Why Primary Care Medicine Is Failing Us—and the Model That Could Fix It | Chloe Harrouche, Founder of The Lanby - Stronger Weekly

Episode Transcript
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(00:00):
You really should be challengingyour doctors.
And often times patients don't know what questions to ask.
And so they just say, well, thisdoctor knows way more than me.
Why am I going to question his authority if he's telling me to
do this treatment plan? I should probably just follow
this treatment plan, but we actually probably should be
getting second opinions. We should be using our primary

(00:20):
care doctors as our sounding board.
And so that's where we also can help.

(00:41):
Let's do it. All right, everybody, welcome to
Running Free. You've got an awesome guest.
Here we have Chloe Harouche. Welcome, Chloe.
How are you? I'm great excited to be here.
A fellow Northeasterner. That's a word, right?
Northeasterner. You know what?
We can make it a word. We can make it a word, but
you're New Yorker. New Yorker.
I'm a New Yorker. You're New York, Manhattan.

(01:02):
Manhattan. Not just New York, Manhattan.
Right. And I don't hear any of like my
father. My father used to talk like
this, like, oh, what are you doing?
Hey, hey, I don't hear any of that in you.
You sound like me, honestly. Yeah, I think I have a pretty
good accent. Yeah, well, New Jersey, New
York. It's nice to meet you face to
face. We've chatted on the phone.
Chloe is the founder of the LandB, which is one of the best

(01:24):
concierge medicine practices. Groups, companies out there will
get into exactly what that means.
I'm really excited to have this conversation because as you
know, Chloe, I work as a chief operating officer in healthcare.
And I say that to say I've seen some problems in our healthcare
system, whether it's the way that it's structured, the fee
for service model, the profitability of it.

(01:47):
I work in nonprofit now, which is is so much better than my my
previous career. But another reason why I'm
excited to have this conversation is because what
you're trying to do is to get medicine, to get healthcare, to
focus on the whole person and toprevent problems from happening,

(02:07):
not just get to the point when we have to treat them already.
And I know you have a story to share around that.
We're going to get into that. So I'm really stoked to have
this conversation with you. But if we could start with two
very maybe like high level questions and then we'll we'll
go deep. But what is the land be and why
did you start it? So 2 great questions.

(02:29):
What is the Lambie? So the Lambie is, as you
described, a modern concierge practice.
We sort of took a different spinon their traditional definition,
which is really focused on 24/7 access, you know, being able to
text your doctor, call your doctor at 10:00 PM on a Saturday
night. That's really what an older
generation craves when they go concierge.

(02:50):
What I felt our generation needed was more prevention, more
holistic, more functional primary care.
And so when we think about modernizing concierge medicine,
it's sort of taking primary careand layering in all these other
modalities to allow it to be a vessel for a more proactive

(03:12):
approach to care. So that's the landing.
We're a membership based model. We sort of have a care team
approach where patients get to work with a physician, a
Wellness advisor, a member advocate collaboratively to be
able to really get at whatever is the root cause of their
current issues, but also use that same investigative lens to

(03:32):
identify personalized ways to optimize your health.
In terms of why, so the Y reallystarted when I was 23.
So I had always been in healthcare.
I've always been obsessed with biology and medicine, but my
career had really been focused on the healthcare side.
Like I was a healthcare consultant, I worked really

(03:54):
closely with providers and hospital systems and was
enamoured by it all. But when I was 23, I was
diagnosed with breast cancer completely out of the blue.
And for the majority of my care,I actually, you know, still
maintained the same level of appreciation for the healthcare

(04:16):
system. I was seeing some of the best
specialists. I had my oncologist, I had my
surgeon, I had my radiation oncologist and they were all top
of their fields at what they do.And I, you know, had this
mentality of like, I'm going to be the best patient.
I want to do whatever it is thatthey tell me to do.
I'm going to be as aggressive asthey want me to be because I

(04:36):
want them to ultimately sit withme as long as they possibly can.
And I felt like the more they liked me, the more time they
would spend with me. So like already I was going into
the patient experience with thismindset of doctors don't have
time. How do I somehow sneak my way
into convincing them to spend more time with me?

(04:57):
It's by making sure that I am a yes patient.
Like, I don't want to be difficult.
I don't want to have problems. I don't want to question their
authority. I just want them to love being
around me and so that when they see me on their schedule,
they're like, yes, Chloe's on my.
Schedule. You thought by being like a
great patient that you would getbetter care.
Exactly, exactly. Well said.

(05:18):
Thank you. You summed it all up really
good, no? I never thought of that.
I never thought you wanted them to enjoy working with you and be
proud of your participation and in so doing get better
healthcare, which could be foreshadowing an issue.
But go ahead, sorry to interruptyou.
No, so that's so that's exactly what mentality was.
And so I just put my head down and did all of the things.
I literally didn't question anything.

(05:39):
Anytime I remember my mom as a 23 year old, my mom came to
every appointment with me and anytime she would question why
they were doing something, I waslike, stop, like you're going to
make them so annoyed at us. And we ended up getting into so
many fights about it at the timeI remember.
But anyway, so Fast forward, I was done with treatment and I
remember sort of like the checkout process, which is like,

(06:00):
OK, you know, now you're going to be on tamoxifen, which is
this drug that you know, breast cancer patients who have a
hormone receptor positive type of breast cancer take for about
10 years. So that was like what I was
going to be on for, you know, the rest of, you know, the next
or at least the next decade. But then that was it.
And so I was like, wait a second.
Like, should I be changing my diet at all?

(06:22):
Like, I was one of those people who was generally pretty healthy
looking, but like, I wasn't eating healthy by any means.
Like, bagels and cream cheese were a big part of my diet,
pizza, burgers, like, I loved all of it.
And so I was like, am I supposedto be changing my diet?
Do I need to cut out anything? Do I need to be exercising more?
I had been an athlete in high school but literally did not

(06:43):
step foot in the gym in college.I was like one of those people
who gained a lot of weight in college because I drank so much.
Like, I just wasn't at all your picture of health.
And they were like, no, like, you know, just, you know, you're
not overweight, so it should be fine.
Quickly they So when you say they were like you're, you're

(07:03):
talking. About my oncologist.
My oncologist. I didn't have a primary care
doctor. Got it, got it.
And why do you, sorry, another quick question, why do you think
of so many patients, you know, breast cancer survivors
included, but any cancer survivor probably walks away
with that limited kind of followthrough instructions and doesn't
even question their lifestyle, their habits, their exercise.
Why? Why do you think that you even

(07:24):
knew intuitively to ask that question?
And then I'm assuming to be a little bit, you know, upset with
the lack of guidance. Like why did you even know to
ask that? It's a good question.
I think that because I was so young, I was like, I have so
many years left. How do I take back control and
feel like I'm doing whatever I can to avoid this from happening

(07:46):
again? Because in my mind, I knew that
if this does happen again, I'm pretty screwed.
Like, it's, you know, more aggressive, probably metastatic.
And at that point, this sort of standard of care, quote UN
quote, isn't going to work. And I'm going to have to have
all these people take care of meagain.
Like, I really didn't want to bea patient.
I didn't want to be a victim. I wanted to feel empowered.

(08:09):
And it felt like the only way that I could do that was by, you
know, changing my lifestyle. Right not take hey, go take this
medication for a decade and let us.
And I was happy to take the medication, but I was like, that
can't be all. Like, there has to be more.
Like I know that alcohol can't be good for me.
And I, I, you know, I know that there are other things that I
should be doing, You know, that there's this whole industry of

(08:29):
Wellness, like, what is it? I didn't know about much about
it, but I know it was there. And so when my oncologist was
like, you know, as long as you're not overweight, you're
fine or not, you're fine, but there's nothing else you can do,
I was like that, that doesn't seem, that doesn't seem right.
And so this sort of, you know, mindset of like, OK, maybe now

(08:52):
is the right time to question mydoctors because maybe they don't
know everything. Maybe they are missing a side of
the equation. And so that's when I started to
explore primary care because I realized I needed more of a
quarterback, like someone who understood my health history,
right? Like, to the extent that my
oncologist to me felt like they needed to be my primary care

(09:14):
doctor, but actually they couldn't because they didn't
understand any other side of, ofmy health.
So I needed someone who could understand that I had been
through this, you know, cancer experience and now needed to
think about my health more proactively.
So primary care felt like, OK, the most generalist resource
that I could find. And I don't know about you, but

(09:35):
like any primary care doctor that I saw, it did not matter
how much I spent, right? Like I went to the concierge, I
went to the in network. They all had the exact same
answer, which is like, you seem healthy.
I was like, I am currently healthy.
I have no cancer in my body. But that's not what my that's

(09:56):
not what I'm asking. I'm asking what more can I do?
Right, right. And you would you would be very
intentional to phrase it that way because I'm assuming they're
just looking at, oh, blood pressure do maybe like do like a
blood, you know, test something like that.
Yeah, they do your basic metabolic panel, they do a basic
CBC and they're like all your levels seem normal.
So like, why are you so worried?I'm like, what do you mean like

(10:17):
that? It's not about first of all,
it's not only about normal. Like am I optimal?
I started listening to Peter TI,started listening to Mark Hyman.
I started to understand like this world of biohacking and
optimization. I was like, why isn't this part
of the conversation with your primary care doctor?
Look, one in ten Americans todaystruggle with alcohol use
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(10:40):
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(11:01):
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Yeah, Amen. And you're sitting there like,
well, I'm, I was faced with my mortality at 23 years old and I

(11:24):
would like to not face it again.What do you got for me?
Not just, you know, send you outthere real fast.
You said it came out of the bluewhen you got the diagnosis.
Was there any like, history in your family of Brett?
Nothing. It just literally, wow, that
must have been scary. I can't even imagine.
It was weird. I was like, is this really
happening? I feel like you guys must have
made a mistake, right? It's like, Are you sure?

(11:45):
I kept on like, waiting for themto be like, oh, actually, I'm so
sorry. This, this isn't this.
We made a complete mistake. This was someone else.
But yeah, no. And then once I started chemo, I
was like, no, this is actually happening.
Wow. Yeah, it was wild.
So where'd you get from there? So you you did this awakening,
you started to sounds like learning about the other things
out there. Yeah, so at that point, I was

(12:06):
like, I don't need a primary care doctor.
Like clearly they're not going to be helpful to me.
Let me go dive into Wellness. Let me become the expert when it
comes to Wellness for cancer prevention.
And so I read a ton of books. I listened to a lot of podcasts.
I just basically was an absorber, a sponge of
information. And again, going back to like
being a perfect patient, I wanted to be the perfect cancer

(12:30):
survivor. I don't know what it is about
me. I guess it's like I'm just a
very disciplined person. But I did all of the things.
I was intermittent fasting, I cleaned my diet, I stopped
drinking alcohol. I stopped consuming any sugar.
I was like Wellness obsessed. And about three years later, I
lost my period. And I thought, oh, maybe this is

(12:53):
an aftermath or a side effect ofchemotherapy.
So I went back to my oncologist.I was seeing him every year.
And I said, do you think that this is just, you know, the long
term buildup of chemo or, or what do you think it is?
And he's like, I don't know, because we don't really know
what happens to women who have chemo at such a young age.

(13:14):
So, like, there isn't enough data for me to definitively tell
you that this is a side effect of chemotherapy.
But he wasn't like, oh, your BMIis really low.
Maybe we should up your weight. He didn't say anything like, oh,
what are you eating? How often are you exercising?
There was no questions about, like, my lifestyle or what else
could be causing it. I went to go see a gynecologist

(13:36):
and she was like, I don't know what the risks of chemotherapy
are. I don't know enough about
oncology to be able to tell you what you know, whether or not
this is that or tamoxifen or just like anything else.
No one was tell asking me about my lifestyle.
And so at that point I was like,all right, no one has answers.
I'm just going to keep doing what I'm doing because it feels

(13:58):
good. I feel like I am doing all the
right things. Like why would I question it?
Maybe I, maybe I just like, maybe this is just chemotherapy
and this is my life. Then I wanted to start a family
and ended up going and meeting with an IVF doctor.
IVF doctor basically told me thesame thing.
We don't know why you don't havea period, but we'll give you

(14:19):
hormone replacement and we'll get you, you know, to produce
those eggs. We'll do, you know, the, the
retreat, the retrieval and then we'll do the transfer and it'll
be fine. I ended up doing 4 rounds of IVF
and the last two rounds actuallystuck.
I was able to get pregnant, but I miscarried both of them.
I miscarried and I was like, this is weird.

(14:40):
Why do I keep miscarrying? And he was like, I don't know.
I was like, really like, we're not going to figure that out
before we try again. And he was like, you know, maybe
we should stop and consider surrogacy.
And I was like, you know what, that's a good idea.
I, if I don't know why I keep miscarrying, I'm not going to
put myself through this again. I'm going to go through
surrogacy and I'm going to figure this out on my own.

(15:01):
So at that point I was like, allright, let's move.
We're moving forward with surrogacy.
Both of my kids were with surrogates.
Thank God for surrogates. That's a whole other story.
But anyway, I then met with a functional medicine doctor and I
was like, clearly there's something wrong and I need to
figure out what it is. So ran a bunch of tests and

(15:23):
eventually figured out that I had hypothalamic amenorrhea.
For people who don't know what that is, it basically means that
your body is in a state of complete stress, whether it's
nutritional deficiency or over exercising or emotional
psychological stress. And I think I, it was a
combination of all three of those things for me, because I

(15:44):
was probably eating under 1500 calories.
I was probably, I don't know because I never counted my
calories. I was just eating so clean and
my, the foods that I was eating were so, you know, filling that
I never, I never felt like I washungry.
Like I was always eating my 3 big full meals.
I was, I'm very much satisfied by my meal.

(16:05):
So I never thought oh, I'm undereating.
Exercise wise. I was not a big cardio person so
I never felt like I was over exercising.
But I was working out 5-6 days aweek.
But like not anything super intense.
So I didn't even question that. And then from a stress
perspective, like mental health wise, I felt like I felt good,

(16:27):
like I had all this energy. I felt extremely motivated by
what I was doing every day. Like I did not feel like I was
emotionally stressed. But lo and behold, like my labs
were saying something different anyway.
So the take away from all of it was had I, at the point in which

(16:47):
I decided to invest in my Wellness, had done a baseline
set of labs, not baseline. And that like it was, you know,
the sort of small panel that a primary care doctor would do,
like a really extensive panel across my hormones, my, you
know, metabolic health, my cardiovascular health, my
nutrient levels. Had I done a more baseline

(17:09):
panel, I would have been able tothen track all of these
different interventions that I was self experimenting with to
see how they were impacting my health.
But I didn't have any clinical oversight.
I was doing this completely on my own.
And I think that that's ultimately what led to my
demise. And so when I think back to how

(17:31):
could I have avoided this from happening, the answer really
lies in having an integrated approach between medicine and
Wellness, having a no insurance model where my doctor could
really spend time with me to figure out, okay, maybe I don't
know enough about chemotherapy, but I'm going to take the time
to figure it out. And I, I'm going to work with a

(17:53):
nutritionist to figure out what should be the right diet for
you. And we're going to also talk
about exercise and we're also going to talk about supplements.
And we're going to track your labs every quarter to see how
they're evolving so that we knowthat we're keeping your body in
the right optimal state. If I had that integration, none
of this would have happened. And so that's the why that's

(18:17):
that's sort of what led to the land is we need a care team
model. We need a membership based
platform that really sort of thinks about the all inclusive
nature of primary care. It can't be a one off here and
there like, oh, you know, let's schedule this visit now.

(18:38):
I need to pay you for this visit.
Oh, but I need a separate visit to go through my labs and oh, I
need a separate prescription refill.
And oh, I need a separate consult about, you know, whether
or not I should be intermittent fasting, like, but by the way,
my doctor doesn't even know the answer to that question.
So it's like we needed a home base.
Yeah, yeah. As I'm listening to you, that

(18:58):
for whatever reason, the word ecosystem popped into my mind.
Meaning like our health truly is, is an ecosystem.
And it all works together in thesame way that nature is an
ecosystem, right? If there's a change to air
pressure that changes precipitation, that changes the
lake, that changes the ground and change it like that, it all
works together. And it feels like you, because

(19:19):
of your persistence and your instinct that you could be doing
more, were like running two separate siloed people and they
weren't connected and they were just kind of focusing on their
little area. And unless as a, as a person,
unless we have that instinct that we, I could do more or the
education. Because it sounds like you
started reading and listening tothings you would not have known,

(19:40):
to question what you were being told and to try to pull up and
look at the forest instead of the trees and how long between.
I would say like when you left your oncologist that first time,
here's some medication, keep in touch to finally having this
awakening or realization that like, oh, I have clarity now.
It's all interconnected. Like how long was that journey?

(20:02):
Five years. Five years it took you to get
there, That's incredible. Yeah.
And by the way, like I still haven't figured it out.
Like it's still an ongoing journey.
And I think that's what's so challenging for, for patients
today is like, to your point, they have to be the quarterback
of their own health. They have to, you know, connect

(20:24):
the dots between all the different specialists that are
telling them one thing versus another.
And they use like 1 specialist as their primary care.
Like let's say you or someone who has a lot of GI issues, you
end up saying, oh, but I've usedmy gastroenterologist for my,
for my primary care needs. But like really you're going to
ask your gastroenterologist likewhat they recommend when you're

(20:45):
dealing with if you know, a consistent bout of, of, of colds
and inflammation or like they don't know anything about that.
Or like you're going to talk to your gastroenterologist about
your metabolic health. And like the fact that you
haven't been able to gain weightand you don't know, sorry, lose
weight and you don't know why oryou, you know, you need to gain
weight and you don't know how. Like people are so confused as

(21:08):
to how we should be interacting with the healthcare system.
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(21:28):
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(21:51):
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And I just want to clarify one term, right, because I feel like
it's healthcare guy talking to ahealthcare gal.
But you say primary care. You said it a couple times,

(22:12):
people. There's other like terms.
I just want to clarify them here.
You clarify, but there's like family medicine doctor, some
people say that primary care, some people just say doctor's
office, which is kind of like a catch all.
But what are the differences with those terms when you talk
about primary care? And then I want to double click
on your model and just go a little bit deeper behind the
curtains of what it's like to step into a concierge model.
But can you clarify? Verify those terms quickly.

(22:33):
Yeah. OK.
So there's primary care, there'sinternal medicine, there's
family medicine and there's functional medicine.
I would say those. And then there's probably like
my other people call it my, my, my GP, my General practitioner.
That's another word that people use.
So family medicine ultimately just means that you have a

(22:57):
Doctor Who is board certified infamily medicine.
That means that they are able totreat patients at all ages, from
newborns all the way to geriatric.
Primary care is really the focuson like all of the sort of, it's
like the first sign of defense in terms of like, oh, you get

(23:18):
sick, you know, you have a cold.You, you know, want to think
about your, it should be like thinking about your health
holistically. It's not obviously, but it's
like the first person that you go to when something's wrong to
like basically triage to figure out like, can that person fix
the issue or do they need to send you to a specialist?
When primary care is done right,85% of healthcare needs can be

(23:43):
addressed by primary care alone.You should not need to go see a
specialist. The problem is that most primary
care doctors will only spend about 8 minutes with you, and if
they're not giving you an antibiotic prescription or some
other prescription, they want tojust hand you off to the
specialist because they can't spend more time to figure out
what's wrong with you. General practitioners are
basically the same thing. They're either a family medicine

(24:06):
doctor or an internal medicine doctor, but they're again,
General practitioner is like first line of defense, like
they're your generalist. They're just different
terminologies. And then internal medicine is
another board certification. But usually those doctors work
within the hospital system. They usually like are, you know,
working within academic or not even academic, but a hospital

(24:30):
system. So it's like when you go to the
doctor and you get seen by an internist, like that's usually.
And then sometimes they do go private practice, but like their
board certification is focused on being in a hospital setting
there and they're usually focused on adults.
Got it. And then functional medicine is
sort of this new model, relatively new model of medicine

(24:52):
where they look at the body, to your point, as an ecosystem.
It's an interconnected system where all of these bodily organs
are interconnected and they depend on each other for
different things. So they don't see your metabolic
health as one siloed system. They don't see your hormones as

(25:13):
one siloed system. They don't see your nutrients as
being. It's your gut.
You know, like all of these things are actually so
interconnected, your brain and your gut, like your hormones and
your cholesterol and all these things.
And so when they look at your labs, they want a much broader
set of labs because they like tosee where these deficiencies are

(25:35):
actually connected. And once they see that, they can
help get to the root cause of what's actually going on in your
body. A lot of times, you know, when
people are like, oh, I have liketerrible acne and I have
terrible fatigue and I have terrible like, whatever it is,
I'm bloated. It's like, okay, let's figure

(25:55):
out what's actually happening inyour gut.
What's the inflammation that's taking place there?
And maybe that could be the one root cause that's causing all of
these other things to manifest. And sometimes when you go, when
you think about, oh, I have acne, let me go to a
dermatologist. They're just going to give you a
prescription for acne. They're not going to be thinking
about it from the root 'cause they're not looking at your gut.

(26:17):
And you know, same with like, oh, I gained a lot of weight and
I don't know why. It's like people are just like,
oh, maybe you should just put you on a GLP one.
Or maybe we should just try to lose weight or like try to put
you on a diet. Like, no, maybe that's actually
not what it is. Like maybe your hormones are
just completely out of whack. Maybe your cortisol levels are
too high. Right.

(26:37):
You know, you're making me thinklike most people choose their
primary care doctor by like, howclose are they to me?
Right. There's a health system in the
area. I'm going to go to them.
You show up with a cold and they're like, Yep, you got a
cold, Here's some medication. Take it for three days when
they're not like, Oh yeah, you drink 30 drinks a week.
You sleep like crap. You eat like trash.
Your, your gut microbiome is trash.

(26:59):
Like your immune system is weakened and that's why you got
the cold, silly. Like, let's talk about all all
those things. They just go, what do you got?
Not here you go. Good luck.
And they don't kind of look, as it sounds to me, like we should
all be looking for a functional medicine doctor.
Would you agree? Yes, So the problem with
functional medicine though, is that a lot of a lot of doctors
who've become certified in functional medicine now don't

(27:20):
want to do primary care. And that was the problem that I
encountered when I finally foundfunctional medicine.
I was like, wait, can't you alsobe my primary care doctor?
Like can't we also talk about myheart health and like prevention
and all these things? But functional medicine doctors,
that's, that doesn't interest them.
They don't want to do primary care anymore.
They want to just focus on functional medicine.

(27:42):
And so that's didn't work for mebecause again, it felt like I
was just creating another silo. So my, my vision was we need
primary care. We need sort of a, a foothold
within the healthcare system, but we need to broaden the
definition of primary care by integrating functional medicine
as a key modality as well as integrative medicine.

(28:06):
So integrative medicine is another modality that is
incredibly useful when it comes to primary care.
So basically what integrative medicine is, is sort of finding
the, the, the bridge between Western and Eastern medicine.
So Western medicine is like, youknow, typical medication,
surgery, like all the things that we are used to.

(28:29):
And then in Eastern medicine is when you think about like
Chinese medicine, like acupuncture, herbs, also looking
at like what you're eating and the sort of the impact that it
has on like your gut and like warm foods, whatever.
So a lot of times when you meet with an integrative medicine
doctor and they're trying to figure out how to improve a

(28:51):
certain issue that you might be having, whether it's your
cholesterol or metabolic health or not, just going to recommend
a prescription drug. They're going to say, let's try
to alleviate this with lifestyle.
And so that's sort of where the treatment approach can also be a
lot more whole body, whole person looking at your

(29:11):
day-to-day and sort of figuring out how to sort of naturally
remove the inflammation as opposed to just like putting a
stop to the symptom. So functional medicine and
integrative medicine can work really nicely together.
Often times you have practitioners who are only
trained in one of the two. And so we like to sort of pull
from both of those modalities, but still be the same practice

(29:35):
that you go to when you do get sick.
And so that's where also the member advocate piece really
comes in because we want to coordinate your care as you
know, in terms of like, OK, yes,you come to us when you're sick,
but let's say you come to us also when you just got diagnosed
with prostate cancer, right? Who do you go to?

(29:57):
You don't want to have to figureall that out on your own.
You need to, you need to figure out like, OK, which specialist
do I need to go to? What's the next steps?
Like who's going to sort of oversee this process for me?
And so that's where the care coordination piece really comes
in too. And advocacy like you can, to
the earlier point, like I had toknow which questions to ask into
a certain extent. Like I was wary to even ask

(30:20):
those questions because I wantedto be such a well liked patient.
But you really should be challenging your doctors.
And oftentimes patients don't know what questions to ask.
And so they just say, well, thisdoctor knows way more than me.
Why am I going to question his authority if he's telling me to
do this treatment plan? I should probably just follow
this treatment plan. But we actually probably should

(30:42):
be getting second opinions. We should be using our primary
care doctors as our sounding board and so that's where we
also can help. And also it sounds like where
you're where you're helping is I'm just kind of picturing
myself being you, frankly, you, you were when you were running
around these different specialists trying to get
answers and guidance. It's probably very stressful.
And it sounds like you're, I'm assuming when you finally got

(31:04):
some clarity like your stress hormones like cortisol and
things were probably through theroof, right?
And you didn't even know it. You weren't experiencing it, but
your body was was stressed. My point is, it's like if I'm
picturing myself working with this team, this integrated team
that has primary care that can treat more like acute things,
like I'm sick, I can go to you. I want to prevent getting sick.
I can go to you. I get a diagnosis, you can guide

(31:26):
me through it. My point is, I would have so
much more Peace of Mind knowing,to put it simply, that like
someone's got my back. Someone's like looking out for
me. I don't have to be
quarterbacking my own care. I can go to this trusted team
that's looking at that ecosystemand to and helping me connect
the dots. Like this is what you're
reporting to feel and experience.

(31:47):
This is what your tests show. This is what your background
shows. Have you thought about this?
Because in the current state, ifyou're just relying on the
status quo, you very much are probably leaving these
specialists and these doctors with this like weight at night.
Like is there something else? And it feels like to have
someone that has your back like that would just if anything give

(32:08):
some Peace of Mind which would lower your stress and improve
your mental health and allow youto focus on your physical
health. Which is probably what got you
to engage with the health systemin the 1st place, if that makes.
Sense. Totally.
One of the things that I love iswhen our members say that we
almost cured them of being a hypochondriac.
Yeah, there you go. I'm like, that's amazing.

(32:28):
That's like the best thing that we could have done is like give
you the Peace of Mind that you don't have to be worried about
your own health because we're thinking about it.
We're making sure that we're, you know, checking everything so
that you don't have to feel likesomething's going to slip
through the cracks. Yeah, I love that your website,
I want to talk about like the journey itself because sometimes
people can understand how it would work because this is a

(32:50):
pivot, it's a change if you would work with like the land be
versus what you used to. But sometimes it helps to kind
of like pull back the curtains and describe like an experience
your website, and I'll point everyone to it, the land be.com,
I'll link to it in the episode description.
But your website does a great job very simply breaking down
what I'll call kind of like the onboarding process and then into
the actual care process. But if a person patient, right?

(33:12):
But if a person says like, hey, I want to, I want to explore
this, like, what is that actual experience like?
And then once they're actually working with your team or teams,
like what can they expect? What does that feel like?
Yeah, great question. So we basically modeled it as
you know, from, from the patientperspective, like what would be

(33:32):
the ideal patient experience? We like to call our patients
members. So it really does feel as you're
going through this that you are a member of, of a, of a, of a
practice where like you feel like there's stuff happening
even behind the scenes, right? So like we're really trying to
change the dynamic of like fee for service to ongoing
membership. So when you join the Lambie, the

(33:54):
first step is an onboarding callwith your member advocate.
So that person is assigned to you as your liaison, your chief
of staff, you know, your admin when it comes to all things at
the Landy and externally interacting with the broader
health and Wellness system. So they'll give you the lay of
the land of what to expect. But then they will also help you

(34:16):
schedule your onboarding call, I'm sorry, your baseline visit.
They'll tell you what to expect throughout the course of your
membership. And they'll also sort of use
that time to just get to know you personally.
Like what are your motivations? What are your fears?
What are the things that frustrate you?
How do we make sure that we create the best experience for
you possible about, you know, a week later, depending on when

(34:39):
they scheduled their baseline visit, they come in in person or
their baseline, which is an 80 minute visit.
So during that time, they first meet with their care team, which
is their physician, 80 minutes. Is is a?
That's a long time. That's great.
That's a. Typical doctor's appointment
these days is 20 minutes, of which you see your actual doctor
for seven and a medical assistant is with you asking

(35:00):
questions. But go ahead.
That's I'm just blown away by 80minutes, but keep going.
So the first like 40 minutes area conversation between you, your
doctor, and your Wellness advisor.
So we actually have created thischoreography where we have
physicians and Wellness advisorsworking together as a team.
The reason for that is because, again, as a patient, it's super

(35:24):
annoying. When you go to meet with your
doctor, you tell them your wholehistory and they're like, OK,
great. I think what we you need to do
is probably improve your diet. Go talk to the nutritionist
about improving your diet. Then you have to schedule a
separate conversation with that nutritionist about two weeks
later and you have to repeat everything that you just said to
that doctor. It's super inefficient and

(35:46):
frustrating, right? Like, why don't you already have
all of this information? Why do I now need to regurgitate
and by the way, schedule two different appointments for this?
So we wanted it to be a joint visit, So 40 minutes go through
your medical history, your family history, your lifestyle,
you know, what are the things that you're doing from the
moment you wake up to the time that you go to sleep?

(36:08):
What is it, you know, a day in the life of Jesse look like?
Then we will do a physical exam where you're doing that with the
doctor. You know, they have a moment to
be one-on-one with you. Talk about things that are maybe
more intimate. You don't want necessarily talk
about in, you know, A2 on one dynamic.
We'll also do body composition analysis.
So that's the measure of your visceral fat relative to your

(36:30):
muscle mass, which is a really helpful longevity marker.
And then finally, we'll do vitals and very extensive labs.
So we draw this is all in person.
No, this is all still in person.This is all still part of the 80
minute visit. So after that 80 minute visit,
you leave, you schedule your baseline follow up visit, which
is a virtual visit and that's togo through your care plan and

(36:53):
your lab results. So during those, you know, about
two weeks, we've collected all of your previous records from
other specialists, we've reviewed your your lab results.
We've also, you know, taken intoaccount your lifestyle and all
of these sort of factors that you shared with us, your family
history and that informs how we want to focus your care over the

(37:14):
next three to four months. So we break it down into a
quarterly care plan. The reason for that is because
if we were to give someone an annual plan, that would be way
too overwhelming and you can actually see progress after
three months in your labs. And so we want to.
How do you share the plan? What does that look like if I
were to receive it? So you receive it as APDF via

(37:35):
e-mail. We then go through it with you
in a your virtual visit where wescreen share with you.
We screen share also your lab results.
We go through every single lab result in detail, even the ones
that are considered optimal. We want you to understand what
that means. What are you doing right?
What do we want you to continue doing?
And then what do we want to tweak so that you can, you know,

(37:56):
obviously improve any of the levels that are deficient,
suboptimal, wherever they stand?We'll also sort of give you an
explanation as to like what our hunches are, as to like why you
might be feeling how you're feeling.
Sometimes though, we need to investigate further and that's
when we can either do a deeper dive on labs or layer in
advanced diagnostics that will all be included in your care

(38:17):
plan. So in your plan, you'll also see
recommendations for nutrition, for exercise, for supplements,
for specialist referrals that wecoordinate for you, for
preventive screenings or imaging, and for any medications
that you might need. So that care plan is like, OK,
this is what I need to do in thenext three to four months.
We try to be as clear and prescriptive as possible.

(38:41):
Then three to four months later,you come back in for repeat labs
in the goal there is to see like, OK, what's the progress?
We move the needle. Did we move the needle?
Did we not? Did we go too far?
Like maybe this wasn't, you know, agreeing with your body?
And so that allows us to then reflect on the care plan and

(39:03):
say, do we need to adjust this care plan?
Do we now want to focus on something different because
you've actually achieved progress and now we can put you
in maintenance mode on this. Or, you know, do we need to
pivot and try something different and, you know, work on
that same, same goal? So it really depends on the
individual. Sometimes that's also just a
good check in moment for people who have, you know, ignored

(39:25):
their health and they use that as a moment to say like, you
know what, my sleep actually hasn't been that great recently.
And I think it's probably because of this.
But like, what do you think? And so it's just a nice sounding
board check in a time to reflecton your health and keep yourself
accountable. So we meet with our members
every quarter and they're alwaysjoint visits between the member,

(39:47):
a clinical member and a Wellnessmember on your team.
So it's very efficient in that way.
And then you always have the ability to schedule one on ones
with your Wellness advisor or your physician or an advanced
practitioner to be able to have those more intimate
conversations if it does feel like a specific, you know, topic
you want to go through. And then we have an app that

(40:08):
allows you to chat with your care team.
So chat ends up being really useful for some of the small
questions that come up, especially now with Wellness
being so overwhelming and confusing and people being
targeted right and left on social media with different.
ADS people use the chat for questions like oh, I just got
targeted this supplement on Instagram.
Can you tell me what you think of it?

(40:29):
Like, do you think that this could be a good fit for, you
know, my, my, you know, this goal that I have or like I, you
know, want to change my meal plan?
Like what do you think that I should, you know, incorporate
that I have for seasonal vegetables?
Or, you know, maybe it's more ofa clinical question, like I just

(40:50):
got diagnosed with COVID. What are some of the natural
remedies that I can be using at home to like accelerate my
recovery? Because, you know, there's not
really much you can take when you get COVID.
You just have to wait it out. But there are ways to accelerate
your recovery. So chat ends up being a great
efficient way to stay in touch with your care team.
Not necessarily have to book a visit and just triage a lot of

(41:12):
the questions that pop up in your head.
That's amazing. I just bought a cold plunge.
I have to build it this weekend,but like I don't know how to use
the thing. I just know it's supposed to be
good for me. Like I can see myself instead of
going to ChatGPT just like chatting you guys and be like,
hey, like I got this. Is this even going to be good
for me and how should I use it? I can see myself using that like
every day. Honestly, I don't know how you

(41:33):
how you provide that access, no.People do.
No, people do. It's great.
I think it's great. I think it's great.
I think that it's, it's, it's a great way to stay engaged with
your members and just like keep them on this steady like
progress train. Yeah, that's amazing.
I know. I off of your website it says

(41:54):
subscription and you use that word before.
Can you describe how that works?The subscription model for your
healthcare? Yeah.
So it's basically 1 flat fee that you pay annually.
And the reason that we did it that way is because we wanted it
to be incredibly transparent. We wanted one moment in time
where you have to think about cost, but then after that you
never have to think about it again.

(42:15):
The reason for that is because there's this like awkward,
there's this awkward like sensitivity that people have
when they interact with their primary care doctor, any doctor
where any question that you have, you feel like you're going
to get up charged and then you're going to get a surprise
bill in the mail. And it's like really, they
charged me for that 5 minute phone call or really I just had

(42:39):
one. Like I just needed that one
prescription refill and they charged me for that or I needed
that one flu shot and they charged for that.
Or like I just, you know what I mean?
Like I don't want, I never wanted people to feel like they
were going to be upcharged rightand left and like that was going
to sort of detract from the experience.
So it's an all inclusive model. You never have to think about

(43:00):
cost again. And then it's subscription.
Like if you ever want to cancel after a year, you can like you
do not, you're not sort of tied to this.
But I think the the benefit froma incentive perspective is that
we're real realigning that, thatthe goals for the physician and
the patient, right? Like in the traditional fee for
service model, physicians are incentivized to increase the

(43:24):
number of visits that they have with patients, whether it's a
single patient or multiple patients in a day.
Their goal is to see as many patients as they possibly can
because that's how they make more money.
For us, we didn't want that. We wanted them to be focused on
retention. How do you retain members?
If by keeping them happy, makingthem feel supported, making them
feel heard, making them feel like this is a worthy

(43:44):
investment. And so this allows us to like
Refocus, where we want providersto invest their energy into
making members happy and making members feel like the customer
as opposed to the insurance plan.
Yeah. And yeah, I I love that you do
it that way because it let's just say you offered like a
monthly subscription that's counterintuitive to what you're

(44:07):
trying to accomplish. Going back to what you just
described, these quarterly checkinsurance and moving the needle
to say that again, you can't move the needle month over
month. And if someone just comes and
sees you and goes through the process and gets their PDF and
they make those changes, what happens next?
If you're just not a member anymore after two or three
months, like you're there for their long term health, It would
make no sense to have a short term type model.

(44:28):
My chance because it takes time to improve your health.
I totally agree. And this is like a big, big
stick that I have with like executive physicals because I
think that they make the create this perception that like in two
days you will be able to have every answer that you need in
order to feel in control of yourhealth.
And that is just not true. They basically bundle in all of

(44:51):
these different diagnostics, allthe same diagnostics for every
single person, which by the way,not every person needs the same
screenings or the same diagnostics, right?
Like you should be tailoring them to the patient's family
history, the patient's medical history, their lifestyle, their
age. But anyway, they sort of create
this illusion that like, you're going to get every test under
the sun. And by having all that data at

(45:13):
your disposal, you are empowered.
By definition. You are basically putting all
this information into the hands of patients that they then don't
know what to do with. And then often they need a lot
of help coordinating, coordinating their care over the
next year. And they don't have any of that
support. So people are paying 10 to
$25,000 on just two days of an executive physical when they

(45:35):
really should be investing in a year's long worth of membership,
which is the same price. But they're going to be a lot
more strategic about when they incorporate those screenings.
And they're going to leverage your insurance to be able to
cover the cost of some of those screenings so that you're not
paying out of pocket for everything.
And that's where our model we really focus on.

(45:56):
We're going to be the primary care guide and we're going to
deliver as much care as we can in house.
But obviously when it comes to screenings, when it comes to
labs, when it comes to diagnostics, we're going to try
to and specialist, we're going to try to use your insurance as
much as we can because those arethe things that you should be
using insurance for. Yeah, 100%.

(46:18):
And also like having long term access to a team like yours.
It it also there's accountability, right?
Like if you give me right, I'm the type of personality where if
you give me something to do, I'mgoing to do it.
And if I don't do it, I feel honestly ashamed.
That's why I do it. But like if I know that I've got
that meeting coming up in three months, I'm not going to show up
and you're going to ask me like,OK, so we talked about all these

(46:39):
habits that you were going to change.
How are you doing? I don't want to be like any of
it so. It's like I think the.
Accountability long term is important for sustained habit
change and lifestyle change and all those things.
So yeah, I love it. I think it's amazing.
I want to ask you Chloe, one more question about the future.
So we talked a lot about kind ofthe current healthcare system

(47:02):
and and where it should go, I'llput it that way.
And and how you or how the land be can help.
But when you kind of look forward into a broader vision,
where, where do you see the landbe going?
Where do you think as a society healthcare should go?
And then maybe mention just anything that if you could, if
you could share anything that you might be working on that

(47:24):
maybe you're not doing now that we should be excited about.
Great question. So obviously my vision is that
more practices embody this more proactive approach to primary
care. That is the future.
I think we need to not necessarily be investing in more
consumer diagnostics that put more data into the hands of

(47:44):
consumers, but rather investing in primary care that is more
comprehensive, more cutting edge, really helping people
navigate all the data that is attheir disposal in a thoughtful,
personalized way. That is what I believe the role
of primary care should be. And I think that that is where
where we are headed. And I think that we are the ones

(48:08):
that are sort of pushing forwardthat message more than anyone
else. And I'm very proud of that
because it's very saturated market right now in terms of
health and Wellness. And I think again, like there's
so much power that we can give to the consumer, including
access to things like Chachi BT,but at the same time recognizing
the role of the provider and howwe can stay relevant is where we

(48:33):
ultimately end up saving as consumers and also saving our
healthcare system. In terms of where I, you know,
hope to take the land, the obviously, you know, right now
we're focused on New York and the tri-state area.
We do have some members in Florida and California just
because we're licensed there. But my goal is to be able to
open a few more locations acrossthe country, but still be very

(48:56):
methodical and how we grow. You know, I want to make sure
that the quality of our care, the consistency of our care is
at the highest standard before we start to invest in more
locations. Often times that like super fast
growth is at the risk of diluting that quality.
And that's not something that I'm willing to compromise on

(49:17):
just because, again, I think from the patient perspective,
you lose everything when when you start to grow too quickly
and, and focus on growth over over quality of care.
And then what we're working on. So, you know, we were talking
earlier about parenthood and, and what it means to be a good
parent today. And I now have two young kids,

(49:39):
three and two year old, and I find myself asking questions all
the time about like, how do I raise these kids to, you know,
have the same values about health and Wellness that I now
have, right? Like we're up against the school
system. We're up against the healthcare
system where, you know, we now are at the whim of what they

(50:01):
impose, whether it's vaccines, whether it's antibiotics and
Tylenol, and whether it's like, you know, a certain milestone
cadence or whatever it might be.Like, I feel like I am very torn
between like, what I want for mykids and what I feel like I have
to do because things are mandated of me.

(50:22):
And I feel like there's no safe space to be able to talk about
that freely. And I don't necessarily have the
answer, but I think what I realize is lacking for parents
today is that safe space to havethose conversations with their
trusted providers. And you know, I think on the
other side of the spectrum, likeif you look outside of

(50:44):
healthcare and you can focus on Wellness, I think the Wellness
industry when it's focused on kids is also becoming very, very
daunting to navigate as a parent.
There are so many quote UN quoteexperts out there telling you
how to raise good children, how to be, you know, include gentle
parenting, how to think about independent play, how to give

(51:05):
your kid the right nutrition, how to help them, you know,
develop better sleep, like all of these things.
And it's like you just feel overwhelmed, like, am I doing
everything right? This literally feels like this
is another part time job. And that was the whole reason
why I did, you know what I did to begin with when it comes to
the, the the model of the Lambie.

(51:25):
And so I think as I think to thefuture, and I don't think it's
too far off, I'm really excited about expanding the scope of our
services to include the entire family because I want moms and
dads to be able to feel like they have a sounding board in
their family medicine doctor to talk about their kids health.

(51:46):
And I want to be able to also support that kids health and,
you know, figure out the right cadence of care that's really
going to acknowledge all of the,you know, crazy things that are
happening with kids today. The anxiety, the, you know,
stress, the technology exposure,you know, the changing of like

(52:10):
what was in our food. I mean, it's, it's everything.
It's everything. And I think that our model is so
well equipped to be able to support that.
So that's sort of where right now my heart and soul is going
with this. The company is like figuring out
what the model of Pediatrics looks like and hopefully we're
launching that in in early late 2025, early 2026.

(52:32):
Now let me know sign me up. And it's, I think it's beautiful
that as a leader, like as you'restepping into and experiencing
parenthood for the first time, now you're inspired to bring
pediatric care and bring that into your into your company.
Look, it's, it's ironic time, but if it just so happens my, my
son JJ is tuned and 1/2 he just had his, I get whatever you call
it, like his regular visit with,with our pediatric provider.

(52:56):
And I wasn't able to go and my wife came home and I said, how
did it go? Like how did his, how did his
appointment go? And she goes, he's 98% in
height. And I'm like anything else?
Like what else? Was there any other
conversation? Was there any other?
And she goes, no, he's, he's good and he's.
Tall. It's like that's all, that's all
we got. It's like it's his case in

(53:17):
point, like what if the questions were more like, well,
like talk to us a little bit about like his behavior, talk a
little bit about his, his screentime, talk a little about his
diet. Like how can we make sure that
like we're we're guiding him, you know, to be a healthy human
that's balanced and has emotional and physical health.
So I think it's lacking. I think it's overwhelming as a
parent if you try to find information because it's

(53:38):
fragmented and often times it's just like diametrically opposed
the guidance that you get and you kind of walk away from it
and be like, well, I'm just going to figure it out, I guess,
you know? So I think it's needed.
I think it's excited. I'll say this, I loved talking
to you. I feel like there's a couple
topics we can probably go deep on and have another hour
episode. I'm going to put you on the spot
and invite you if you could comeback.

(54:00):
I think we should check in maybelike every couple months and
just have different topics because, yeah, the the wisdom
that you shared and what you're doing, I think is exactly what
people need. And it was an honor to host you
on the show today, So thanks forjoining.
Thank you. It's so sweet.
Yeah, I would love to come back.Yeah.
Love talking to you too. This is so fun.
Awesome. Chloe Hirosh, everybody.
All right, everybody. That's the show.

(54:21):
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(54:41):
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Why Primary Care Medicine Is Failing Us—and the Model That Could Fix It | Chloe Harrouche, Founder of The Lanby

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.css-14f5ked{margin:0;word-break:break-word;display:-webkit-box;-webkit-box-orient:vertical;box-orient:vertical;-webkit-line-clamp:2;overflow:hidden;}Why Primary Care Medicine Is Failing Us—and the Model That Could Fix It | Chloe Harrouche, Founder of The Lanby