A Direct Primary Care Doctor Takes Over My Medical Care

a stethoscope and pen on a medical recordAn account of a frustrating experience with the fee-for-service medical world and how health outcomes are better with direct primary care


The Problem

Shortly after moving to Chicago from Vancouver, Canada in 1999 I developed a rash on my face. I thought it would resolve on its own, but after several weeks of persistent itching I went to see a primary care doctor. She told me she thought the rash was the result of dust mites in my apartment. So I moved. Read More→

In the News: Flu shots save lives

Though the flu shot is known not to be 100% effective, a recent study confirmed that the flu shot dramatically reduces the risk of death in children and adolescents. From July 2010 through June 2014, 358 laboratory-confirmed influenza-caused deaths were reported in the U.S. among children age 6 months through 17 years. Vaccination status was known for 291 of those who died.  Read More→

A Patient Asks: “How do you treat snoring?”

Snoring is a sound produced by vibration of the soft tissues of the upper airway during sleep. It usually occurs during inspiration, but can also occur during expiration. Habitual snoring is common, occurring in 44 percent of men and 28 percent of women between the ages of 30 and 60. Occasional snoring is almost universal. Read More→

Intermittent Fasting for Weight Loss (and Other health Benefits)

In recent years, interest in intermittent fasting—that is, not eating at all for a certain number of days per week—has been increasing. Intermittent fasting (IF) has been practiced worldwide based mostly on traditional, cultural, or religious grounds, but recent experimental data suggest it’s not only safe but also effective for achieving weight loss. What’s more, evidence is accumulating that it can produce a myriad of other health benefits. In this article, I summarize the data supporting the use of IF and include my recommendations for who might want to try it and how they should do it. Read More→

In the News: Advances in treating Alzheimer’s disease

New studies have been showing some exciting results that hold promise for the effective treatment of Alzheimer’s dementia. One such study showed that infusion of an investigational drug cleared amyloid plaques—the tangled clumps of protein found in the neurons of Alzheimer’s patients—by stimulating the immune system. The study wasn’t powered to show if it had an effect on the symptoms of Alzheimer’s but larger studies are sure to follow. Read More→

A Patient Asks: “How do you know if an infection is bacterial or viral?”

The question: When you have an upper respiratory infection, how can you tell if it’s bacterial and you need antibiotics or it’s viral and antibiotics won’t help?

The science: Statistics show that by far the majority of infections in the respiratory tract (sinuses, nose, throat, lungs) are viral. Bacteria are responsible for sinusitis, for example, in only 0.5-2% of all cases. Bacteria (specifically strep infections) are responsible for pharyngitis (sore throats) in only 5-15% of cases. Rarer bacteria are responsible in less than 5% of cases. Viral infections account for sore throats in 80% of cases. Bacterial infections are responsible for bronchitis in only 1-5% of cases. Read More→

Letter to a Widow

I remember when I first read the pathology report on my patient, Mr. Jackson (not his real name), my stomach flip-flopped.  “Adenocarcinoma of the pancreas” it said. A week later, a CT scan revealed the cancer had already spread to his liver. Two months after that, following six rounds of chemotherapy, around-the-clock morphine for pain, a deep vein thrombosis, and pneumococcal pneumonia, he was dead. Read More→

An Alternative to Willpower for Losing Weight


A common belief, even among doctors, is that almost no one succeeds in losing weight in the long term. And for almost two decades, I’ve counted myself among the skeptics, being able to tally on the fingers of one hand the number of my patients who’ve managed to do it—literally less than five out of multiple hundreds, if not a few thousand.

When I stumbled across the ideas put forth in the slow-carb diet though (“slow” in contrast to “low” because one cheat day a week is allowed), I became excited—and not just for my patients. Read More→

Why Executives Don’t Need Executive Health

Traditional Executive Health programs designed for business executives take advantage of the widespread belief that more medicine is better medicine. That is, if a test is available to detect disease, it should be done. For this reason, such programs typically offer a full day of testing designed to detect hidden disease at an early (and therefore theoretically curable) stage and assess the risk for future disease. Read More→

A Patient Asks: “What’s better for back pain, heat or cold?”

lower-backThe question: When you strain your back, which should you apply, heat or cold?

The science: One study reviewed the literature and concluded: “The evidence base to support the common practice of superficial heat and cold for low back pain is limited, and there is a need for future higher-quality randomized controlled trials. There is moderate evidence in a small number of trials that heat wrap therapy provides a small short-term reduction in pain and disability in a population with a mix of acute and subacute low back pain, and that the addition of exercise further reduces pain and improves function. There is insufficient evidence to evaluate the effects of cold for low back pain and conflicting evidence for any differences between heat and cold for low back pain.”

Caveats: When you strain your back, pain may emanate from more than one source. There is the pain that comes from the structure that’s actually been injured, frequently a structure buried far below the skin, out of the reach of either heat or cold. Then there is often the pain from accompanying muscle spasm. These muscles are located superficially and therefore are easily within the reach of heat and cold. Thus, it’s this latter pain that heat or cold has a chance to affect.

My recommendation: Muscle spasm, in general, is made worse by cold and improved by heat. Thus, though I have the occasional patient who tells me that applying cold to a back injury improves pain, in general I always recommend heat to reduce the pain of muscle spasm. The best way to apply heat is through water, either in a hot shower or with a hot washcloth. Heating pads are good, too. I usually recommend applying heat for 20 minutes at a time throughout the day. I warn against sleeping with a heating pad on because of the risk of burning the skin.