How the “I Feel Fine” Syndrome™ Is Costing You Millions – Part 3

By DrScott – Posted on January 2, 2014 on

In the last blog we took an honest look at what is accomplished by closing our gaps in care for primary and secondary prevention. Primary prevention is defined as taking actions to prevent a disease from occurring. So identifying and addressing metabolic syndrome, the “pre-disease” for diabetes, heart disease, strokes, and certain cancers is an example of primary prevention. Secondary prevention is helping employees identify the problem after a disease has occurred, but before the person notices that anything is wrong. Early detection of cancer is a great example of this.

What both primary and secondary prevention highlight is that the person with the pre-disease has the “I Feel Fine” syndrome. Said another way,  how do we get an employee who feels fine, who has gotten up and gone to work for decades, usually without having a health issue arise in their life, go through the trouble of:

  • finding a good provider;
  • setting up an appointment;
  • going to the doctor’s appointment; and,
  • making additional appointments for additional testing (mammograms, colonoscopies, and so forth), every year?

To realistically expect this to happen, efforts must be made to address the inertia that has kept them from doing this previously. This requires answering the following questions:

A) Why should I do this?

  1. What are the implications to my life for doing or not doing this?
  2. What are the implications to my job for doing or not doing this?

B) Who is best to go to?

  1. Should I go to a primary care doctor or specialist? What is the difference? Why is one better than the other?
  2. Are there differences between doctors? Who is the best?
  3. How do I know if they are good at addressing this problem and even if they are good overall?

C) How do I get this done?

  1. Is it as simple as making an appointment?
  2. Will they do the right test?
  3. If I have to communicate to my employer that I have taken these actions, how do I do this?

D) Where do I get this done?

  1. How are my choices impacted by my health insurance plan?
  2. Can I go close to home or work?
  3. Do different doctors cost different amounts?

E) Who can I ask to get answers to these questions?

  1. Do I call my human resource staff, the health plan, etc.?
  2. How do they get cost and quality information on doctors and tests?
  3. Who can I trust to get these answers?

While intuitive for most of us in the health care arena, these are often intimidating issues that must be overcome for employees before they act. While it may be as simple as saying “call your family doctor”:

  • Over 40% of employees have not been to a primary care doctor at all in over 2 years; and,
  • 40% have only seen them for acute illnesses and have no true continuity of care established for prevention or chronic issues.

That means that up to 80% of employees may not know where to go to get their physical and age and gender appropriate tests performed properly and at the best price.

What if there were a way to simplify this process and greatly improve the chance of the right tests being done at the right place, by the best medical provider, at the right cost virtually 100% of the time?

In the next blog we will examine specific strategies companies are incorporating to help overcome the “I Feel Fine” Syndrome.

How the “I Feel Fine” Syndrome™ Is Costing You Millions – Part 2

By DrScott – Posted on December 31, 2013 on

In the last blog we examined the fact that during the early phases of disease development we don’t feel symptoms. Despite this, the disease is developing in our body and we can discover and cure it, but over 80% of us don’t take action.

So why don’t we do it? Why do 8 out of 10 of us put off these simple tests and condemn ourselves to years, or decades of pain and suffering?

Asked another way, why would a rational human being who is busy and challenged keeping up with obligations to family, employer, friends and social groups, stop what they are doing to:

  • go spend their time sitting on hold trying to make an appointment,
  • take time off from work – usually unpaid or using personal time,
  • take off their clothes and have a stranger probe their body, stick a needle in them,
  • go to another facility to have their body squished (mammogram) or a tube inserted (colonoscopy),
  • spend time worrying and waiting for results, and then,
  • often pay their hard earned money for additional tests or procedures that often turn out to be “nothing.”

This on top of the fact that this person has awoken for forty or more years and not discovered a problem, they don’t feel any different now, and frankly they really could not afford emotionally and financially if a problem was discovered.

Hard to imagine, isn’t it? Looked at from this perspective, one does wonder how we ever get anyone to get these tests done! To get people to overcome the “I Feel Fine” Syndrome, an effort to simplify and support employees’ acting effectively must occur.

The wonderful news is that it is happening. One company required their employees to have a biometric screening done and discovered that nearly a third of their employees were not only overweight or obese, but they had metabolic syndrome. Heart disease and diabetes were at the top of the list for health costs and their healthcare spend was rapidly increasing every year. They decided to actively engage in primary prevention with an aggressive metabolic syndrome program. Three years later heart disease and diabetes were costing them literally millions of dollars less and had fallen down on the list of causes of pain, suffering, disability, and death for their employees.

“Our costs were going up rapidly and difficult economic times created a very real challenge to our company. Our advisors were recommending that we change directions and become more proactive and aggressive with our health benefits by doing biometric testing and taking other steps that would mean more cost and a change in our culture towards wellness. The decision we made was to bet on the future health of our team members and not short measures to control cost.”

— Cary Evert, President Hilti North America

To learn more about their journey, request a copy of The Seven Numbers and read the introduction by Cary Every, President of Hilti North America.

In the next blog we will examine the issues companies are addressing to help overcome the “I Feel Fine” Syndrome.

How the “I Feel Fine” Syndrome™ is Costing You Millions – Part 1

By DrScott – Posted on December 26, 2013 on

How could this go on all these years without us discovering diabetes, heart disease, or cancer in your body and not acting? To understand this we just need to ask a person with pre-cancer, early cancer, metabolic syndrome, hypertension, diabetes, or heart disease how they feel. What would they tell you?

As a practicing doctor I can assure you it is almost always the same; “I Feel Fine.”

How could this be? The changes discussed in the first of the Seven Numbers Series describing the changes occurring in our bodies as we begin to develop diabetes, hypertension, heart disease, strokes, and cancer all occur without symptoms. Literally our bodies start to fail, either in the processing of food – metabolic syndrome, in the deposition of fat in the arteries – heart disease and strokes, or in the regulation of cells – cancer, without us feeling a significant difference in our bodies.

On one level this may not be a bad thing. ”Mother Nature” had to make a choice. Should I have people with early conditions “feel bad”, with milder symptoms as conditions begin, and then gradually increasing during the five to fifteen year window before the disease is fully manifest? Or should the pain and suffering be delayed as long as possible, with symptoms beginning much later in the process? Well, for diabetes, heart disease, and early cancer the choice was option B – hold off symptoms as long as possible, even though it is often too late when symptoms finally do appear to completely reverse the illness.

Until modern medicine discovered how these processes occur in our bodies, it was difficult to know where we are in this continuum. This means if we “feel fine” we may be perfectly healthy (and so as not to alarm everyone, the majority of working-age people are functionally healthy), or we may be walking around with a debilitating or terminal condition percolating in our bodies. But that is not the case today. With a few tests like blood pressure, cholesterol, blood sugar, and cancer screening (following the USPTSF recommendations) we can substantially increase the odds of knowing whether we are in this situation, though the testing is not perfect. Acting early, to reverse or remove the problem, is not only possible, but it is very likely to lead to arresting or delaying the problem for years. Even better news is that it is not necessary to do this testing daily or even monthly. Annual, bi-annual or even every decade (depending on the guideline) is enough to allow us to discover and keep these nefarious characters out of our bodies, while balancing the risk of being stressed over false-positives that can arise from over testing.

Setting up and encouraging employees to discover whether “I Feel Fine” = “I Am Healthy” or “I have not developed symptoms yet” is vital to preventing further illness and costs for your company.

Missed The Window? It Is Not Too Late

By DrScott – Posted on December 19, 2013 on

In the first three Seven Numbers posts the natural history of the most important conditions to your healthcare spend were shared. But what do you do if you have missed the primary prevention window? Is it too late to control costs? So let’s say that the disease has appeared in the body – diabetes, heart disease, or cancer. It is not too late.

With cancer, for example, one cell becomes two, then four, eight, sixteen, thirty-two, and so forth. But the cells are localized, contained in one small area. They could easily be removed by a short procedure. It is not until literally hundreds of thousands of cells have appeared that the ability to completely cure the cancer is lost for many of the common cancers. Again, it is estimated that 3 to 5 years go by during which we could act and literally save our own lives. Which cancers could be diagnosed early?

  • Breast cancer (detected with breast exam, mammography, and breast MRI),
  • Colon cancer (detected with colonoscopy, occult blood testing and exam),
  • Cervical cancer (detected with an exam and pap smear),
  • Endometrial cancer (detected with a history, exam and a simple test) and
  • Skin cancer (detected with history, exam, and a simple biopsy).

For heart disease, diabetes, or hypertension, blood sugar and blood pressure gradually rise. Fat gets deposited in our arteries (LDL cholesterol for example) and begins to accumulate. No untreatable “end organ damage” in our heart, brain, kidneys, or other organs has occurred (if they had the employee would have had a heart attack, stroke, or kidney failure). With proper treatment these complications can be prevented or delayed for decades. But the window to act is closing.

How does your company make sure this occurs? Why don’t we and our employees act? Why do the majority of us allow these changes to occur in our bodies without acting? In the next Seven Numbers Blog we will explore the answer to this question.

Why You Care About Your Employees Numbers

By DrScott – Posted on December 18, 2013 on

In the first two installments of the Seven Number Series, we examined how heart disease, diabetes, and cancer, gradually appear in our bodies. Every one of us is born with a higher likelihood of developing one disease over the other (a genetic predisposition). We then take in more calories than we burn, and we begin to gain weight and can become overweight or obese. Next, we continue to force calories into our body and our organs – the blood vessel, pancreas and other tissues of our body, are forced to put in overtime, often to the point of exhaustion or destruction, until finally the control (homeostatic) mechanisms become overwhelmed and fail, allowing the disease to manifest and gain a firm foothold in our body.

Why do you and your company care about this process? They significantly determine the health and future of your career and company; the loss of good employees, loss of productivity at work, and the cost of managing absenteeism. Here is where you find this on your health benefit reports:

  • Heart disease and type 2 diabetes (which is over 90% of diabetes) are directly driven through this process.
  • Many cancers – endometrial, pancreatic, breast (after menopause only), rectal, and colorectal cancers
  • Many emergency room visit are related to these processes, but are reported as “Injury and Poisoning” on cost reports,
  • “Pain and Suffering” on health cost reports include headaches, chest, abdominal, and pelvic pain not uncommonly related to these issues, and finally
  • Musculoskeletal costs are driven through the same pathway of decreased fitness, overweight and obesity with neck, back, hip, knee, and ankle destruction and the resulting treatment.

Altogether, these account for over 70% of many companies’ health spend. What would it mean to your company to reduce or eliminate a significant portion of these conditions?

The Five to Fifteen Year Window to Reduce Healthcare Costs & to Save Lives

By DrScott – Posted on December 12, 2013 on

In the first installment of the Seven Number Series, we understand how three of your biggest expenses are slowly (and effectively) attacking your company. The key to stopping this epidemic? Acting early – preventing pre-disease from moving to disease. During this phase, which lasts 5 to 15 years, our bodies have the ability to undo or delay any long term damage. If we stop the lifestyle and habits, our bodies will heal the damage – return to normal functioning, and even repair body tissues that are beginning to fail (diabetes & heart disease) or grow abnormally (cancer). Perhaps the best example of pre-disease that can be reversed is metabolic syndrome.

Metabolic syndrome is defined as the appearance of any three of these five numbers on an employee’s biometrics:

1. A waist circumference of 35 inches for women, 40 inches for men

2. Triglycerides (a lab test for blood fat) of over 150 mg/dl

3. A reduction in good – HDL cholesterol to <50 in women, < 40 in men

4. A blood sugar of >100 mg/dl

5. A blood pressure of >130/85

What do you do when you know these numbers? Simple, set up programs and activities to get them down. Everything from participating in 5K walks and bike rides, changing food out in the vending machines and your café, bring in targeted programs, and so forth. These actions should be part of your health benefits design and included based on their effectiveness.

Equally important to these efforts is activating and empowering employees to get more involved in understanding, monitoring and managing their health. Focus on what really matters – getting these Seven Numbers to goal. Putting incentives and penalties in place over a series of years is vital to actually decreasing illness, disability, and costs. Having a foundation to communicate with your employees, to empower them, is necessary for success. Please feel free to request a copy of The Seven Numbers book.

Follow my blog posts and I will give examples of companies that are doing these types of changes today with outstanding results.

Give Up Wellness Programs – It Is Time For Prevention

By DrScott – Posted on December 10, 2013 on

Catastrophic conditions, such as debilitating heart disease, diabetes, and cancer, don’t just appear in our body. They progress from having a predisposition passed on from your parents, to increased risk of the disease (for example when we gain weight or become overweight); to pre-disease, where the numbers we monitor like cholesterol and blood pressure begin to change; and to disease like diabetes, heart attacks, or cancer appearing in our body; to complications like strokes, amputations, and kidney failure, widespread in our body. Why is this important? Every step along this disease progression can be slowed or eliminated.

Most wellness programs try to attack this problem with lifestyle changes to reduce pre-disease – a good strategy if you are monitoring and targeting the appearance of pre-disease in your employees. How do you know if “pre-disease” is appearing in your employees? An effective program looks at the bio (life)-metrics (numbers) of your employees. If you don’t start with an understanding of the disease prevalence, time and money may be wasted.

Frankly, today the term “Wellness Program” encompasses such a broad range of initiatives, it has lost its meaning. Too often these programs amorphous well intended, information gathering and sharing efforts, devoid of actual metrics, and clearly defined next steps for the employee – point to a program that will fail.

In the next installment, we will discuss a proven set metrics to follow and why they are so vital to your company’s well-being.

Proactive Providers Save Lives and Money

By DrScott – Posted on November 26, 2013 on

In my private practice in the 1990s, I often would see patients for 7 to 15 minutes, three times a year, trying to inspire them and direct them in management of high cholesterol, diabetes, high blood pressure, and other medical conditions. One particular patient I remember was a mechanic working at a large defense contractor. He had diabetes, high cholesterol, and an at-risk blood pressure. Every year he would come in for his physical because it was required by his employer. I would test his blood and consistently find that his cholesterol and other numbers were not well managed. We talked about how important it was to treat these conditions. I would offer additional medications and teach him to improve his lifestyle. He always assured me that he “felt fine” and didn’t think there was anything significantly wrong. A year later nothing changed and he continued down the same path.

Then one year, he came in with a form from his employer and asked me to fill in his numbers to then send back to his employer. Upon completing the form and handing it back to him, he said he had a new incentive program at work and was rewarded if his numbers met the goal. I asked him if he was willing to take additional medications and he said he would do “whatever it takes”. Low and behold, he saw a dietician, took additional medicine, and got his numbers to goal. Upon receiving the reward from his employer, he and his wife used that money to take a trip in their RV to the Pacific Northwest.

This continued for the next several years with him maintaining and managing his numbers to goal because his employer would reward him for his behavior. After he retired he was no longer incentivized, lost focus on his numbers, and had a significant heart attack several years later. I believe we prevented this for years through his engagement.

It was through interactions like this that it became clear to me that seeing a patient for 7 to 15 minutes, three times a year was only a portion of the solution. Having a partnership with employers that encourage and support employees engaging in proactive healthcare was equally important. Through this partnership, employees would win significantly.

Exciting Update from GOH Medical-New Clinic Merge!

Important Update from GOH Medical Practice
Dear patients and friends:My dream has been to provide timely, state of the art, proactive, convenient primary care to add years to your life and life to your years by empowering you to take control of your health.  To accomplish this takes significant resources. GOH (Game of Health) Medical has tried to do this as a solo physician practice for the past 4 years with mixed results – and so it is time to evolve.The question was which group do I associate with to bring you outstanding care?  Fortunately, I had access to a huge database to research and find the best medical group.  Working with the team at Compass PHS, we created a Value formula to identify the best primary care doctors in North Texas.  We looked at quality, safety, service and cost – 21 variables in all, to identify The Premier Providers.

A group of practices use team based, outcome-oriented, evidence-based medicine to care for patients.  Some have received the NCQA Patient Centered Medical Home designation.  After this analysis, it was my job to get to know these practices. In doing so, Dr. Chrisette Dharma and Southwest Family Medicine Associates (SFMA) were discovered as the #1 doctors in this analysis. Her new, state of the art office is located halfway between my current office in Dallas and Irving. SFMA has the ability to do online appointments, extended office hours and Saturday appointment availability, all major insurances accepted, and provides extensive imaging, lab, travel medicine and other services.

It is with great excitement to tell you that effective January 1st 2015, I will be moving GOH Medical’s practice to SFMA to join their team and see patients.  Our team includes Nurse Practitioner Angela Kemp, Dr. Asa Hadwell to make sure you get great musculoskeletal care, and our new lifestyle coaching team who will offer you support on weight loss, smoking cessation, and staying with your 2015 health goals.  We will be working with Dr. Dharma and her excellent team of physicians at SFMA to make sure you get the best care possible.

The Park Cities MedSpa, Concierge, Women’s Health & BioTE bio-identical hormone practice will remain at the current GOH Medical location in the Preston Tower. The providing team here includes Celia Dolinta (DNP-Women’s Health), Jill Ethridge, Brandi Padilla (Medical Esthetician) and Cheryl Reinhart (NP). All other medical patients will be seen at SFMA.  To make an appointment at the SWFMA location, please call the direct number below, or you may use our current number and press option #3.

If you have any questions, please contact Lauren Kirschner before Jan 1st

I look forward to seeing you soon!

Scott Conard, MD

Southwest Family Medicine Associates
8877 Harry Hines Blvd
Dallas, TX 75235

Automate Doctor’s Office

If I could get doctors and present it would be to automate their office. We rely so much on being able to handle the patient’s primary complaint, all the best, screen for common conditions, and do the national prevention guidelines. It’s just overwhelming and leaves to Johnston games. In this article points out how he Dr. Buehler in Venice Florida has automated process the screen for prediabetes. The effect of this for thepatience and for the medical system as a whole is significant and profound. In work you done with corporations the average savings for the corporation when their employees or screen and given support in addressing that won’t syndrome is hundreds of dollars per month. This initiative would strongly considering.
Here to me is the crux of the article; Before the pilot program, Dr. Buhler said her practice had no standardized protocol in place to screen for prediabetes. Now, she’s using tools from the AMA collaboration to screen her patients and refer at-risk patients to the local YMCA. One patient who recently started the program already has lost five pounds.
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AMA Wire®: How one physician is helping stop diabetes among her patients

Scott Conard, MD DABFM, FAAFP

Check out our new book:

The Art of Medical Leadership: A Guide to Identifying and Moving Beyond Common Leadership Mistakes

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