Celebrating Five Years of DPC: Growth, Challenges, and Community Impact

Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Hey there, my DPC storylisteners, I'd like to let you
know that this episode containssome sensitive language.
If you have little ones nearby,please use discretion.

Dr. Maryal Concepcion (00:12):
Direct Primary care is an innovative
alternative path toinsurance-driven healthcare.
Typically, a patient pays theirdoctor a low monthly membership
and in return builds a lastingrelationship with their doctor
and has their doctor availableat their fingertips.
Welcome to the my DPC storypodcast, where each week.

(00:33):
You will hear the ever sorelatable stories shared by
physicians who have chosen topractice medicine in their
individual communities throughthe direct primary care model.
I'm your host, Marielleconception family physician,
DPC, owner, and former fee forService.
Doctor, I hope you enjoy today'sepisode and come away feeling
inspired about the future ofpatient care direct Primary

(00:57):
care.
this is incredible how fast thelast year has passed.
We are already celebrating yearfive of the practices that we
are highlighting today.
And if you are new to thepodcast, please start by
listening to the first 10episodes of the podcast where
you can hear the, NIUs of all ofthese physicians.

(01:18):
We've been so fortunate to havethem share their stories at year
one, year two, year three, yearfour anniversaries, and now year
five.
So welcome back to the podcasteverybody.
Thank you.
Thank you.
And if you wanna see theiramazing faces, go to YouTube for
sure.
But you know, I was justlistening to, as I traditionally
do before we were, we do ourannual recording, I was

(01:40):
listening to your guys' updatesfrom last year, and DP C has
changed for all of your lives interms of one more year under
your belt, but also this countryhas changed in the past year.
So we're gonna be talking aboutthat.
So I would love if we couldstart with updates as to what's
been happening.
So let's start with Defiant DPC,Dr.
Jake and Dr.
Christina much are here today,and they're going to be talking

(02:03):
about what's been happening atDefiant.

Dr. Jake Mutch (02:06):
So super exciting.
Over the, the past year one ofthe things that kind of just
happened again by happenstanceis we ended up hiring a fourth
doctor up to the practice.
So it's the two of us, plus Dr.
Eileen and now Dr.
Derek.
And and that has been wonderful.
That was earlier this year.
And so we've just been kind ofgetting all of the protocols
that we had set up when we werehiring Dr.

(02:27):
Elene.
'cause that was a kind of a hugething to undertaking to figure
out.
We kind of use that same sort oflaunchpad and those like that
to-do list to help make it alittle bit easier for the next
time.
And now we're fine tuning thatbecause we're kind of getting
mus from other doctors who havereached out thinking about
something similar.
So we're very excited aboutthat.
We also, just recently, a coupleweeks ago, we hired a

(02:48):
nutritionist slash wellnesscoach as what we're kind of
putting as a a wellness guide,so to speak, to help bring the,
like our vision for what primarycare is.
So, longevity forward doctors,unparalleled care coordination,
but then also having.
A wellness professional to helpguide people who really want
hand in hand service.
And so, we'll have a, a wellnessmembership.

(03:09):
There's a, we've just bought abio impedance scanner as well,
and so we're gonna be doing somemore detailed measurements for
the people who want that reallyhigh touch specific tracking.
So very, we've expanded ouroperations team as well.
And so, we're kind of gettingthe crew bigger and just trying
to make sure that we're allstaying focused on trying to
deliver what we see as elevatedprimary care.
So, super excited.

(03:30):
Lots of stuff happening.
It feels like it's all beenhappening very, very quickly.
But we're excited.

Dr. Christina Mutch (03:34):
I would say the only thing I have to add is
that we've expanded ourcommunity outreach a bit.
Yeah.
So we, we started Walk With aDoc now, oh my God, two years.
I think we celebrated our twoyear anniversary this year.
And we've expanded that to kindof doc talks around town to
different fitness studios tokind of, again, in a day and age
with so much misinformation.
Oh, and.
Resource overload, kind of justtaking it back to grassroots and

(03:56):
being available in thecommunity.
And those have been really wellreceived.
And, and I can tell that thepeople there, really have
appreciated it and they're juston basic prevention topics, but
they just don't get that timewith their doctors and they may
not be a patient of ours.
So it's like giving them thattime to ask questions and dive
deep on some preventative topicshas been really fun.
And then we've also expanded oursweat with the doc series, which

(04:18):
is basically where we take ourpatients and make partnerships
with different fitness studiosto try different exercises
together and just kind of,again, trying to get everybody
to find their exercise home.
And it can be reallyintimidating.
So we get to look silly withthem.
I tell them.
And so we're doing Tai Chi thisweekend.
I've never done that before.
We've done Pure Bar, we didorange Theory, we did yoga.

(04:40):
I feel like I'm missing one.
But yeah, it's been really funand the patients have really
loved it, so it's just been afun way to kind of, I think
we're trying to find ways tobuild community outside of the
office.

Yeah.
Oh, and Christina got menopauseuh, certified as well too, which
is awesome.
And so we have a lot of patientsasking about that and so it's
nice to be able to kind of pullthose resources together and
talk about, challenging cases orthe best way to move forward
with stuff.
Absolutely.
Love it.

Dr. Lauren Hughes (05:03):
your pause before certified, I thought you
were just like, Christina gotmenopause.
I know.
I don't think that's your

No, you're not dealing with top bras when
you're talking to me, that's forsure.

Dr. Deepti Mundkur (05:19):
Oh my God.
I thought I was like, sorry,Christina.

Not yet.
I'm certified.
Certified.

Happy wife, happy life.
That's hilarious.
Not today.
So we're dipping our toes in,and I have so many questions to
follow up with what you guyshave already mentioned, but
let's turn it over to Dr.
Lauren Hughes at BloomPediatrics and lactation.
I would love to hear your updateas to the things that have
happened in year five for you.

So I, now I, my third doctor is starting on
Monday, which is just wild.
Still have no staff, stillholding strong with no staff.
And it's been really fun.
I, my social media has, hasgotten I kind of like this
platform now and I get to liketalk and I get to educate and

(06:08):
it's opened very unexpecteddoors.
Anytime I talk about DPC or I'mlike, Hey, this, guess how much
an x-ray is 30 bucks withoutinsurance.
And I do that anytime.
People are like, excuse me, Ihave good insurance and it costs
me three times that much.
I'm like, well, good insuranceis an oxymoron, so, Hmm.
And, and so I, there's a lot ofjust like education about people

(06:31):
didn't even, people not knowingthat they could ask for a cash
price at, at, at specialties.
Or, or, and for imaging or forlabs, not knowing that that is
an option.
Giving examples of I, here ishow d this is how DPC saved this
patient money.
A lot of education around likeother direct care clinics and

(06:52):
like how to become what what weare is a Medicaid ordering,
preferring prescribingproviders.
So like we conceive Medicaidpatients, Medicaid recognizes
our orders, we just don't billMedicaid.
So it's there was a lot of well,what about those kids?
And it's no, we actually have a,a gap coverage for that.
And so that has been reallygood.
I do every year I do a communityfall vaccine clinic because

(07:14):
people are really scared ofvaccinating kids and so, that
has been.
Interesting to figure out thisyear.
And and so it's been reallyhelpful that I've was able to
talk with like my Pfizer rep,with my VaxCare rep, with all of
these different people on, onhow access is going to look.

(07:35):
And luckily for us this yearaccess is looking equivocal to
previous years.
I just have to click one morebutton.
Fine.
And so that I, that's somethingI always do, which I think is
really important for people tounderstand, like the importance
of, of vaccination, theimportance of, of like herd
immunity, protection, that sortof thing, but also just as a
like, free way to, to providethat to kids and get more kids

(07:57):
in the community protected.
And like kind of going alongwith the vaccines is that I,
I've had.
I can't even count the number ofmessages of people that are
like, thank you for continuingto talk about this and
continuing to debunk.
I can't, dozens of messages ofwe were scared to vaccinate.
Now we are.
And that's been reallywonderful.

(08:17):
I even had someone from, wherewas it?
They were stationed in the ukand it was just, it like, oh, it
got me.
She said, just thank you so muchfor sharing your knowledge, your
work matters and has made apositive impact on my family's
life.
And just like that sort of thingof me yelling at my phone is
making a positive impact acrossthe world.

(08:41):
What it's just, it's wild.
And so it's not even like justmy own community now and I just.
That's so cool.
It's so

cool.
It's so cool.
And I just, I think it goes backto even when you opened your
practice, all of you,, youprobably couldn't have seen this
coming.
Nobody could have seen what hashappened in the past few months
happening.
But what I will say is that, itreally it really builds on why
you guys started practicing andthe doctors that you were before

(09:12):
opening, and the doctors you arenow.
So.
Dr.
Mco, I would love to hear aboutwhat's happening at my Happy
doctor, because one of thethings too that you were part of
this year that wasn't in inexistence prior was you were
part of the California DPCSummit.
Yes.
I was gonna mention that set ofspeakers.
Yeah.
And so, community, I, I'vedefinitely boots on the ground

(09:35):
wise have seen the impact thatyou've made in California, but
I'd love to hear what's beengoing on with your practice and
your community.

Yes.
So I think I took your advicefrom, Jake about raising his
prices and actually seeing agreat outcome.
And I did it and it workedgreat.
I feel like I went from being acheap doctor to a rare disease
expert.
It's just incredible how moneyis, your time is valued and

(10:04):
money kind of defines how yourpractice might be.
It made a huge difference andI'm so thankful for these get
togethers we have every yearbecause it teaches me so much.
Even though it's not, we are, weare so different in many ways in
how we practice and like how wegrow our practices.
I just feel like there's thecommon theme of community

(10:25):
wellbeing really being like.
Providing personal care,personalized care to each
patient and valuing each patientas a person and not like a
number that they usuallyexperience in the, in the
healthcare system that we haveright now in with the insurance
model.
So one is I become a raredisease expert.
It's crazy because I feel likeover the five years there were a

(10:48):
few patients I've accumulatedmaybe early on, and it was very
challenging to get a diagnosisand like I had to go to
Harrison's textbook medicine,which I had time for because I
have a DPC.
And so in general, I feel likeit reached it was very
interesting to see how thingsculminated into finding a
mitochondrial disease expert andnavigating that and just making

(11:10):
connections through otherpatients', family who are
genetics experts and like tryingto bring the community together
to help me help my patient.
And that has been incrediblebecause now with that.
With that scale at which I'mable to connect with the
community.
I have so many connections, likea massage therapist who's

(11:31):
massage, and a like, how do youget these people?
You just have to be out thereand reach out to the community,
find these people.
And so when I, when I was ableto connect to this mitochondrial
disease expert and then theytold me the usual timeline for
diagnosis of this takes about 10years.
And it's crazy that you've cometo us in two and a half, three

(11:55):
years.
And for me it was hard to evenbelieve that two and a half to
three years is the timeline fordiagnosis.
But anyway, so that's beengreat.
Success.
It also with my pickleball, I'vebeen up and about everywhere
playing pickleball and we wentto this one location and the
mayor of Escondido.

(12:15):
Not San Diego, but Escondido,which is a neighboring city was
there and he had never heardabout DPC and I was able to
share it with him.
He is, people with differentpolitical views, but having that
common theme of, I need care.
He was not happy with his care.
He was being sent around and I'mlike, you're the mayor.

(12:36):
And it was interesting to seethat he had never heard of DPC
and he had never heard that thisis something doctors do.
They all know concierge, butthey, there's, this kind of
personalized care.
So that was very interesting.
Also connected with more doctorssince the DPC conference.
So they reached out for, justfiguring out how to get started.
And that's been great to justshare and give back.

(12:58):
And then I've read a lot ofbooks lately because I have the
time and there's this one book Ihave to share.
It's called a, a Well Lived Lifeby 103 year old doctor, and
she's, she's a white doctor wholived in Arizona for the longest
time, but she was born in Indiaand like she actually spent
years in India.
She even saw Maha Ma Gandhi.
It's just incredible.

(13:19):
I found that book and I sharedit with everyone I love because
I think she speaks about thetrue care DPC tries to give with
connecting with another humanbeing.
And it used to be like that withdoctors who are now 103.
So, it's, it is great and Ihighly recommend that book, but

(13:39):
that's pretty much, that'spretty much how I've been just,
just so happy that I chose thispath.

One of the things I wanted to go back
to is Dr.
Jake much had mentioned this inthe very first episode you guys
did about Defiant this idea ofsmall batch practice.
And I'm just wondering if youguys could all talk to us about
how even though you're five plusyears in you've, grown in some
cases with multiple doctorsgrown in terms of more community

(14:06):
members, more physiciancommunity members reaching out
to you, how do you guys stillview the quality of care that
you're able to deliver and howyou actually do that, even
though you might have morepeople in your DPC ecosystem
locally

I would say that small batch in my mind still
means a little bit moreproactive.
A little, we see people a littlebit more often.
We're talking about longevityforward stuff.
I saw that outlive book.
Yeah.
On on Dr.
T's shelf.
Like we use some of this as aframework to help bridge that
gap for patients.
But we know that no matter whatthe, the physician curriculum or

(14:43):
what they're going through,patients no matter what that
looks like, ultimately there'sgoing to be.
Stuff on the back, there's gonnabe obstacles, roadblocks that
need to be paved in order toconnect the dots.
And so we realized in our areacertainly with our I guess, some
of our specialist conundrums,we've realized that oh, no, no.
Part of what differentiates usis all of the wonderful work

(15:03):
that our operations and clinicalteam does on the background to
make up for the shortcomings ofthe healthcare system.
And that's something we'reextremely, I mean, it lights a
fire under my butt, like youwouldn't know.
And because it's sodisappointing and to get it
wrong is, is often to misscancer or to delay diagnosis and
nothing pisses me off more.
And so there is, there's thatpart of it.

(15:24):
And then trying to make a goodexperience for patients, for
sure it doesn't require sheetrock and waterfalls.
But we wanted to make sure thatit was a good experience and
that there are some people whohave, who want kind of that,
physician care coordinator, butalso a wellness professional
too.
And we're working out anddevising what that looks like in
the future.
We're kind of seeing like theshape that that's taking.

(15:45):
So that's how we think aboutspread care.
Even though we're scaling theteam, we want to keep a very
small field where everybody haspeople that they can trust and
it doesn't feel anonymous.

And, and I think just building on what
Deepti said earlier, you knowabout the, her finding the
mitochondrial expert.
It's like we are, we arecurating handpicking specialists
for people.
We're not just sending'em towhatever cardiologist is in our
system.
When we click a little box, it'sno, no, no.
Who's the cardiologist that aspecialist on X, Y, and Z?
And we'll also their personalitywill match you.
So you'll have a therapeuticrelationship and I know you guys
will have a good thing.

(16:16):
And so I think that is one ofthe ways we keep it small batch
is like the, it is not cookiecutter, it is personalized.
And I kind, I know not to knockon concierge, but I feel like
insurance-based world is cookiecutter, insurance-based world
and some concierge practices runa cookie cutter, but expensive.

Yeah.
And

everybody gets full body MRI and everybody
gets a gallery and everybodygets X, y, z.
I'm like, that's notpersonalized.
You're just, you're just acookie cutter in the opposite
direction.
And what delineates us is thatwe are personalized for the
patient in front of us and we'renot gonna take so many patients
per doctor that we lose sight ofthat.
And that's really important tous.

Very similar to what Christina said I'll give
you an example.
I had a one month old that wasjust in for a well check and I
was doing his vitals and I waslike, huh, your heart rate's
high.
So I just left the monitor onand I was like, okay, we'll feed
him, we'll get him to calm down,wouldn't come down.
And it was like, not SVT high,but it was, it was, and it just

(17:11):
made me feel weird.
Like enough, the, the doctorSpidey sense, I'm like, I don't
like it.
So picked up my phone called thecardiologist, called Ped Cards
and I was like, I'm sitting herewith this one month old, we're
staying in the one eighties atrest Room's dark.
He's calm.
I don't like it.
What do you like it?
I don't like it.
And he was like, yeah, send itdown.

(17:31):
I'll call the office, gimme thelast name, we'll put a Holter on
'em, and then we'll give him acall in a couple days.
And this is an insurance basedcardiologist, by the way.
And just things like that, thatI can, you just can do things
better.
The, and I maybe, I don't knowif this is true in adults, but
impedes, you can just call andconsult with specialists.
And, and so, I had a kid with anelevated blood pressure on

(17:55):
multiple well checks.
And so I was called nephrologyand I was like, it's not like
enough to be anything, but it'ssomething, and he was like,
yeah, get him.
No one ever calls about elevatedblood pressures.
Yes.
And ended up having some likekidney issues.
And so similar exactly whatyou're saying.
Like you look at the patient infront of you.
And like you, you were able tofigure out okay, the, the one

(18:18):
month old, they're getting readyto go on vacation, and it was
like a big vacation thing and Iwas like, and they were driving,
so I was like, okay, that wayyou can on your way home, put
the Holter on, they can monitor.
They got'em set up, was able togo on vacation.
I was texting and calling andthen I was like calling the
cardiologist and reporting backand you're able to do this.
God, this really, what you, whatI imagined at six when I was

(18:41):
like, I'm gonna be a doctor andhelp people like this is it, it
is what I'm doing.
It's cool.

So cool.
It's like special treatment foreverybody, right?
It's like everybody gets theIt's what I would want for
everybody.
Exactly.

Exactly.
Yeah.
You're like bit biting at thechomp.
So go in, go in, just dive in.
Oh, right.

Well, I think this is so cool like this
over the years connections withall these different specialists,
but you can just text them.
I go visit bird conservatorieswith these doctors because I'm
just like, you are cool people.
Let's just go hang out.
And then they ask me questionsabout internal medicine stuff

(19:24):
when they have a patient who'scoming in for a year thing.
The ENT doc was like, oh shealso has a brain tumor.
Like what do I do with this?
And so it's just veryinteresting how we could
actually help each other.
It's not just one way.
And I send gifts to these peoplewhenever they help my patients.
Once in a blue moon, randomsurprise.
What do I do?
I usually send those all thosedipped chocolate dipped

(19:46):
strawberries and stuff that theycan edible arrangements.

Oh, that's my go-to too for all her like
fitness studios.
It's

awesome.
It's like kind of healthy, butkind of, kind of treat.
So I do that and then it's justlike, all these doctors find it
so convenient to communicate.
It's not like they, hard, hardor like they're trying to just
please you and stuff.
It feels very natural after awhile.
And so there's just like Laurengave examples, I feel like
there's one who, she was juststruggling.

(20:13):
She's a psychiatrist, childpsychiatrist who by the way, a
lot of doctors have become mypatients.
It's just I think doctors arejust so, so, fed up and the, the
most burnt out profession.
So she was, ketamine fordepression.
Like so many complicated thingsgoing on.
And I just listened to her onthe meet and greet and I said,

(20:34):
you need a rheumatologist.
I texted a Dr.
Zach Fellows and Carlsbad.
I texted him.
I was like, I'm sending you apatient.
I think it's room.
And he is so good that he's notthe kind of specialist who will
say oh, not my territory.
Go find somebody else.
He was like this seemshematologic.
I'm like, great.
Okay, good.
So he is one of those fewdoctors who's like really good

(20:56):
internist too.
And I think it's so hard tofind, like Christina was saying,
you want to find a, you wannacherry pick a doctor who
actually cares, who's aspecialist, who cares, who
doesn't wanna say, oh, this isnot my, which is I'm seeing,
which is what I'm seeing a lotactually these days.
Oh, this is not room, sorry, gofind somebody else.
Not my problem.

(21:17):
And I think those kind ofspecialists are the ones that
have burnt out within thehealthcare system.
And they just, I would've becomelike one of them just referring
out all the time.
And is, it's such a sad way topractice medicine because you
did not become a doctor to justrefer out.
And, and I think all thoseexamples you guys gave kind of
really give me, you, me remindme of the same experience I'm

(21:41):
having with my practice.
It's like I just texted aneurologist because I saw like a
one centimeter cyst in the rightparietal hemisphere of one of my
patients who has balance issues.
But she also has parts that I'mlike, well, the parietal
hemisphere also has balance.
So do I do anything about this?
Because I don't wanna freak outand send her to a neurosurgeon.
And then they, just having thatconversation with the patient,

(22:03):
she trusts me.
It wa there was no crying.
You know what I mean?
It's so much easier when youknow your patients, they know
you and they know you will doanything to make sure that, kept
safe.
And I think that's why he, hejust texted me and he's ah, it's
okay.
It doesn't look like that wouldcause those symptoms.
It seems like that might beparts, but, keep an eye on it.
And she didn't even have to seehim.

(22:25):
And this is a free concert.
Like I'm, I think the communityyou give to gives you back.
And, and that is such a bigexample in five years of
practice.
It's a really short time to havethat.

Amazing.
So I will put out a challengehere for all of the listeners
because as you guys are talkingabout people who we all can
picture, our specialists, ourgo-to people that we love
talking with, I will say thatthis is one of the reasons why I
had created the DPC directory.
So the dpc directory.com, if youhave a specialist who you love,

(22:59):
please encourage them to createa profile.
It's totally free to start.
And what it enables is a placewhere these people can be.
Visible to the rest of us andnot based on what your Facebook
algorithm says.
So I definitely would say tohelp empower us with pairing
with the good people in ourecosystem or the good people who

(23:19):
are helping our DPC patients,please encourage them to grab a
profile.
And then the second thing I willcall out is I have created a
patient facing, excuse me, apatient facing mapper of
physician-led DPC practices.
It's at caring directly.com.
So if your practice is not onthere and you are a
physician-led clinic, especiallythe specialists, go on there

(23:39):
because as I'm recording patientstories, this is a whole
separate, separate.
Stream than my DPC story.
When those come out, there is amapper that, this is what I'm
talking about on caringdirectly.com, where patients can
go and find you as DPC doctors,but also specialists.
Because if a, if a, if one of usdoesn't necessarily know, Hey,
I, I don't necessarily know amitochondrial specialist, but I

(24:02):
found a mitochondrial specialiston this map and they're licensed
in the state that I am I, thatmy patient is in, that's a way
to help each other also.
So I definitely would say thedpc directory.com and caring
directly.com.
Please add yourselves to thoseresources because those were
built as, as I realized peopleneeded more resources from
interviewing everybody on thepodcast.

(24:23):
And those are just out therelive right now.
So one of the things I wanna.
Turn to is we talked a lot abouttools and technology and AI and
definitely over the past yearwe've seen more and more come
out.
Open Evidence is my go-to placenow for You can even create
Yeah.
Everyone's yes you can.
And if you have not just proTip, you can even say create,

(24:43):
please create a patient handoutfor Sprain Ankle and it will
literally do it for you.
'cause I used to have to put myopen evidence stuff into chat
GBT and now that's not even athing.
But I would love if you guyscould talk to us about how your
electronic health records arefunctioning.
We just had the results of theBattle of the EHRs come out.
And it was very interesting tosee the results from the

(25:05):
community, but also, AI has,like I mentioned, just continued
to blossom.
So I'd love if you guys couldshare with us about tech at your
practices.

This is definitely a fun one.
For me, this is my like nerdalert.
And it's because I love liketrying to optimize workflows and
just looking back at like how wetried to handle all this stuff
when we were first starting thepractice versus the technology
that's available right now.
I mean, it's just unbelievable.
Now you've got the AI scribes orwe'll do like an AI dictation,

(25:36):
upload it into the chart, have anote done in, in just a few
seconds which used to be, quite,a burdensome operation.
But it's also wonderful becausesometimes you can ask AI with
our EMR like questions about thetimeline from years ago where it
was like, Hey, they've beenhaving a lot of urinary tract
infections.
Can you like summarize the, likeall the urinary tract

(25:56):
infections, what antibioticswere given, what things were
isolated from the, from theculture of sensitivities and
just B-B-B-B-B-B-B.
And that, that makes it reallyeasy.
And then it's also wonderfulbecause when you were trying to
generate a referral or pulltogether a coherent timeline
from now, we've had patients forso of them for five years,
sometimes you really have to goall the way back.

(26:16):
And that can take so much timeto save them time once they get
to the specialist appointment.
That requires a lot of backendcoordination to make sure that
we have a compelling narrativefor what happens.
So they don't just get to thespecialist office and the
specialist office says whyyou're here.
Sometimes they don't read ournotes anyways, but we stop
referring to those specialists.
But it, it's very nice becauseit, it can, it's almost like

(26:37):
having a really good intern orresident giving you a report on
what has been going on with thepatient, the texts, the emails,
all of that stuff so that whenyou get there, you're fresh,
you, you've, you understandwhat's happening with the
patient and these people thatyou've known for so long, you're
ready to move on with the nextstep.
So it saves a ton of time from,from that perspective.
We definitely use open evidence.

(26:57):
That has been extremely helpfulas well to whether it's, every
now and then for patienteducation, that kind of thing.
But it's also nice to to, helpsummarize or, or think about a
case in a different way.
It's nice to get updates on whatthe newest stuff is, if there's
anything we need to think about.
And you can also like, for, for,a, a lot of times there were
like if you're trying to, there,there are some like radiology

(27:19):
guidelines that are justdifficult and onerous to access.
I'm like, I know what this Iknow where we need to go.
It's just gonna take 40 clicksto get there.
Being able to outline a patientcondition and then say, this is
what the, this complicated MRIfinding showed.
What is the typical workup?
What other things should wethink about?
You're like, at what point do wedo X, Y, or Z?
What are the regular guidelinesand when do those differentiate?

(27:40):
Like, all of those like, complexquestions that would've been
like waiting on the horn to geta call back from a specialist or
like doing an e-consult over acouple of days.
A lot of that stuff has beenreplaced by, by having quick
access to the data you actuallyneed and the fact that they're
integrated with like medicaljournals and you can pull up
those journals as well insteadof like random hallucinated
articles from that really thatreally.

(28:02):
Really helps.
And so, that has completelychanged what we do because we
used to give like research toour clinical system be like,
Hey, help us out.
Pull all of these articles.
Like she was, she was our chatbt And so, and now it's oh, we,
we don't need to do that.
And the more of that, that'seasy for the physician to
actually do that means that theteam can focus on all of the

(28:23):
other difficult nebulous carecoordination stuff.
And it helps keep our team kindof close knit as, as opposed to,
having to completely destroy ooverhead with payroll for, for
things that don't require thatthey just require a better use
of technology.

I will make a point here that open
evidence is free.
All you need is your NPI.
And I will say that if you arenot, if you ask, if you query
one question you can set thetoggle button on.
So open evidence will prompt youto send you if there's an update
on whatever question you lookedup, as long as you have one
question in the thread.

(28:59):
But yes keep going guys.
'cause this is also my jam.

I mean, I would just like the technology
that allows me to seemitochondrial challenges in an
airport

while we're at it.
Your, your face is so straight.
I was like, oh, was that, oh, itliterally took me a minute
there.
That was great.
That was really, that was a goodone.

In peds, our patients don't have the
extensive health history.
So it's if you got a febrileUTI, you're seeing a
nephrologist.
So.
It's not as robust in the pedsworld.
I ha my EHR has the ability, andI've used it a couple times.
It's quite judgy.

(29:39):
If you can imagine, I tangent inmy appointments and there was
one that I was like, I wanna trythis.
The mo parents were doctors andI was like, can I try this, this
AI EHR assistant whatever,scribe.
And somehow me and the dad gottalking about facial symmetry

(30:00):
and like the concept ofattractiveness and like equal
symmetry and like whatcelebrities have really, I don't
know how, I think it was aboutplagiocephaly, I think was our
transition period, but the AIwas said, doctor and patient
became went off script or likesomething and it was so judgey
about that they talked aboutirrelevant topics and it was

(30:23):
like, Hey, Brad Pitt's face isrelevant here.
Like

irrelevant topics.

That's so rude.
I don't think it, it was sojudgy that I was like, ah, how
dare, and the problem is like inpedes.
We can't just do standard soap,like our well checks aren't
soaps, it's developmentalmilestones, it's M chats, it's
ASQs, it's smoking, it's vitaminD.
There is specific targets thatlike, not for metrics and

(30:52):
insurance that I need, but likefor healthcare that I need.
And then AI just yet, yet cannotgo through and fill in my
template and I have to phone mydemo or I will go off talking
about Brad Pitt's face and likenever actually get back to the
point of the visit.
And so for me it is not ashelpful and it is mean, but I

(31:17):
have used it.
I use open evidence constantly.
I love open evidence.
I, every time I use it, I'mlike, sorry, planet.
But like I am big fan.
And, but for our EHR.
Again, it's like not, I act likenone of it's really specifically
designed for pediatrics becausewe are not, we are not the money

(31:41):
makers in any aspect ofmedicine.
And so for EHRs, the only everpediatric specific EHRs I've
used are like so stupidly clunkyand click heavy.
And like I just, so I wouldrather have a very streamlined
EHR that I can figure outpediatric workarounds than like
a pediatric specific EHR.

(32:02):
But like again, outside of openevidence, tech ain't, and maybe
that's just my old laziness.
I bet it could be super helpful.
I bet it could.
I just refuse.

Can I just add onto that, that I, I don't
think AI scribes are meant forDPC world because oh man, we
talk too much.

Hell no.
And

so that's why Jake started Transcr, like
dictating his note and then justhaving AI be the
transcriptionist.

They were getting lost in the weeds.
He was

getting lost in the weed.
We, because we we're talking myWell, did you get the house?
Were like, yeah, exactly.
Exactly.
So I cannot function.
It's like this, this is toomuch.
And the better your prompt is,the better it gets at scribing
it.
But that takes so much time thatI, I just haven't gone there.
But I like that it has that,that add-on option at least.

What's that?
It changes literally every age.
So that just seems like way toomuch work.

Yeah, I know.
I'm like, I'd rather just typeabout and I

have it like now that I

can just send it in via telegram.
See

I have all my F two like wild cards and I have
my prefilled common answers.
So it's a note takes me 30seconds.

Mm-hmm.

Unless something is wrong, in which
case then I do get moredetailed.
And a lot of times I'm sofocused because in DPC I'm not,
I'm gonna be like, okay, your 10review systems, I can sit and I
push the computer aside and wetalk.
Mm-hmm.
And so then at the end then I'mgonna go through and summarize
because maybe the information wetalked about was relevant, maybe
it or maybe not.
And, and so I myself, with aquite extensively minuscule

(33:34):
attention span is like I can'teven read through my own weeds
of like my talking sometimes andI just need the bullet points.

Definitely

I do have an EMR, which works with AI and for
transcribing.
And it does gimme summaries.
But I do have to go back in andedit it because like you said,
yeah, we talk about other stuffand it does a good job.
But sometimes I think itconfuses me to be the patient

(34:03):
because patients ask me how I'mdoing and I'm like, yeah, sure.
I'll tell you everything aboutme.
And they're like, oh, patient isreading this book.
Patient is,

yes.
What the heck?
I'm like, oh my God, my sciaticaflaring.
And they're like, patient essay.
I'm like, no, they're two monthsold.

See?
Exactly.
And so I think it's useful tojust make it easier where you
don't have to type everythingfrom scratch and then you can
just go edit.
But also on my phone front it'santi-tech.
I'm like, I.
Time limits for websites, timelimits for browser, no social

(34:41):
media on that.
So you might have seen, I'm alittle quiet on social media.
It is just, I am living a simplelife.
I've become a mountain girl,even though I live in San Diego.
It's there's mountains here,guys.
And then there's lots morebirdwatching and all these other
things.
So I feel like technology islike a, you just gotta use it

(35:02):
the right way.
Use it exactly for what youneed, and then say buy, because
it's, I'm, I'm needingartificial tear drops, guys from
screens.
This is like after getting ridof social media and stuff, just
because there's so much teleappointments and, and you, you
look at your phone becausethere's like a text from the
patient and stuff like that.
So there's always gonna bestuff, the technology that also

(35:25):
can be negative.
And I just feel the fine balanceis, but I totally love the AI
thing.
I use it every single time withevery patient.
It's just not perfect.
And so, we just have to workaround it.
Yeah.

I love it.
And I, I am the same way.
Our AI scribe, just likeChristina's mentioning, is, is
literally dependent on how thethe level of detail is set and
how your prompt is set.
And so I do think that also,this is a, a, a recommendation
for everybody if you have goodprompts, depending on your
specialty, whatever.
This is the type of stuff thatwe could share amongst each

(36:01):
other so that, it's, it's nothaving to redo the wheel, but I
totally hear you.
That, that getting the finesseof, the, the prompt so that it
works for what you need it toois definitely an ongoing
challenge at our practice.
So one of the things I thinkabout, especially because you
guys are now going into your sixI think about there's a lot more
people in this movement, a lotmore people interested in this

(36:23):
movement, medical students,pre-meds, even residents.
And I'm wondering if you guyscould could talk to us about
common questions that you'reseeing from them, especially
fears about DPC, but also howyou're answering them peppering
in your ability to balance yourlivelihoods with the, the
practice of medicine because youchose DPC.

Ooh, I can do this one.
I take students I like, and Italk about this probably every
day with them.
I will come back to you.
Patient's calling.

I'll, I'll take this one too while she's
on, on the call.
So I, we'll say that we have aninflux of physicians who are now
burnt out, right?
So we're about, what, sevenyears from medical school.
And so, we are starting to hearfrom our formal classmates,
resident, co-residents who arelike, I'm done.

(37:14):
Please help me out.
I need to get out.
And it's, it's like this secondwave, right?
Like I never really consideredus early adopters, but in some
ways we were, obviously weweren't the ones doing it like
fresh, but I would say we'restill kind of part of that, the
late early adopters or like latewave of the early adopters.
And now we're seeing kind of.
It gets so mainstream andpopular that people are like,

(37:35):
oh, they're seeing the socialproof and now they're like more
serious about considering it andtrying to get out.
And I relish in getting peopleout.
I will talk to everybody I canto get them out.
And so it's been so fun.
And it's also how we have foundour physicians, right?
Like they are coming, burnt out,pissed off.
They wanna practice medicine ontheir terms.

(37:57):
And so now there is even moreoptions to not be your own
entrepreneur.
And trying to team up like our,our patients with other DPCs or
not our patients, our ourfriends with other DPCs, and be
like, Ooh, you need to talk toso and so in your region.
I think I texted you, Mariel.
I was like, Ooh, you need totalk to this person.
And so trying to play matchmakerfor DPCs now is kinda like my

(38:17):
new pastime.
And so that's, that's beenreally fun.
And I just be like, it'shappening guys.
Like it is happening.

And it, it's a, a lot of the, I guess the, I'm
about to see actually two, Ithink one's a pre-med, one may
be a medical student tomorrow.
But they are reaching outproactively.
And those flood gates arestarting to open because it's
catching up, not just in thepeople coming out of residency
and getting burned out, butthey're also starting to see it
exactly where they should, whichis before they hit year three of

(38:46):
medical school.
Because all these people who,used to dream about being a
primary care physician as a, asa premed, or when they get into
their first and second years,they see what life is like as a
third year in a family medicineoffice.
Lemme tell you friends, thatain't too pretty.
And so now they're seeing adifferent competing narrative
that, oh, no, no, no familymedicine or primary care in

(39:07):
general.
Could be quite wonderful if donecorrectly.
It just requires you to talk topeople who have lived it.
And so they're starting to reachout proactively.
And I think that's where we'regoing to, what are we gonna do
with this primary care shortageor maldistribution or whatever.
It's not about trying toshoehorn a whole bunch of people
into, suffering through 35 yearsof practice and just seeing 30

(39:29):
patients a day.
No, no, no.
It, it is restructuring the waythat that primary care is
delivered to actually make itsomething that is sustainable
and wonderful so that physicianscan, medical students re they
people who have opted to go todermatology or whatever because
they were looking lifestylewise.
'cause they, they wanted to doprimary care and then saw what
that specialty was like andsaid, no thanks.

(39:50):
Instead they're re-looking atthat and saying, you know what?
I wanna make a difference.
Not to say that othersspecialties don't, but they have
that, that dream of what theywanted to do and what they
wanted medicine to be about andwhat those relationships wanted
to look like.
And they say, no, no, no.
I don't have to give up on that.
I can make that happen.
I just need to talk to the rightpeople.
So it's very exciting to helppeople be a part of that and to,
to help the movement grow.

(40:11):
It's, it's a, it's a wonderfulthing.
I love coming home after talkingto a pre-med or a medical
student about this stuff.
Because you can see their eyeslight up'cause they're seeing us
light up too.
It's, it's, it's, it's great.

this is one of the reasons I'm so
grateful for you guys all,coming on to give your updates.
Because to me, especially whenpeople are in pre-med or medical
stu school or in residency, I,this is, it's your guys' voices
who I send because I'm like, notonly can you hear about how
things were going before theystarted, but also now we're
going into year six guys.

(40:42):
So it's the, the proof is in thepudding.
And also I think that it, it isa way for us to, where whatever
our feelings are about ourprofessional societies elevating
DPC celebrating different voicesin DPC and not having the same
people talk about the sametopics over and over and over.
My DPC story is very excited tobe highlighting your guys'

(41:03):
stories, the stories ofeverybody who comes on.
Because it's through diversity.
People find relatability.
And I have heard that,especially from residents
saying, I didn't think I couldbecause I'm the primary
breadwinner.
I didn't think I could becauseI'm a single parent.
I didn't think I could because Ilive in rural, state, whatever.
And so I, I just wanted to saythank you also to you guys and

(41:24):
everybody who's come on thepodcast and who has yet to come
on the podcast because this ishow we reclaim the narrative.
And so I love that more peopleare reaching out to you.

my, a lot of my students, I am their, I do, I
take a lot of third years.
And so I'm usually their firstexperience with direct Primary
care first.
A lot of them have never heardof it.
And so there is like just eventhat little bit of exposure, is
great.
And the most common question Iget is they're like, you just
have so much time.

(41:55):
You have so much time.
They're like, how, how is thishappening?
Or I'll have students come.
I'm like, yeah, my kids areoutta school.
So you can come, they're gonnabe here.
You hang out with them.
If you hate kids, you don't haveto.
And, and there's, so, there's alot of they get to see that.
And so, especially my studentswith kids that, you know, that,
that's everyone's worry is like,how, how do I be a doctor and a

(42:18):
parent?
With kids, obviously you don'thave to have kids.
So with a lot of these students,they're, they're really worried,
like, how can I have kids?
How can I be present with mykids?
And they like, I, they get tosee it and I'll tell them, I'm
like, yeah, I'm not gonna behere Friday because we have
lunch on the lawn.
And so I'm going to these schoolevents.
I am going to the, the Halloweenparty, I'm going to the, on the

(42:44):
pumpkin patch field trip.
I'm doing these things.
And it's, that is okay that youdon't have to be a martyr in
medicine and

yeah.

That, that it is fully possible to be a happy,
successful, competent physicianwho actually has a life outside
of medicine.
And so, they'll, they'll I willtell make sure you're
exercising.
I have them I have them readlike different books that I
think are helpful in terms ofnot like textbooks, but like my

(43:13):
favorite that I make them allread is Overkill by Paul Offit.
Of I want you guys to learn,even if you don't wanna do
pediatrics, you wanna dopsychiatry, you wanna do
anesthesiology, you wanna dowhatever you have, want nothing
to do with kids.
You need to know how to notoverdo medicine regardless of
the type of practice you're in.
And.
It has been, I think reallygood.
I haven't got, they keep sendingme students.

(43:36):
I got a title that says I'm aprofessor.
So I think it is going well forthem too.

Yeah, so I think in general the DPC
conference was like one of mymost biggest exposures this year
of seeing, doctors who are muchmore senior in terms of how long
they've been practicing andthey've burn out three times.
What does three times mean?
What is burnout?
Three times.
Like I burn out one time realbad, and that was bad.

(44:03):
So I don't know how you burn outthree times.
So I guess the fear of having tostart something by yourself and
like the worry about how you'llmake ends meet if you have a
family and stuff like that is soprofound.
And the, the systemsystemically.
Trains us to be very scaredright from med school.

(44:26):
They keep telling you, oh, yougot a joint, you gotta, you find
a recruiter and this is how youfind a job and this is how it's
gonna be.
This is these ICD 10 codes.
This is, and the billing.
And this is exactly a, and Istill remember this one doctor
who I really hated I, I don'twanna use that word, but it was,
so she made me see the worst ofprimary care during my

(44:50):
residency.
And she had all horrible thingsto write about me in my
evaluations and stuff like thatbecause my focus was on care.
And like the patient's cryingbecause they're suicidal and
stuff, she wanted the CPD codesand ICD 10 codes written the
right way.
And I think.
I think it could really burdenyou if you're trying to get

(45:14):
outta residency in flyingcolors.
And here you are not, notimpressing your professor who
cares about that.
And, and I think it makes, itmakes you kind of think back and
see, you just, just because theyare professor doesn't mean
they're smart.
Just doesn't, I mean, Lauren isa smart professor, but No, you
are.
But I'm, but not there are realidiots in medicine.

(45:37):
Yeah, exactly.
And they've been, it is likedodos.
They've been told by somebodyelse that this is the way to do
it.
And here I am listening to theAlmanac of NA about how to get
wealth and happiness and I, he'smy professor.
Think about it like you wantmentors who've actually done
well in life, not the ones wholike more to write ICD 10 code

(45:58):
and they're like, just.
Upset all the time witheverybody.
And I think if you, if you'rewriting bad reviews and not
actually helping students,that's the worst kind of
professor.
Get out of that university.
Just go, go find something elsebecause you are demotivating
these spirit who are trying tolike, bring so much health and

(46:19):
happiness in the world andyou're like extinguishing it by
making them think about thesestupid insurance codes.
And

Yeah.

And honestly I have to just, just say this,
in this particular stage.
Insurance has gotten way out ofhand, like way, way, way out of
hand.
This is, I mean, I'm eventhinking, do I retire already
like this?
Because it's like you have amission, but if someone's like
sucking the soul out of youevery time, like literally

(46:49):
yesterday's five appointmentswe're all about me making calls
that needs to be done.
And I can see how it can beoverwhelming for, when you have
way more patients.
And that's why staff who arereally good is beneficial.
And I feel like it may make adifference, but I still won't do
it right now.
Staff.
But at the same time it is, itis very interesting.

(47:13):
You pick up the phone, you speakwith this person, and a stat MRI
takes two to three business daysto get a result.
Like what?
When did that happen?
In 2020 when I first started mypractice, that was not the case.
So imaging centers have gottensloppy, pharmacies have gotten
sloppy insurance has gotten way,way worse.

(47:33):
This whole prior auth nonsenseis every two months, and they're
like, oh, sorry, we already hadit.
Like, why did you waste my time?
And I think, I think, I mean,it'll probably, you probably
wanna talk about this too, but Ijust wanted to say it right
here, because this year has beenparticularly very disturbing.
I'm getting texts frompharmacists who are independent,
who are saying maybe because ofthe tariffs, their medicine

(47:55):
supply is gonna stop, and theywon't have all those, cheaper
alternative prices that we usedto have for cash.
And it's, it is very disturbingto see that we were not in the
best place to begin with.
And now even though there's moredoctors who are burning out and
coming out and trying to dothis, it's just really shitty.

(48:15):
I just wish I could heal peoplewith my stethoscope, but it
doesn't work that way.
We need medicines and we needthe country and the world to
just be way, way more proactiveabout truly caring about humans.

Indeed, if you figure that out, let me know
how to get people to care aboutother people.
So,

yeah.
One thing that I do, first ofall, I love your book
recommendations.
Deepti and Naval Hanza Alman.
Oh, Alman.
Naval Raman is amazing.
But the one thing that,especially for your solo
practice that I'm just kind oflike riffing on, that I'm
starting to see in like thehealth tech world is like AI
agents that can like, make callsfor you, sit on hold and also
sound like real human beings.

(48:57):
Oh, wow.
And that is starting to getreally, really good.
And I'm, I'm just waiting forthe right company to come along.
Because they're, that, I mean,that space is actively being
developed.
And so when that happens, andthey can.
Report back to you on, Hey, is,does the pharmacy have this or
that Instead of you sitting onhold with a pharmacist I, I, I
actually know the jingles formost of these imaging places.

(49:18):
I know.
It's so crazy.
Do, do, do, do you know, becausebecause it's, I've been on them
for so long and not having toask my staff or I have to do it
myself.
And this can just be delegatedlike that.
I am so looking forward to it.
I think it's gonna be a hugechange.
And I think that we're kind ofin this AI romantic period where
it was like, it was likepenicillin a hundred years ago.
Yeah.
And now it's like, how do youmake a AI workforce?

(49:38):
It's very, very exciting.
I just wanna jump in there.
Sorry.
It was just a random scap brain.

No, that's very helpful to know because I
was doing dishes and I had thatthing on and it's I need to turn
the water down.
When someone's saying you werein the queue and it's dude, I
thought you were back.
What

heck is it open evidence that we'll do,
that'll listen to your priorauths and like immediately send
you the.
Like studies that they'retalking about.
I feel like I remembered hearingsomeone talk.
I think it was open evidencethat like you have it open like
for prior auths and the, youhave your phone on speaker and I

(50:14):
think it will listen and sendstudies like proving the need of
what you're looking for.
Mm-hmm.
And I, which is awesome

though.
Maybe I was gonna say

it's hope I'm not making this up, but I feel,
I feel very confident that I'veheard.
Multiple people talk about this,

they can also generate letters to the same
effect.
I haven't It be,

it's gonna be AI versus ai, it's gonna be
the insurance.
I know, exactly.
Because ai, we already know BlueCross is using them to deny.
And so they're docs that wassaying that they got a denial
and they're like, you approvedthis.
What happened?
They're like, oh, that wasactually AI's mistake.
It should have never gottenapproved.
Did you guys see that story?
and so I was like, oh my God.
Like it's, it's gonna be like,whose AI is better at, at this

(50:53):
chess match of trying to denyand approve, right?
And it's just and just beinglike, oh, doctor

said we need this to care for the patient in
front of them.
I mean, yep.

Yeah.
And I we're seeing, I mean,within the past 12 months, I
mean, I was really.
Racking my brain with this,trying to figure out our
workflows because there is so eespecially with the advent and
use of GLP ones for weight loss.
Oh my goodness.
Like it's all over the place.
And like there, there are somany dangers to not getting it
from a reputable source.
Yes.
And so you really got I, so Ireally have to explain to my

(51:23):
patients like, no, no, no, thisis not something you wanna get
in the back alley.
There's a reason we're, we'redoing it this way, but.
It's just so expensive and it'sgetting a little bit better as
they're bringing the price down.
But if we're going throughinsurance, like a lot of
patients naturally want tobecause they're paying these
ridiculous premiums it is very,very difficult to get, get
covered, and it's just likereally hard stops.
So the amount of prior authpaperwork we've had to do in the

(51:46):
past year compared to the last,five years, it's just been
astronomically like

quadrupled.

Oh yeah, absolutely.
Because we're dealing with oneof the most common conditions,
right?
And so many people can clearlybenefit from this.
There's so many people, I waslike trying to get blood
pressure control and like theOSA route and the cpap, da dah
dah.
And like you can, somebody justsent me a picture of like their
before and after from 10 monthsago and they, it, it's just like
the, the before and afters arejust.

(52:13):
Fantastic.
And so, and, and I don't mean tobe like a, I guess an apostle
all this stuff, but like, it, itreally moves the needle for
patients.
And it's extremely frustratingthat we're getting Roadblocked
left and right, where they willactually tell the patient one
thing and they will, theinsurance company will tell us
something different.
It's say, oh yeah, it justdrives me nuts.
They'll, they'll be like, oh wedon't see a plan exclusion here

(52:34):
or whatever.
Your doctor should just tryanother medication or try a
different prior auth.
And I'm like, you are giving,you are what, what you just
communicated to the patient was,oh, this door is locked.
Why don't you just, your doctortry another key?
The door is welded shut and youwere the one who closed it.
Please stop wasting my time anddon't do

that.
I'm lying and saying yourdoctor, they lying.
They do, they just make it look,they do, or I think they always
wanna make this forever.
They've tried to create a hatredtowards doctors because they
feel like.
This is, this is that one thing.
Let us just get them fightingwith each other and we win.
And it's so easy with the DPCmodel to just go, they're gonna

(53:16):
say this, okay.
You're gonna get a lettersaying, I'm not doing my stuff.
Okay.
Just be aware.
And it makes such a hugedifference because patients go,
oh, there, I got that letter.
Yep, yep.
That is very true.
Have to, even

for prescription refills, I'm like,
Hey, we get a bunch of refillsthat you never requested.
They're like, you do?
I'm like, yes.
I was like, stop, likerequesting it through the
pharmacy.
Just text me.
Just text me that you need arefill.
That's exactly, and I put you todo it.

Who It's

like, it is such a scam.
They're like, I never asked forthis.
I'm like, well, they asked for a90 day refill.
I didn't, I'm like, yeah,they're just trying to get you
refill that you didn't even askfor.
Right.
And so, so when I, when I saythat and then they get it,
they're like, oh, okay.
So you're right.
At least we can, I only check.
So we get a little bit of streetcred back that we're not crazy
and we're not the ones doing it.
Oh, Walgreens said that youdidn't you denied, you denied my

(54:01):
refill request.
I'm like, I didn't get a goddamnthing.
Please text me when you need arefill.
And they're literally like, theydenied it.
I'm like, I got, I got Jack.
Shit.
Like how dare they like say youdidn't hear from us, but don't
dare you say that you didn't.
I denied it.
Are you kidding me?

No, they do this obviously

Marielle, this is a hot button.
I'm getting red.
I'm gonna

flush you.
Hit the Trump wire.
Oh

God.
But I will, I will say that it'snot just a hot button for you.
It's a hot button for all of usbecause it's literally a way to
fake deny people care.
Yes.
And let's, I'll say, let's aboutPBMs.

Oh my gosh.
Well, I will say here though,

that to Lauren's point open evidence,
this came out last year, soDecember of 24 they do have the
open evidence.
Again, a free resource.
Yeah.
All you need is your NPI has theadministrative ability to write
prior authorization letters, andit does use the evidence.
This is for multiple journalslike Jake was mentioning, but
also citations and references.
So absolutely.

(54:57):
It is a thing to help with thatfrustration.

Yeah.
Yeah.
And they sign a, b, a A too likefor PHIS, but you have to

like to enroll.
Yeah.
Yeah.

Which is, it makes me feel so good when
you're like talking about, or,or trying to figure out a
particular patient situation.
I think they also have theability to like.
I, I haven't experimented withthis, but something about
uploading patient informationfor an avatar to use, almost
like as a, a reservoir for whenyou're asking about a specific
patient's history.
I haven't played with that, butI just kind saw something like
that.
I was like, oh, I gotta likekind of look into that a little

(55:27):
bit more.
But it is especially ifsomebody's, if somebody's EMR
doesn't have native AI featuresand they're looking for a
stopgap or something to take itfurther, that's evidence
informed.
That, I mean like I, it hasreally changed the practice and
changed what I use as my defaultresource for getting Oh, for
sure.
I

almost like, but I don't know if I use open
evidence or up to date moreanymore.

Yeah.
Yeah.

Well, and

with open being free I mean it was a
no-brainer for Well, as apractice professor, I get up to
date through my, through myThat's right.
School.

Yeah.
Yeah.

I love it.
So talking about hot buttontopics, as we've been alluding
to, this, this entireconversation and on multiple
conversations on my DPC story,direct primary care is where
patients go to forrelationship-based medicine.
They go to, to establish carewith a physician who they can
trust.
And in this day and age,misinformation even where to

(56:22):
find guidelines for professionaluse is getting challenging.
I won't even go to the CDCanymore right now.
No.
Unless I have to download VISsheets for vaccine clinics, use
immunized.org.
So this is exactly what I wannatalk about.
I would love if you guys couldtalk to us about challenges that
you've seen in your ownpopulations and your own

(56:43):
communities and how you've beenable to help your patients ride
the wave of whatever the heck ishappening in this country,
because you are DPC doctors.
I mean, just to call out Dr.
Hughes was, just happened to beon a call with Senator Elizabeth
Warren that that's cool.
That's

what I, I do wanna point out, I was in full
blown outfit mullet.
I, I had on a blazer and bikershorts, so it was an outfit
mullet.
I was sitting down and I just,so, yeah.
I don't know how that happenedeither.
Wow.
We're we are all as confused asyou.
Yeah,

I I would say it's intentional and it's
strategic, right?
Because we are literallystanding up, just like Christina
said, so that everybody canaccess this quality of care, and
we're delivering it in a waythat is affordable, accessible,
and is expandable when morepeople are doing this movement.
And this is where, I, I wouldlove to see how you guys are,
are, are truly navigating the,the current changes and whatever

(57:42):
happens with, the loss ofhealthcare access.
That is going to be tremendous.
I mean, just to give you aperspective from our rural
community for thousand people inour community are getting
CalFresh benefits.
So fresh food benefits.
Yeah.
1500 of those will lose theirbenefits by March.
And then if you throw in workrestriction, dah, dah, dah, dah,
dah, and the number of peopleare already in place.

(58:02):
Yeah.
So I, I will say that, this is,this is where we as DPC doctors
can, we, we're living in thisplace where we can say, yes,
those things are happening, buthow can we make a difference?
Because I definitely have my ownanswers as to how we're doing
things here in Calvers County,but I'd love to hear what you
guys are doing.

I think, I think one of the things that we
did pretty early on was was takea stance on measles.

Yeah, that was a big one.
We

did lose one family from that email, but
we decided, so one in adultworld, very different.
There's a subset of people whomay have only received one
vaccine and.
And Dr.
Yeah.
They missed that, they missedthat window

of the two dose.
Right?
Right.

Yeah.
And so we have a huge populationof that.
And a lot of them are nowgrandparents or have small chi
or maybe are around smallchildren or daycare workers or,
or are, working in the schoolsand they don't know that they're
not immune and obviously Tcell,humoral, blah, blah, blah.
But still they wanna be sure weget it as med students.
They want their titers.
And so we're like, Hey, we didthis entire handout.

(59:04):
We, I mean, hours of researchtrying to make it digestible.
Jake's awesome skills, making abe, making it beautiful.
And we have this timeline andwe're basically an algorithm for
all our patients.
I was like, if you're born here,you're good.
If you're born here, you'requestionable.
If you're born here, youprobably need titers timeline.
And, and did that whole timelineand then it links to a Google

(59:24):
doc and we did a measles titerclinic because the
recommendations did not makesense for DPC.
They're like, oh, just givepeople boosters.
The titers are too expensive.
I'm like, they're 20 bucks forMMR.
$9 for just measles.
So this is very different.
And in adult world, nobody hastheir childhood immunizations.
They're like, I got whatever thedoctor told me to get, but okay,
well then that's what made methink, oh my God, I need to know

(59:47):
the history of this.
And so we had to do a deephistorical dive to understand
what there was, because nobodyhas their rec records.
So it was actually moreeconomical for the healthcare
system for us to do a tighterclinic.
Next to nothing.
Then to send them for a boosterthat's really expensive, that
the insurance may or may not.
Pay for, we saw very similar as10% or non-responders to one.

(01:00:07):
We had a very similar 10%.
And some of them were schoolteachers.
Some of them were taking care ofgrandchildren and they got their
boosters and they were like, ohmy God, thank you so much for
doing this.
Thank you for just even talkingto us about this.
We're scared.
We're hearing things in thenews.
And I did this so much earlierthan I feel like anybody else
too, because everybody in townwas like, huh.
And I'm like, I got my kidssecond MMR booster in October.

(01:00:28):
I was like, I'm not, I'm hearinginklings.
I want it now.
Yeah.
And I'm like, I'm not waiting.
There's zero reason to wait.
And so, we did this what in thespring and we had a great
turnout.
People were so appreciative andit was just such a great way to
be like, let's focus on what wecan do with our community for
our people and make intelligentdecisions based on the
information we have and justdrown out all the noise and be
like, we're gonna take chargeand do what we need to do for,

(01:00:50):
for you guys.

Dr. Jake Mutch (01:00:51):
Yeah.
And it really helps to be able,like sometimes, I don't know, in
trying to, this is just my ownthing and trying to give people
the full story of something.
Sometimes it dilutes the messagea little bit where oh, there's
should I get a vaccine?
Well, there are like threeschools of thought and dah, dah,
dah and that and all the patienthere.
'cause that's the problem

Dr. Lauren Hughes (01:01:09):
with science communication.
It's nuance.
Right?
Exactly.
Stand for nuance.
And what, what

they hear is that we have equivocated, so it
must not be that important.
And so being able to distill toas many patients we have that,
no, no, no.
Measles is the most infectiousdisease on the planet and it
preferentially kills children.
Like being able to say this iswhere we stand.
These are the diagrams, theseare all the diseases that you're
worried about over here.
And this is measles.
A way on the right side of theinfectivity curve, be are, are

(01:01:36):
patients.
Often need to be convinced andwant that information.
But what I've, what I'verealized is they want a doctor
who takes a stand and IU and Imean, listen to the early
episodes.
Oh, like there are, I, I, I, Ifelt and acted in a different
way in the attempt to, try to beas professional and that kind of
thing as possible.
But what I'm realizing, fiveyears in with the comfort of a

(01:01:59):
full panel being like, no, no,no, I it important.
This is who I am.

This is what I stand for.

This is what you stand for.
And a lot more people it, it, itis so much easier when I, when
you just lean into that and say,this is what's gonna happen and
this is what's not gonna happen.
This is how I'm gonna be treatedin my clinic, and this is not
how I'm gonna be treated in myclinic.
And if you have a problem withthat, the door is that way.
And it, it really clarifiesthings because all of a sudden
you're not, you, you, you get tosolve the problems that actually

(01:02:27):
matter, right?
And you, you just remove all thestuff that's a distraction.
I love it.
And that's why I love mypractice.

I, there's so many things I'm scared of.
And I think, so for example,like one of the things I've been
talking with my families aboutwho have Medicaid, who have kids
with complexity I'm like, we areordering equipment now.
Why we have Medicaid.
So that standard, you need thatgate trainer, you need that bath
seat, you need that adaptivewheelchair, you need all that

(01:02:53):
stuff.
We're gonna start that battlenow while we still have
Medicaid.
And, and so there, that is likeone of the ways which I don't
know, just kind of side becauseI do think this is something
that we need to talk about asDPC docs.
The big beautiful bill willbenefit DPC while it shits on a
third of Americans.
And that's, that feels veryicky.

(01:03:14):
And so that is not somethingthat I am addressing at all is
like the benefit of directprimary care from the big
beautiful bill, because I don'tbelieve that we as a community,
as a DPC community are wantingto do this on the back by
stepping on the backs ofAmericans and like taking away
their healthcare.
I don't want to force peopleinto DPC, I want them to choose
DPC, not because there's not analternative, but because they

(01:03:37):
realize.
Oh, okay.
This will work.
And so I, I just, I kind ofwanna put that out there.
Again, like taking the stancelike this is, I am always going
to do the benefit of everyone,not the benefit of me.
Which is again, and going backto what Deepti said, getting
people to care about otherpeople is in inherently American
issue.
But so like that is one of theways that we are, we are
addressing it, is okay, for ourMedicaid kids, what can we do

(01:03:58):
now that is going to beexpensive and is going to be one
of the first things cut.
Which I already have had issuestrying to get what insurance
companies call luxury items forparents because their 3-year-old
needs a, a wheelchair andthey're calling that a luxury
item or a bath seat.
And so I'm having to I'm usingopen evidence to write, I'm

(01:04:19):
like, no, here's how he candrown.
And, and like that sort ofthing, we're already looking at
that.
So that is an, that is one areathat we are, we are preparing
our pa our patients and kind ofgoing back to what, like what
Jake and Christina were talkingabout, which is just like that
we can be proactive.
We are able to help with justnavigating like the.

(01:04:41):
How you were saying like a titeris$9.
Like we're having familiesutilize that and under, and like
I am talking about open, likeahead of open enrollment.
My, my monthly newsletter waslike, Hey, here's if you are a
self-employed person, here issome other options.
If, if your premiums are tooexpensive, here are other
options.
And so just using that as a wayto communicate directly to our

(01:05:03):
people and get the informationto them as accurately as
possible.

Dr. Deepti Mundkur (01:05:08):
So I think the pulse, I try to keep a pulse
on what's going on in thecommunity around me because
there's pharmacists, there's, ingeneral the, the key people that
play a huge role in my patients'lives where they like deliver
medicines for much cheaper thanthe regular system, I think.

(01:05:29):
Over time, this is how, this ishow it's been.
Even in, even in India there'sthere was polio and we did all
polio vaccines.
We went home, house to house andput drops in kids amounts.
And I think talking about allthose kind of things with my
patients over the years hasbuilt that trust and there's,
there's this trust andconfidence that there is DPC

(01:05:54):
that will remain like no matterwhat my insurance and like
employer situation is gonna be.
I've had friends who quit the vaand similarly patients as well
who had lost their jobs and thenthey were having really good
insurance through the va.
And then now went to, they, theyhad me as a DPC doctor, but then

(01:06:15):
now it's like.
They were scared.
They were scared about beingwithout health insurance.
So I had to kind of like helpthem navigate, you, you can buy
and then you can purchase itseparately and you can have a
private practice.
And they're doing really well.
And not doctors, but the, inhealthcare and doing extremely
well thanks to that trust andfaith they had where they could

(01:06:39):
comfortably leave that job and,and transition.
So DPC made, just thisrelationship made an impact to
the point that they could makesuch a big career decision and
actually see way more growth intheir wealth compared to how it
was with the va.
And I think all I can say is youjust gotta stand by.

(01:07:02):
Just like you guys said, justgotta stand up for what you
believe in and what you know,science.
Tells you for a fact, andthere's no two ways about it.
And then no matter what thepolitical situation and whatever
else going on, if we just standreally strong on, evidence-based
science and then have thatcompassion while, like Jake

(01:07:27):
said, being very clear about howyou would practice medicine and
never put anyone in dangerbecause.
Because of how there's a fewnuanced, things out there about
the, about the, about the topic,which has been very well studied
by like molecular biologists andlike all these like vaccine

(01:07:48):
experts.
And, and it's really, reallyhard to,'cause I know someone
who was a professor who was likea dean of medical school,
molecular biology professor wonlike the top award when he
retired.
And I can see the pain in hisface because he, he, when, when

(01:08:08):
he's retiring, he expectedthings to be way more scientific
and advanced.
And unfortunately it's like acliff.
And, and, and he is, he is veryhopeful that the people taking
over next will, grow this.
But it's, it's hard.
It's a hard time.

Dr. Maryal Concepcion (01:08:26):
I definitely appreciate you guys
sharing another update year fivein, in review, and I'm so
excited to hear year six join usover on our substack.
We're going to be talking aboutthe challenges that these
practices have been experiencingin the last year.
And I hope that this is veryhelpful for those people out
there who are considering DPC orwho are wanting another set of

(01:08:49):
stories as to what they havelooking in the future for their
practices.
So thank you guys so much.
Thank you for listening toanother episode of my DBC story.
If you enjoyed it, please leavea five star review on your
favorite podcast platform.
It helps others find the show,have a question about direct
primary care.
Leave me a voicemail.
You might hear it answered in afuture episode.

(01:09:11):
Follow us on socials at thehandle at my D DPC story and
join DPC didactics our monthlydeep dive into your questions
and challenges.
Links are@mydpcstory.com forexclusive content you won't hear
anywhere else.
Join our Patreon.
Find the link in the show notesor search for my DPC story on
patreon.com for DPC news on thedaily.
Check out DPC news.com.

(01:09:33):
Until next week, this isMarielle conception.

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