Trust in Medicine, Trust Your Doctor

Episode Transcript

Speaker 1 (00:01):
Thirteen ten WIBA and full scope with doctor Nicole Hemkis.
Of course, doctor Cole Hemkiss comes to us from Advocate MD.
It is a direct primary care practice with four locations
here in the area west side of Madison and Middleton,
east side of Madison, right at one fifty seven South
Fair Oaks I Janesville For you southern Dane County, Rock

(00:21):
County folks. They are right across from the hospital at
ten twenty one Mineral Point Avenue and the newest location
of Advocate MD right up the road here from the
radio station, right on the Madison Fitchburg line at thirty
two to twenty siin Road. Beautiful clinics, great doctors at
all four clinics of Advocate MD. You'll learn more online
the website ADVOCATESDPC dot com. That's Advocates DPC dot com

(00:44):
and of course telph norm making a point become a
member at Advocate Advocate MD six eight two six eight
sixty two eleven. That's sixh eight do six eight sixty
two eleven. Doctor. How you doing this morning?

Speaker 2 (00:54):
I'm doing Also on how are you.

Speaker 1 (00:56):
I'm doing pretty well and real quick before we're going
to talk about trust with a doctor and mistrust that
folkses have developed with medical systems. Get to that just
a moment. I really want quickly though, want to just
talk about the clinics. And I know last week we
got pretty in depth about direct primary care and Advocate MD,
but let's talk just about some of the great benefits

(01:16):
of direct primary care and Advocate MD.

Speaker 2 (01:19):
Yeah. So direct primary care is a membership model, So
it means that you pay a monthly membership fee and
then when you come in to see us, there's no
cost for that visit. There's no copay, there's no if
we do a procedure in the office, there's no cost
for that procedure, Urgent care appointments, all of that is
included in your membership. Then things like if you needed
lab work done, if you need medications, those are an

(01:41):
additional cost. But those are all done at wholesale prices.
So for example, a lab might be you know, five
to ten dollars instead of two hundred to three hundred dollars.
You know, a generic prescription might be you know, five
to ten dollars for a ninety day supply. So again,
all of those are done at much lower cost than
likely if you were to use your insurance card to
do that. So this is a model that's not intended

(02:04):
again to replace insurance or for people that don't have insurance.
This is meant for people that do have insurance but
actually want better care, better access to care. It's easier
to get an appointment. We spend an hour with you
when you come in. So it's just a different level
of healthcare that you can't get with health insurance currently.

Speaker 1 (02:23):
It's an amazing model, an affordable model. You get access,
affordable access, and it's just a great, great model direct
primary care and Advocate MP again. You can learn more
online Advocates DPC dot com. That's Advocate DPC dot com.
You think about the important relationships in your life, obviously family, spouses,
you know that type thing. Outside of that, I've got

(02:45):
to guess for most of us, it should be probably
your doctor. And unfortunately, what's happened doctor Hemkis is a
lot of folks have kind of, you know, they've kind
of changed their perspective on doctors and people saying I
don't trust doctors, I don't trust hospitals. What is what's
going on there?

Speaker 2 (03:06):
Yeah, it's interesting. I feel like things have definitely shifted
just in the time that I've been a position. So
then I think about people like doctor Balen, who has
been a position for you know, about twenty years longer
than I've been a doctor, and I think it's definitely
changed a lot since he started practicing. But you know,
I think there's a lot of things going on in

(03:27):
the world and also just you know, the access to
information that we have nowadays, where you know, if you
can remember back to where we didn't all have the
Internet in our hand every every minute, or you know,
a personal computer. I remember when our family got our
first PC, and my dad at that time worked for IBM,
so I think we got it probably before other people did.

(03:48):
So I was in either seventh or eighth grade and
it was a crazy thing where you had this thing
where you could actually look stuff up and they had
these chat rooms and you could talk to people that
were across the world or across the country. So so
I think that definitely the world is a lot different
than it was, you know, twenty years ago. But you know,
so it used to be. I would say that before

(04:08):
people had all that access to information, you know, they
came into the doctor and they really relied on their
doctor to be their reference, their source of information. Nowadays
people sometimes do that, but they also tend to, of course,
look up a lot on their own. So it's not
uncommon that when people come in, you know, it's more
so it's not necessarily to get your diagnosis, but they've

(04:30):
already kind of diagnosed themselves, and now they want you
to either confirm it or deny it, you know, So
I think that that part has changed, But I also
think that, you know, there was that article that I
sent to Sean that kind of brought this to my mind,
and it was written by a medical student who came
from a sorry. The title of the article is Americans

(04:50):
no Longer Trust doctors And this was an op ed
done on doximity. I don't know if it was published
someplace else, but that's like a I guess it online
forum where a lot of doctors share information. So so
this medical student, their mother was was the type of
person that did not like going to the doctor, did
not trust medicine, even to the point where she like

(05:14):
didn't get routine you know, health maintenance type things like
you know, mammogram's colonoscopes or you know, take the kids
to get vaccinations and things like that. So then it's
interesting that this person actually ended up becoming a medical doctor.
But they're kind of offering, I guess, a different perspective
based on how they grew up and how they saw
their mother in terms of, you know, the perspective that

(05:35):
they got from her, which I think is a valuable
thing to think about. You know, I think that a
lot of this kind of accelerated around COVID. Of course,
we had this, you know, this event that affected everyone's lives.
You know, whether you got it or you didn't get it,
it affected your your home life, your work, your children's school,
and so all of a sudden you had to kind

(05:59):
of rely on and you know, not just the information
that you're getting online, you know, through the governments, through
your doctor, and there was a lot of obviously bad information.
There was a lot of information that you know, six
months or a year later, it was kind of contradicted
because I think, you know, much of it was like
we were doing the best that we could with the
information that we had. So I think that that of

(06:20):
course led to, in my opinion, a greater distrust of
the medical system and doctors, because I do think that
there are people out there that felt that some doctors
or the medical system was kind of pushing vaccines that
you know, had not been proven to be safe, and
that you know, there are some people that feel that

(06:40):
there are doctors getting kickbacks from these vaccines. Of course,
the pharmaceutical companies are making you know, millions or billions
of dollars off of these vaccines. No debating that. I
don't think doctors, unless they have some affiliation with the
pharmaceutical company which they might, are getting any kickbacks from,
you know, giving a patient a vaccine in their office.

(07:01):
In our office, when we give vaccines, we are selling
them at costs. We don't make any profits. And also
just to open up that can of worms of vaccines,
I viewpoint on vaccines is that, like almost anything else
in medicine, you know, as as a doctor, I counsel
my patients on what I believe is the best medical
information that we have, what I believe that the safety

(07:22):
profile is, and whether the risk out you know, outweigh
the benefits or the benefits outweigh the risk, and then
I ultimately leave it to the patient to make that decision. Right,
So so we can we offer that we can definitely
say that we recommend certain things and then ultimately the
patient makes that decision. I know there's a lot of
fear out there amongst patients or people that you know,

(07:45):
if they don't do certain medical treatments, if they don't
do certain vaccines that you know, a doctor's office won't
take them, or they won't treat them the same or
you know. So I like to dispel that that you know,
we treat everyone with respect, you know, even if they're
making a different medical decison, and then what we would
we would make for them or what we personally would make.
So so I think that that's important to point out too.

(08:06):
But I think, yeah, and that's also brings up the
point of you know, trust and respect. Those two things
kind of usually go hand in hand. So it's it's
if you don't respect something or someone, you know, it's
probably hard to trust them. So I think that there
there was probably a loss of trust and a loss
of respect. I would say for the medical system.

Speaker 1 (08:28):
You know. One of the very interesting dichotomies that that
I see and kind of that that's kind of sprung
up in the last decade or so, is these individuals
that are and I think part of this, this this
op ed that you shared kind of highlights that there.
I know, I think we all know people in our
lives that are hyper focused on their health. They eat right,

(08:49):
they exercise, they're very very conscientious about about what they
do with their body and how they do it. And
there's like this dichotomy of their very much into being healthy.
But then when you say well there's you know, modern
medicine and there's there's other things out there to help
your body remain healthy, there's that they suddenly kind of

(09:13):
change and say, well, you know, modern medicine, and they
kind of they go down this. I'll use bring Aaron
Rodgers into the mix here, but probably a prime Did you.

Speaker 2 (09:24):
Watch that documentary on Netflix?

Speaker 1 (09:25):
I did, I did, and.

Speaker 2 (09:28):
I got through I think two of three episodes. I
think I watched the second and I think there was
maybe a third.

Speaker 1 (09:33):
Yeah. Yeah, And there's He's a great example. Here's a
guy who does and I have a huge respect for
his talent and for you know, for what he does.
But I go like, is this I don't know, like
they get they kind of get into this world of
like I get, I get like being conscientious and I
get like higher, you know, trying to you know, achieve

(09:55):
you know, a higher I don't know whatever it is,
but I understand that. But like this idea that some
of these I don't. I don't want to be too
insulting either, but like, there are there are reasons why
despite all of our all of our poor health decisions
we make, that we're still living quite long. And a
lot of it has to do with with some pretty

(10:17):
amazing modern medicine, amazing doctors, very very smart people that
that really are there to help. And sometimes I just
I get I get really confused by that, Like what
had happened? Do how do we reset that? Doctor? Is
there a way to kind of kind of rebuild that
that trust, that or that that understanding that doctors don't

(10:40):
just go to school forever just just just to do harm.
I mean, how do we how do we fix that?
Is there a way to repair that relationship? Doctor? Yeah?

Speaker 2 (10:51):
I think well you bring up a good point, Sean
of you know, they're they're kind of different terminology we use.
So I I like to use the terminology complementary medicine
versus alternative medicine. Right, So it's not it doesn't necessarily
have to be an either or type situation, Like it
doesn't have to be well, I don't believe in antibiotics,
or I don't believe in chemotherapy for cancer, so let

(11:11):
me try this alternative medicine that really hasn't been proven
by any type of studies. It's kind of anecdotal. What
if instead we still have Western medicine and all of
the resources that you have, But then there are things like,
you know, for example, acupuncture, there are you know, erbal
medicine and Chinese medicine, and I've personally tried some of
these things and I think that in some there are

(11:34):
some conditions where they might help. There are definitely conditions
where I don't feel like that they are a benefit, right,
that we need you know, western medicine for those. But
I think that there is a very low risk for
things like acupuncture, right, and herbal medicine. So I think
that it's okay to do complementary medicine and and just
you know, as a Western medicine trained doctor, I do

(11:55):
not have all the answers. There's definitely things in medicine
and in life. Right they say medicine is an art,
I mean it's a science, but it's also an art, right,
So there's there's definitely things that that can work for
people that we don't truly understand why they work. You know. Again,
doctor Balin does prolotherapy, which is an injection technique for

(12:15):
people that have chronic pain or chronic joint inflammation, and
it works amazingly well. And I don't think we really
understand this. We understand some of the science behind it,
but we don't fully understand all the science of why
it works so well because it doesn't really logically make
sense that it should work this well. And last, you know,

(12:37):
kind of indefinitely. So I definitely think that there are
a lot of things that we don't have all the
answers for, and I think it's okay to have complimentary
medicine for those things. The parts that worry me is
when we try to replace kind of all of western
medicine with complimentary medicine or kind of There are people
out there that you know, believe in a lot of
homeopathic things. And again I am all for I am

(12:58):
a vegetarian, I'm all for eating a lot of plants
and you know, being very healthy lifestyle medicine wise, but
I do I do you know certainly believe that there
are conditions where we need to have western medicine, you know,
prescription medicines for those. So so when we have situations
where kind of a person is so distrustful to the

(13:20):
point where they, you know, don't want to take any medication,
I always say to patients that for me as a
doctor in the way I in my personal beliefs, I
think medication is a last resort, right. We try everything
else first, you know, we try the lifestyle medicine, We
try weight loss and diet and limiting you know, your
salt or increasing other things in your diet. You know,

(13:42):
we try all of those things first, physical activity, exercises,
whatever it might be to make that condition better. And
if we've tried all of that and it's still not
getting better to a significant point or the point we
need it to be, then we go to the medication.
So that's like a secondary thing.

Speaker 1 (14:00):
Yeah, I was gonna ask this is that how? And
I I feel like as as you know, as your
we talk, of course, talking this morning with doctor Nicole
Hempkause of Advocate MD Online Advocates DPC dot com. Doctor,
it feels like when we talk about some of these things.
So you talk about, you know, lifestyle medicine, and we
talk about you know, making making simple adjustments to our life,

(14:20):
like getting more exercise, things that are that have clearly
shown it to prolong life and quality of life. It
seems like in the current healthcare system, though, having those
conversations with patients just isn't you know. I think of
for folks that you know, go to one of the
big three here in town, they've they've got a couple
of minutes with their doctor. I don't know that their

(14:41):
doctor really has the time to go through with them
to say these are these are some techniques, or these
are some some suggestions for ways without getting on drugs
to help help remedy these these medical issues. It just
doesn't feel like like the current healthcare system is conducive
to that type of thing.

Speaker 2 (15:00):
That is very true, and I would say that's one
of the biggest travesties of the fee for service. You know,
what we call factory line medicine system that you know
ninety percent plus of patients are using, is that they
are treating the symptom or you know, they're they're treating
the condition, but they're not actually you know, helping you

(15:20):
with the basis of health, which is the lifestyle medicine stuff.
You know, are you getting out and moving every day?
You know, what are you eating? Or how much alcohol
do you drink? You know, what is the stress like
in your life? Do you do you sleep well? Like
all of these questions that people should be getting asked,
probably at almost every doctor's appointment, because all of that

(15:40):
will affect everything else, right, I mean, if you have
additional stress, that's going to affect the way you perceive pain,
If you know that's going to affect your blood pressure,
if you're not sleeping well, you know. I mean that
that obviously can affect you know, cognitive ability, that can
you I mean, there's so there are so many facets
to it. And as you said, Sean, they you know,
a study that came out a few years ago from

(16:01):
the American Academy Family Practice said that the average family
physician is sitting in the room with the patient, talking
to them examining them for approximately seven minutes on average. Again,
that doesn't include the time before they walk into the
room they're going through your chart, or when they leave
the room they're putting in orders or reviewing labs. So
the seven minutes that they're actually in the room with

(16:22):
the patient, you know, and I always what I present
this a lot during my presentations I make to employer
groups and you know, different groups that I speak to.
You know, once you get in the room, you say, hey,
miss Jones, you know, how are you, how's your family,
how's work going? You know, you know, and then you
ask them, you know what you need these prescriptions refilled.

(16:43):
Then there's a list of three or four things that
she's written down that she wants to talk about. And
we're already into minute five at that point, oh six,
so we have two minutes left, you know, according again
to the statistics of how long a a an insurance
based doctor can stay in the room. So it is
no under that patients are rushed through their visits. They

(17:03):
are told to make another appointment to come back. And
that doesn't include, as you said, Sean, any discussion of
lifestyle medicine or any discussion of those tenants Like I
said that the tenants of nutrition, exercise, stress, substances, sleep,
those are the five things that I usually like to
talk about with patients as much as I can. So

(17:24):
we could be missing huge things because usually when I
ask those questions, there's always at least a couple things
that come up. There are things we need to talk about.
So instead we're just you know, filling the prescriptions, we're
ordering the labs, kind of rushing the patient out of
the visit. That's not satisfying for the patient. Of course,
that's not satisfying for me as a doctor, because you know,

(17:45):
I didn't go into medicine to just triage people out
to other doctors. I went into it because I like,
actually like taking care of medical issues and you know,
being the one that's managing their diabetes or their hypertension,
their thyroid instead of sending them out specialist to manage everything.
So it's a much better way of practicing for a physician,
and it gives me a lot more satisfaction. And also

(18:07):
just being able to talk to people. I remember and
residency because they already start to talk to you about
burnout even before you finish your training. They're already preparing
you that you are going to be burnt out when
you get out into the world. Is not crazy, but
I remember an attending I believe in residency saying maybe
it was my mentor was saying, you know, when you
start to feel yourself getting burnt out with seeing patients,

(18:31):
you remember that you know, this is a human being,
and you know, start asking them about their life, and
then it becomes interesting, you know, it's becomes like now
we're just having a conversation again. And that's of course
how you build trust, That's how you build that doctor
patient relationship because then I you know, patients of course
will talk to us about things that they don't share
with anyone else, you know, stressors and their marriage, stressors

(18:52):
with their children, you know, like deep personal things. And
again that is the part that I enjoy about my
job because I like having that relationship with my patients
and I could not have that in the system, and
the big system. To me, I don't know how doctors
have deep relationships with their patients because I was not
able to form that in a seven minute visit seeing

(19:14):
a patient once or twice a year, so I see
them for fourteen minutes a year, and in our model,
we see them for an hour, you know, forty five
minutes to an hour. So then if they come in
two or three times a year, I mean I'm spending
some quality time with them, and then we have a
mutual respect and you know, trust and so they like
they know me a little bit better, and so then

(19:35):
that helps me a lot to be able to talk
to them about their medical issues. And again, if it's
whether they have a distrust of pharmaceutical drugs a lot
of people do, Whether they have a distrust of vaccinations,
many people do. You know, we can talk through that,
and again my job is to tell you, you know,
what I think the research shows and the best you know,

(19:57):
whether the pros outweigh the cons of that ticular treatment,
and then ultimately the patient makes the decision.

Speaker 1 (20:03):
It's one of the great things about what you're able
to do at Advocate MD and direct primary care. You
talk about the lengths of the appointments and you're actually
in with your doctor medical doctor. Do you're actually in
with your doctor spending that time getting to know each other,
really working through that stuff to get you the absolute
best healthcare and primary care. Of course, you can learn

(20:24):
more online the website ADVOCATEDPC dot com. That's ADVOCATESDPC dot com.
Tel for number six so eight to six eight sixty
two eleven, great data. Make an appointment and become a
member at Advocate MD. Again their number six oh eight
to six eight sixty two eleven. We'll continue our conversation
with doctor Nicole Hemkiss next as full Scope continues right
here on thirteen ten WIBA. Thirteen ten WIBA and full

(20:46):
scope with doctor Nicole Hemkiss, Wisconsin's direct care doctor. Of course,
Doctor Hemkiss comes to us from Advocate MDA direct primary
care practice with four locations right here in southern Wisconsin,
two here and three here in Madison west Side, east Side, Southside,
and one in Janesville. Right a ten twenty one mineral
Point av You can learn more all online ADVOCATESDPC dot com.

(21:07):
That's ADVOCATESDPC dot com. If you are a business owner
a business leader, there's a great tab right across the
top of the page that says businesses gives you some
great details about some of the advantages for employers and
employees when it comes to direct primary care and Advocate
MD and real Quick Doctor. It's got a couple of minutes.
One of the things I did want to ask about
is we are talking about all the great benefits of

(21:29):
and that what you're able to do as a doctor
and spending time with your patients. And we talked a
little bit about that. In that last segment, people then
automatically say, well, this must be expensive, this must be
cost prohibitive for the average person, and people are going
to be surprised. It's absolutely not cost prohibitive. It's actually
quite affordable, isn't it.

Speaker 2 (21:51):
Yes, so on average when you look at our prices
are based on age, but when you average it out,
it averages out to about seventy dollars per patient per month.
So a family, you know, with two adults and two
children might be you know, two hundred and twenty dollars
approximately a month for the whole family. And it's meant
to be affordable so that patients can, you know, have

(22:14):
a direct primary care membership along with their insurance and
ideally hopefully it's a higher deductible insurance. You know that
there's different you know, high deductible for some people might
be two thousand, for other people might be five thousand
or ten thousand, but you know, a higher deductible insurance
and then the direct primary care kind of fills that gap.
But again, most of our patients, you know, ninety percent
of our patients have insurance, and this is an add

(22:37):
on because they are not getting good access. They're not
getting enough time with the doctor. All they're out of
pocket costs like labs, you know, medications, X rays, all
that stuff is super expensive. So this is providing them
with better care and more affordable you know, out of
pocket cost.

Speaker 1 (22:51):
It's a pretty amazing model. And again all the details
available to you at ADVOCATESDPC dot com. That's Advocates DPC
dot com. You can see what it's all included in membership.
I know transparency is very important to the doctors. At
Advocate MD. You can learn about membership fees, everything you
need to know up at ADVOCATESDPC dot com. Great data,
Make an appoint and become a member six oh eight

(23:13):
two six eight sixty two eleven. That's six oh eight
two six eight sixty two eleven. Doctor hepkis you enjoy
the weekend and we'll talk real soon.

Speaker 2 (23:21):
Thank you, Shiny too.

Speaker 1 (23:22):
News is next here on thirteen ten wib E