Tag: Family Medicine

Finger Stick, Diabetes Care, Direct Primary Care, Beyond Primary Care, Ann Arbor Doctor

Your Sugar is a Little High- Diabetes Type 2

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11 December 2018

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.

Meet and Greet at Beyond Primary Care

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29 November 2018

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
Doctor Visit, Appointment Time, Direct Primary Care, Ann Arbor Doctor, Family Doctor

Exceeding Office Expectations

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26 November 2018

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. 

Beyond Primary Care, Chicken Noodle Soup, Real Medicine, Family Doctor

BPC Good Eats: Chicken Noodle Soup

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9 November 2018

Hello and thank you reading my blog at Beyond Primary Care and trying the BPC Good Eats recipes. This featured recipe is a Chicken Noodle 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.

 

Chicken Noodle Soup
Adapted from: Original
Prep time: 10 minutes
Total time: 25 minutes + slow cooking time


Ingredients:
6-8 chicken thighs (Or Drumsticks)
6 cups chicken stock
1 yellow onion, diced
4 carrots, diced
6 stalks celery, diced
¼ tsp nutmeg
1 tsp whole peppercorn
2 tsp sea salt
1 cup parsley, divided
1 (12 oz) bag egg noodles

Instructions:
1) Add all ingredients (except for noodles and ½ cup parsley) to slow cooker, cook on low for 8-10 hours.
2) 20 minutes before serving, cook egg noodles separately per package instructions.
3) Meanwhile, shred chicken from bones with fork, discarding bones. Add chicken back in.
4) Place noodles in bowl, add the chicken soup, top with remaining parsley.

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Health Care, Health Insurance, Direct Primary Care

A Better Plan- DPC with Health Insurance, Part 1

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7 November 2018

If you are in the process of open-enrollment, consider a better plan- Direct Primary Care (DPC) with Health Insurance. I often get the question, “How does direct primary care work with health insurance?” This post is the first of a two-part blog post where I detail how anyone, regardless of their coverage of insurance our level of income would potentially stand to benefit from direct primary care (DPC) services. Check my blog post regularly for the second part (and other cool things too… like the recipe for a Dorito Taco Salad, because why not?!).

 

Figure out your Monthly Costs: Known as a Premium
Premiums are what you pay on a monthly basis to be insured. Premiums vary on the type of plan you choose. As example, you’ve done your homework and picked a health plan that costs $150 per month. You are paying $1,800 for essentially an insurance retainer, a cost to keep your insurance active. You’ll need to pay your premium on time every month.

Direct Primary Care has most membership fees are between $50-$100. The pricing for membership fees at my clinic, Beyond Primary Care, can be found here. This gets you full access to your doctor, regardless how many times you need to be seen. You could pay around $600 a year. The cost of a DPC membership is often significantly less than just the cost of having the insurance, let alone using it.

 

Reaching your Deductible
Deductibles are what you have to pay out of pocket before your health care plan kicks in. You may also have different annual deductibles for different types of care (as example: hospital care, laboratory tests, medications, etc). As example, you pick a plan with a $1,000 deductible meaning you are on the hook for all medical bills up to that amount before insurance kicks in.

Direct Primary Care provides you with with primary care services without government or insurance involvement. Your membership to a DPC practice does not influence your deductible. As example, you see your DPC doctor because of a mysterious symptoms. That visit was covered by your membership. When a person goes to a traditional fee-for-service practice, they won’t know the cost of care upfront, and labs and medications are potentially much more expensive than we offer. The predictability and transparency of cost is what makes DPC appealing.

 

Understanding the Relationships between Premiums and Deductibles
If you are healthy, you may want to dish out as little money as possible on the monthly premiums (to keep more in your own pocket), but still have coverage in case of an accident, sudden illness, or life change. Be aware, the less you pay for that monthly premium, the higher your annual deductible. Some folks may want a low deductible, but your premium will be thousands of dollars a year.

Direct Primary Care offers these healthier people improved access to care. Just because you are assigned a doctor by your insurance doesn’t actually mean you get to see your doctor, let alone in a timely fashion. DPC does not charge more for complicated patients, or management of difficult or chronic medical conditions that require more frequent trips to see the doctor.

 

Co-Insurance
This is a fixed percentage of your medical bill you share with your insurance company once you have reached your deductible. As example, you have a 80/20 plan. This means if you have a doctor visit after you reached your deductible, and their fee is $150, you are on the hook for $30 while your insurance covers the rest. You still have your copayment though.

 

Out-of-Pocket Maximum
This feature is just as important as premiums and deductibles, and is a term for the total amount your insurance plan will require you to spend on medical care in a single year. If you reach this amount, your health insurance will cover the rest of your care. Note, you may have reached your deductible, but are below your out-of-pocket maximum, you will still be required to pay some of your health care costs.

 

Seeking Transparency in Health Care Costs
No wonder health insurance is so frustrating and confusing for most people. Using automobile insurance as a parallel, health insurance has done the equivalent of paying for gas, oil changes, windshield wipers, and other car repairs in addition to covering collision and liability. Using insurance would allow these things to have artificially set prices which are unreasonably high (since it’s covered by insurance). The cost of your routine maintenance would go up, and insurance could dictate what shop or gas station you could go to for service. But in reality, consumers are already motivated to do those things and will pay out of pocket to maintain their car so as to avoid needing to use their auto insurance at all.

Health insurance is suppose to be a hedge against financial disaster, but people are seemingly are using insurance to cover every ache, pain, anxiety, and pill resulting in artificially inflated prices. How can a outpatient clinic charge $600 for 1-hr procedure? Or $90 for a generic medication? Because unlike bananas, Americans and most doctors have NO idea what an one hour procedure or generic medication should cost- and ultimately how much they will be on the hook for- until they decide to get it done. For better or worse, this has created a demand for transparency among individuals. Direct Primary Care can help fill that void. Check back soon for part 2 of this blog post.

BPC Good Eats: Apple Harvest Salad

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22 October 2018

Hello and thank you reading my blog at Beyond Primary Care and trying the BPC Good Eats recipes. This featured recipe is a Apple 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.

 

Apple Harvest Salad
Adapted from: The Seasoned Mom
Prep Time: 15 minutes
Total Time: 15 minutes

 

Ingredients for Cider Vinaigrette Dressing
3 tablespoons extra-virgin olive oil
3 tablespoons apple cider vinegar
1 teaspoon onion powder
4 teaspoons Dijon mustard
4 teaspoons maple syrup
½ teaspoon salt
¼ teaspoon pepper

 

Ingredients for Apple Harvest Salad
4 cups spring mix (or other greens of choice)
2 apples (a variety you would enjoy), diced
Juice from ½ of a lemon
1 cup dried cranberries
4 ounces crumbled blue cheese
1 cup pecans, coarsely chopped and toasted

 

Instructions:
1) Whisk together dressing ingredients in a small bowl or measuring cup until completely combined, set aside or divide into smaller containers for individual lunches.
2) Place diced apple in a small bowl and squeeze lemon over the bowl. Toss apple in lemon juice to coat (this will prevent browning).
3) Divide salad ingredients among the containers, layering in the following: greens, apples, cranberries, and cheese.
4) When ready to serve, empty the dressing containers onto the salad, top with pecans, and toss to coat.

 

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BPC Good Eats: Hot Dog Hash

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19 October 2018

Hello and thank you reading my blog at Beyond Primary Care and trying the BPC Good Eats recipes. This featured recipe is a Hot Dog Hash. 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.

 

Hot Dog Hash
Adapted from: Lauren’s Latest
Prep Time: 45 minutes
Total Time: 1 hour

 

Ingredients:
2 tbsp olive oil
2 medium potatoes, cubed
3 carrots, peeled and cut into coins
1 yellow onion, cut into chunks
½ tsp paprika
½ tsp dried tarragon
Salt and Pepper, to taste
1 pinch red pepper flakes
1 green bell pepper, cut into chunks
1 red bell pepper, cut into chunks
1 (12 oz) all-beef franks, cut into inch pieces
chives, chopped

 

Instructions:
1) Preheat oven to 425F. Line a baking sheet with parchment paper.
2) Toss potatoes, carrots, and onion with olive oil, smoked paprika, tarragon, salt, pepper, and red pepper flakes. Spread onto prepared baking sheet in 1 even layer and bake 20 minutes.
3) Remove baking sheet from oven, toss with bell peppers and hot dog pieces. Spread out evenly on baking sheet and return to oven for 15 minutes.
4) Toss with fresh chopped chives.

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Open House at Beyond Primary Care, 2018

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17 October 2018

Beyond Primary Care is hosting an open house this month and next month!

 

  • Friday October 26th, 2018 @ Noon
  • Friday November 2nd, 2018 @ Noon
  • Friday November 9th, 2018 @ Noon

 

All open house events start approximately at noon. Dr. O’Boyle will discuss his clinic Beyond Primary Care, and the movement of Direct Primary Care, for approximately 10 minutes. Afterwards he will take questions from anyone. If your question is really good, it may end up on our FAQ page!

 

Can’t make these dates or times but still interested? Don’t worry, just contact us or call 734-395-2850. We will work with your schedule to arrange a time where you can visit the clinic and discuss your health care!

 

Hearing about Beyond Primary Care for the first time? Beyond Primary Care is a family medicine clinic and a part of a new way for patients to access medical care called ‘direct primary care.’ The model is membership based health care, where the patient pays a monthly fee directly to the clinic. The doctor provides the patient with primary medical care without insurance or government involvement. The patients get great access at a low, predictable cost, about the same as a cell phone or cable plan. This model allows the clinic to offer innovative services to further add value to the membership.

Affordable Blood Work

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16 October 2018

Did I mention that at Beyond Primary Care in Ann Arbor Michigan, we aim to bring affordable blood work to you by being 100% transparent about our pricing? I have mentioned this before about individual medications, but after all, there is more than just medications to be transparent about. 

 

Can you remember an instance where a doctor advised you to get blood work done, but they didn’t know if your insurance would cover it or even how much it would cost? There are examples of this occurring all the time in the news. Such as a $17,000 bill for a urine drug screen or owing $478 dollars for a complete blood count and comprehensive metabolic panel (Our shameless self-promoting plug, Beyond Primary Care’s total price for these tests is $17.28). As a personal example, my wife recently got blood work for what the doctors described as a nominal cost. Yet, the explanation of benefits we received stated the insurance would not cover the tests, which are priced at 4-figures! Upon discovering this and discussing with both the insurance and the doctor’s office, no one has yet to give us reassurances or answers. No transparency there. 

 

The jury is still out on my personal experience, but you can avoid the headaches and uncertainty of this type of disjointed healthcare. At Beyond Primary Care, if lab work is needed, Dr. O’Boyle will discuss with you the reason for the blood work and discuss the total costs of the blood work before beginning. Dr. O’Boyle performs his own blood draws (naturally at no additional cost to you), and then finally sends them out to be interpreted at those agreed upon reduced costs.

 

What about those affordable blood work results? Dr. O’Boyle will communicate with you what the laboratory study means, perhaps in office, through a phone call, or a text- just to give you peace of mind. That is comprehensive family medicine.

BPC Good Eats: Artichoke and Rice Filled Peppers

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12 October 2018

Hello and thank you reading my blog at Beyond Primary Care and trying the BPC Good Eats recipes. This featured recipe is a Artichoke and Rice Filled Pepper. 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.

 

Artichoke and Rice Filled Peppers
Adapted from: Nick at Allrecipes
Prep Time: 30 minutes
Total Time: 1 hour 10 minutes

 

Ingredients:
1 cup brown rice
2 cups water
2 tablespoons olive oil
8 green onions, chopped
6 garlic cloves, minced
2 (12 oz) jars marinated artichoke hearts, drained and cut in half
2 large tomatoes, diced
2 tsp dried basil
1 tsp red pepper flakes
6 large bell peppers, tops and seeds removed
2 (4oz) containers feta cheese, divided
Salt and Pepper to taste

 

Instructions:
1) Preheat oven to 375F.
2) Place the bell peppers in the oven while pre-heating to soften the peppers, about 10-15 minutes.
2) Bring rice and water to boil in a saucepan and cook per package instructions, between 20-30 minutes.
3) Heat olive oil in a skillet over medium-low heat, add green onions and garlic. Cook until fragrant, about 1-2 minutes.
4) After green onion and garlic are fragrant, add artichoke hearts, tomatoes, basil, red pepper flakes, salt, and pepper. Stir in mixture until heated through, about 5 minutes. Stir in rice when tender and water is absorbed.
5) Crumble and add about 1-2 teaspoons of feta cheese to the bottom of each bell pepper. Place bell peppers into a baking dish.
6) Spoon rice mixture into the bell peppers, pressing down, saving enough rice mixture for each bell pepper. Top with feta cheese.
7) Bake for 30-40 minutes until feta cheese is melted and bell peppers are softened.

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