can (and does) reduce the need. With Direct Primary care we are delivering a higher level of care at a known price.

Cold and Sinus Infections invariably go hand-in-hand with winter. Snow isn’t bad for a month or so, and living in Michigan I do tolerate brief stretches of freezing temperatures. But for complete honesty, my favorite part of winter is that it always ends. Yet, for those days and months with freezing weather, everyone tends to huddle inside together and germs and viruses are increasingly spread. This can lead to the common cold or sinus infection.

Fortunately, the possible solutions for people with an infection have never been better. Now, before you rush to get antibiotics, consider some important points from this well-written piece:

• Between 90-98 percent of sinusitis infections are viral and won’t respond to antibiotics.
• At least 200 viruses can cause the common cold. None will respond to antibiotics.
• Only 5-10 percent of sore throat cases in adults are caused by strep throat.

Remember that coughs ad other URI symptoms can take between 7-21 days to resolve. The average duration of a cough is 18 days. You may just have to be patient. But do NOT get discouraged! The goal during this time is symptomatic care.

What can you do for symptomatic care? Ahem, FREE ADVICE!

1. Minimize exposure! I am not talking about locking yourself in your house until winter ends, but keep washing your hands or using hand sanitizer as frequently as possible.
2. Contain that cough and/or sore throat. Studies show that honey that is either by itself or mixed with a liquid works just as well- or sometimes better- than leading (and drastically more expensive) anti-sore throat/cough medications. Honey can safely be used in any children > 1 yr old.
3. Nasal Steroids. When symptoms are bad enough to need a daily medication, these medications do a great job on reducing overall inflammation in the nasal cavity.
4. Dunk your head in the ocean! Ok, just kidding. We are in Michigan. But make your own saline rinses and use the suction bulb as I detailed I while back.
5. Hydrate. Your body will interpret hydration as fatigue. With all that mucous you are producing, you need to replenish it.
6. Antihistamines. These are what most people think of as ‘allergy medicine.” While they aren’t quite as effective as nasal steroids, they act more quickly and usually work well.