June 11, 2025 • 10 mins
Healthcare's identity crisis sits at the heart of our inability to truly help patients get healthy. Dr. Caroline Collins, an internal medicine physician at Emory University, joins the Reverse Mullet Healthcare Podcast to reveal how she's championing lifestyle medicine inside one of America's leading academic medical centers.
What happens when a physician decides to focus on the root causes of disease rather than just treating symptoms? Dr. Collins shares her personal journey, sparked by witnessing diabetes and cancer in her own family, that led her to become a voice for change at Emory. "I can't give you a pill or an injection to make you healthy," she tells patients. "It's really about how we live our lives."
The conversation unveils Emory's groundbreaking work in lifestyle medicine research and their upcoming lifestyle and weight management clinic focusing on employee health and pre-surgical optimization. This "prehabilitation" approach demonstrates how preparing patients before surgery dramatically reduces complications and costs—transforming potential ICU stays into outpatient procedures.
The most revealing moments come when discussing healthcare's fundamental misalignment of incentives. "If patients are healthier, who's going to fill your clinic schedule?" This exposes the uncomfortable truth: our current system financially rewards sickness, not health. Dr. Collins describes the "schizophrenic" nature of healthcare organizations pushing volume-based metrics while simultaneously embracing value-based care contracts.
Ready to understand why common-sense approaches to health aren't common practice? Listen now and discover what it takes to transform healthcare from within the system itself.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Justin Politti (00:02):
Welcome to the Reverse Mullet Healthcare
Podcast from BP2 Health.
We are live at the ACOMConference in Orlando, florida.
I'm your host, justin Politti,dave Pavlik.
Ellen Brown (00:11):
Ellen Brown.
We are here in the AmericanCollege of Lifestyle Medicine
Conference and we are here withsomebody that was one of the
first people I met in myexposure into lifestyle medicine
.
Justin Politti (00:24):
Oh.
Ellen Brown (00:24):
And, yes, Okay, Caroline was one of the first
folks that I talked to and itwas, I don't know.
I just really appreciated thework that you're doing and the
challenges that you face and wejust talked with Caroline's with
Emory, physician at Emory andhas a very exciting, yes,
challenging job of bringinglifestyle medicine into an
academic medical center.
Justin Politti (00:45):
Outstanding.
Caroline Collins (00:46):
Yes, so with all of that tell us about
yourself.
Yeah, I'm an internal medicinedoctor focusing on lifestyle
medicine at Emory, so I alsoteach medical students and
residents about internalmedicine, but also how to
integrate lifestyle medicineinto the care of patients at
Emory.
Ellen Brown (01:04):
Yeah, so, yeah, so tell us about what Emory is
doing with lifestyle medicineand, and yeah, ask some
questions.
Caroline Collins (01:11):
And this is a great time to be at Emory.
I really feel like there's amovement towards integrating
lifestyle medicine into all thecare and and not just the care
of patients, but the care ofemployees and really focusing on
research and how we do thisright.
I do think that most people inhealthcare want to do the right
(01:32):
thing, but we don't know how,and so that's where people who
know a lot about lifestylemedicine can be the voice of
change, and that's what I'mtrying to be at Emory right now.
So we're doing a lot ofresearch on how do we spread the
word to other faculty members,because, believe it or not, this
is not taught in medical school.
(01:52):
Most of us did not get thistraining in residency either, so
we have to start with theteachers, we have to teach the
teachers, and so that's what I'mdoing right now with my
research is educating facultymembers, so then we can help
residents and medical studentsunderstand how to integrate this
into practice, because medicalstudents and residents are going
(02:14):
to be the future doctors notjust internal medicine.
They're going to be surgeons,they're going to be
cardiologists, they're going tobe the specialists too.
We all need to be on the samepage in healthcare to make this
a real change.
Justin Politti (02:27):
What led you to this lifestyle medicine path?
Caroline Collins (02:29):
You know, in my own life, my own family, I
saw the havoc our lifestyle washaving on us.
My parents both had diabetes orprediabetes.
My mother unfortunately hadbreast cancer and I thought we
need to make a change, andthat's when I started
researching more about how wecan change what we're eating,
(02:50):
how we can move more, how whatwe do in our everyday lives
matter.
I always tell my patients thisand I tell my family members
this I can't give you a pill oran injection to make you healthy
.
It's really about how we liveour lives, and that's got to be
the most important thing.
We talk to people about.
Justin Politti (03:08):
You mentioned momentum that you said there's.
Now what do?
Caroline Collins (03:10):
you think, what's the trajectory been like?
Is it just the last couple ofyears, has it?
Justin Politti (03:14):
been like over five or 10 years, where
lifestyle medicine started tobecome this movement.
Caroline Collins (03:21):
I am building on what those who came before me
started.
So Dr Sharon Berquist at Emoryand Tina Morgan both started
this movement at Emory manyyears ago so about 10 years ago
really and there was slow uptakefirst, but as we have grown,
grown in numbers, we've become alouder voice together and I
(03:44):
think that's important torealize.
It's not just one person, it'sreally a group of people, it's a
team that can make this happen.
Especially at a large academicinstitution like Emory, it
really takes a team and that'swhere we have found success
together.
So now we are doing theresearch, but we're about to
(04:06):
open our lifestyle and weightmanagement clinic at Emory as
well, focused on lifestylemedicine, and that shows me that
Emory is serious about this, ifthey are willing to give us
dedicated time to focus onlifestyle medicine.
Ellen Brown (04:20):
So tell us about what you're going to do with
that clinic Like.
Is there a like?
Ajay was just on.
He's from St Francis at Tulsaand you know he has an eight
week intensive interventionthat's available to those that
want to participate that getreferred in.
Also has the.
You know you can see us onceevery three months.
There's different ways tointeract with lifestyle medicine
(04:40):
, depending on the person'slevel of commitment, et cetera.
Caroline Collins (04:43):
Yeah, what we're doing is starting with
Emory employees and pre surgicalpatients, because those are
patients who rehabilitationExactly so we are.
We are optimizing the patient'scare before they have surgery
to help reduce their risk ofcomplications during and
(05:03):
post-surgery.
So that's been our valueproposition to the surgeons Let
us help you do this so thepatients can be healthier,
moving forward.
Ellen Brown (05:13):
You talked about your family and your person.
I think everybody has sort of apersonal journey that has
brought us to these places,especially with lifestyle
medicine.
And we were talking on theprevious episode about
prehabilitation and you know myown mom is the perfect example
of ended up with unexpected.
You know she was in septicshock from a undiagnosed
(05:34):
diabetic long term.
Then it turned into a kidneyinfection, you know the drill
right.
And then what?
Because she came in, you know,basically dying of septic shock.
You know they just wentdownhill fast, icu and AFib and
ischemic stroke and like youknow the whole thing that you're
trying to avoid.
But the crazy part is she cameback the following year to
address the kidney stone issue,right, and in that
(05:57):
hospitalization she didn't evenhave to have insulin.
They didn't have to, theydidn't have to intubate her,
like it was a completelydifferent surgical process, it
was outpatient.
It's amazing.
I don't think people understandat a practical level that when
you have these chronic,untreated, uncontrolled
comorbidities, that what thatdoes in an acute care setting is
(06:20):
just dramatically differentthan when you're just moderate,
like it's a small little changethat makes a massive difference
economically.
Caroline Collins (06:30):
I couldn't agree more.
I've seen the same thing in mymother's life and also my
patients' lives.
If you can help people be theirhealthiest selves, that's going
to make a big difference ifthey do need to be hospitalized
and how sick they get and howmuch medicine that they truly
need while they're hospitalized.
(06:50):
So that's why I really thinkthat this is one of the most
important answers to thehealthcare crisis we're facing.
I was just at anotherconference in Washington DC
talking about healthcare policyand how do we change where we
are going, how do we change thetrajectory of healthcare in the
United States and change thecost curve?
(07:11):
Because we're going to have todo something to bend the curve,
and this is the answer in mymind.
Justin Politti (07:18):
Yeah, pay people to be healthy.
Caroline Collins (07:19):
Exactly, our incentives are misaligned right
now, both from a providerperspective, but then also just
from a patient perspective.
Justin Politti (07:28):
Yeah, it's like we've collectively lost our
minds.
Ellen Brown (07:31):
honestly, I know it's funny, but not funny I'm
wearing a mullet and sunglassesin an interview.
At nine o'clock in the morning,right?
Yeah, yeah, yeah.
Caroline Collins (07:40):
You know, one of the presenters said you know
it's funny, this is common sense, but it's not common sense.
It's not.
We need to make it common sense.
Ellen Brown (07:49):
Yeah, the financial side is something that you know
we talk a lot about, and youknow it's.
What was one of the things thatstruck me when you and I talked
initially was your point.
You know I had asked you.
I said, well, so is Emorydeploying this with all primary
care right?
Like, are you guys going to usethis where you train all of
your primary care physicians inlifestyle medicine and then they
can start treating patients,addressing the root cause?
(08:11):
And you know, your statement tome was we're an rvu model and
that doesn't fit into thetraditional rvu model, and so I
think that is that that is thefriction point.
You know, don't you guys think?
Justin Politti (08:23):
well, no, there's a CFO somewhere going
whoa, whoa, whoa, whoa, whoa,whoa.
You know how are we going to.
How are we going to pay forthis?
How are we going to pay forthis?
I?
Caroline Collins (08:28):
mean.
The hard truth is that whenpeople become physicians, you do
so because you want to seepeople be healthier.
But when you get into thesystem, you're incentivized to
see patients.
If your patients are healthier,who's going to be admitted to
the hospital?
Right, right, who is going tofill your clinic schedule, right
(08:49):
?
I don't think most people, mostphysicians, think of it that
way, but I know that healthexecutives may, because you need
your hospitals to be full.
Justin Politti (09:00):
You need your clinics to be full.
No, we've built these hugestructures that would be empty,
exactly have to be retrofitted.
Caroline Collins (09:08):
That's where value-based care can come in.
I think we need to be carefulwith value-based care, because
you do want to again alignincentives.
I think it's folly toincentivize A and expect B
Absolutely, and that's whatwe're doing right now.
Ellen Brown (09:25):
Yeah, no, and it's a cultural shift.
You know, I was with the headfrom HAP, you know from Henry
Ford, and I was with their chieflegal counsel and she was
talking about the fact that it'sa real disconnect where they're
embracing at the corporatelevels, they're really embracing
value-based care and trying toput that into place.
But from a cultural level youhave to, from the, you know,
(09:48):
again you're pushing yourphysicians in an RVU mindset but
then you're signing up withvalue-based care.
It's a conflict and you have to, culturally, you have to align
those things and it doesn'thappen overnight.
Justin Politti (09:59):
No, it's like schizophrenia.
Ellen Brown (10:00):
Yeah, it is.
It is so well.
I think we could probably solveall of the woes if we stayed
here.
But there's, there are there'sa line, the sure size are
presenting and I think younobody wants to miss that.
So, but we appreciate youcoming and excited to talk more
and really excited for the workthat you're doing to be a
champion of lifestyle medicine.
We're there for you, cheeringyou in the background when you
(10:22):
get a little burned out from the, from the uphill battle.
Caroline Collins (10:25):
So thank you.
Thank you for inviting me.
I'd love to come back.
Ellen Brown (10:27):
Okay, great, have a great day.
Caroline Collins (10:29):
Thank you.
Welcome to the Reverse Mullet Healthcare
Podcast from BP2 Health.
We are live at the ACOMConference in Orlando, florida.
I'm your host, justin Politti,dave Pavlik.
Ellen Brown (00:11):
Ellen Brown.
We are here in the AmericanCollege of Lifestyle Medicine
Conference and we are here withsomebody that was one of the
first people I met in myexposure into lifestyle medicine
.
Justin Politti (00:24):
Oh.
Ellen Brown (00:24):
And, yes, Okay, Caroline was one of the first
folks that I talked to and itwas, I don't know.
I just really appreciated thework that you're doing and the
challenges that you face and wejust talked with Caroline's with
Emory, physician at Emory andhas a very exciting, yes,
challenging job of bringinglifestyle medicine into an
academic medical center.
Justin Politti (00:45):
Outstanding.
Caroline Collins (00:46):
Yes, so with all of that tell us about
yourself.
Yeah, I'm an internal medicinedoctor focusing on lifestyle
medicine at Emory, so I alsoteach medical students and
residents about internalmedicine, but also how to
integrate lifestyle medicineinto the care of patients at
Emory.
Ellen Brown (01:04):
Yeah, so, yeah, so tell us about what Emory is
doing with lifestyle medicineand, and yeah, ask some
questions.
Caroline Collins (01:11):
And this is a great time to be at Emory.
I really feel like there's amovement towards integrating
lifestyle medicine into all thecare and and not just the care
of patients, but the care ofemployees and really focusing on
research and how we do thisright.
I do think that most people inhealthcare want to do the right
(01:32):
thing, but we don't know how,and so that's where people who
know a lot about lifestylemedicine can be the voice of
change, and that's what I'mtrying to be at Emory right now.
So we're doing a lot ofresearch on how do we spread the
word to other faculty members,because, believe it or not, this
is not taught in medical school.
(01:52):
Most of us did not get thistraining in residency either, so
we have to start with theteachers, we have to teach the
teachers, and so that's what I'mdoing right now with my
research is educating facultymembers, so then we can help
residents and medical studentsunderstand how to integrate this
into practice, because medicalstudents and residents are going
(02:14):
to be the future doctors notjust internal medicine.
They're going to be surgeons,they're going to be
cardiologists, they're going tobe the specialists too.
We all need to be on the samepage in healthcare to make this
a real change.
Justin Politti (02:27):
What led you to this lifestyle medicine path?
Caroline Collins (02:29):
You know, in my own life, my own family, I
saw the havoc our lifestyle washaving on us.
My parents both had diabetes orprediabetes.
My mother unfortunately hadbreast cancer and I thought we
need to make a change, andthat's when I started
researching more about how wecan change what we're eating,
(02:50):
how we can move more, how whatwe do in our everyday lives
matter.
I always tell my patients thisand I tell my family members
this I can't give you a pill oran injection to make you healthy
.
It's really about how we liveour lives, and that's got to be
the most important thing.
We talk to people about.
Justin Politti (03:08):
You mentioned momentum that you said there's.
Now what do?
Caroline Collins (03:10):
you think, what's the trajectory been like?
Is it just the last couple ofyears, has it?
Justin Politti (03:14):
been like over five or 10 years, where
lifestyle medicine started tobecome this movement.
Caroline Collins (03:21):
I am building on what those who came before me
started.
So Dr Sharon Berquist at Emoryand Tina Morgan both started
this movement at Emory manyyears ago so about 10 years ago
really and there was slow uptakefirst, but as we have grown,
grown in numbers, we've become alouder voice together and I
(03:44):
think that's important torealize.
It's not just one person, it'sreally a group of people, it's a
team that can make this happen.
Especially at a large academicinstitution like Emory, it
really takes a team and that'swhere we have found success
together.
So now we are doing theresearch, but we're about to
(04:06):
open our lifestyle and weightmanagement clinic at Emory as
well, focused on lifestylemedicine, and that shows me that
Emory is serious about this, ifthey are willing to give us
dedicated time to focus onlifestyle medicine.
Ellen Brown (04:20):
So tell us about what you're going to do with
that clinic Like.
Is there a like?
Ajay was just on.
He's from St Francis at Tulsaand you know he has an eight
week intensive interventionthat's available to those that
want to participate that getreferred in.
Also has the.
You know you can see us onceevery three months.
There's different ways tointeract with lifestyle medicine
(04:40):
, depending on the person'slevel of commitment, et cetera.
Caroline Collins (04:43):
Yeah, what we're doing is starting with
Emory employees and pre surgicalpatients, because those are
patients who rehabilitationExactly so we are.
We are optimizing the patient'scare before they have surgery
to help reduce their risk ofcomplications during and
(05:03):
post-surgery.
So that's been our valueproposition to the surgeons Let
us help you do this so thepatients can be healthier,
moving forward.
Ellen Brown (05:13):
You talked about your family and your person.
I think everybody has sort of apersonal journey that has
brought us to these places,especially with lifestyle
medicine.
And we were talking on theprevious episode about
prehabilitation and you know myown mom is the perfect example
of ended up with unexpected.
You know she was in septicshock from a undiagnosed
(05:34):
diabetic long term.
Then it turned into a kidneyinfection, you know the drill
right.
And then what?
Because she came in, you know,basically dying of septic shock.
You know they just wentdownhill fast, icu and AFib and
ischemic stroke and like youknow the whole thing that you're
trying to avoid.
But the crazy part is she cameback the following year to
address the kidney stone issue,right, and in that
(05:57):
hospitalization she didn't evenhave to have insulin.
They didn't have to, theydidn't have to intubate her,
like it was a completelydifferent surgical process, it
was outpatient.
It's amazing.
I don't think people understandat a practical level that when
you have these chronic,untreated, uncontrolled
comorbidities, that what thatdoes in an acute care setting is
(06:20):
just dramatically differentthan when you're just moderate,
like it's a small little changethat makes a massive difference
economically.
Caroline Collins (06:30):
I couldn't agree more.
I've seen the same thing in mymother's life and also my
patients' lives.
If you can help people be theirhealthiest selves, that's going
to make a big difference ifthey do need to be hospitalized
and how sick they get and howmuch medicine that they truly
need while they're hospitalized.
(06:50):
So that's why I really thinkthat this is one of the most
important answers to thehealthcare crisis we're facing.
I was just at anotherconference in Washington DC
talking about healthcare policyand how do we change where we
are going, how do we change thetrajectory of healthcare in the
United States and change thecost curve?
(07:11):
Because we're going to have todo something to bend the curve,
and this is the answer in mymind.
Justin Politti (07:18):
Yeah, pay people to be healthy.
Caroline Collins (07:19):
Exactly, our incentives are misaligned right
now, both from a providerperspective, but then also just
from a patient perspective.
Justin Politti (07:28):
Yeah, it's like we've collectively lost our
minds.
Ellen Brown (07:31):
honestly, I know it's funny, but not funny I'm
wearing a mullet and sunglassesin an interview.
At nine o'clock in the morning,right?
Yeah, yeah, yeah.
Caroline Collins (07:40):
You know, one of the presenters said you know
it's funny, this is common sense, but it's not common sense.
It's not.
We need to make it common sense.
Ellen Brown (07:49):
Yeah, the financial side is something that you know
we talk a lot about, and youknow it's.
What was one of the things thatstruck me when you and I talked
initially was your point.
You know I had asked you.
I said, well, so is Emorydeploying this with all primary
care right?
Like, are you guys going to usethis where you train all of
your primary care physicians inlifestyle medicine and then they
can start treating patients,addressing the root cause?
(08:11):
And you know, your statement tome was we're an rvu model and
that doesn't fit into thetraditional rvu model, and so I
think that is that that is thefriction point.
You know, don't you guys think?
Justin Politti (08:23):
well, no, there's a CFO somewhere going
whoa, whoa, whoa, whoa, whoa,whoa.
You know how are we going to.
How are we going to pay forthis?
How are we going to pay forthis?
I?
Caroline Collins (08:28):
mean.
The hard truth is that whenpeople become physicians, you do
so because you want to seepeople be healthier.
But when you get into thesystem, you're incentivized to
see patients.
If your patients are healthier,who's going to be admitted to
the hospital?
Right, right, who is going tofill your clinic schedule, right
(08:49):
?
I don't think most people, mostphysicians, think of it that
way, but I know that healthexecutives may, because you need
your hospitals to be full.
Justin Politti (09:00):
You need your clinics to be full.
No, we've built these hugestructures that would be empty,
exactly have to be retrofitted.
Caroline Collins (09:08):
That's where value-based care can come in.
I think we need to be carefulwith value-based care, because
you do want to again alignincentives.
I think it's folly toincentivize A and expect B
Absolutely, and that's whatwe're doing right now.
Ellen Brown (09:25):
Yeah, no, and it's a cultural shift.
You know, I was with the headfrom HAP, you know from Henry
Ford, and I was with their chieflegal counsel and she was
talking about the fact that it'sa real disconnect where they're
embracing at the corporatelevels, they're really embracing
value-based care and trying toput that into place.
But from a cultural level youhave to, from the, you know,
(09:48):
again you're pushing yourphysicians in an RVU mindset but
then you're signing up withvalue-based care.
It's a conflict and you have to, culturally, you have to align
those things and it doesn'thappen overnight.
Justin Politti (09:59):
No, it's like schizophrenia.
Ellen Brown (10:00):
Yeah, it is.
It is so well.
I think we could probably solveall of the woes if we stayed
here.
But there's, there are there'sa line, the sure size are
presenting and I think younobody wants to miss that.
So, but we appreciate youcoming and excited to talk more
and really excited for the workthat you're doing to be a
champion of lifestyle medicine.
We're there for you, cheeringyou in the background when you
(10:22):
get a little burned out from the, from the uphill battle.
Caroline Collins (10:25):
So thank you.
Thank you for inviting me.
I'd love to come back.
Ellen Brown (10:27):
Okay, great, have a great day.
Caroline Collins (10:29):
Thank you.
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