Too much lab testing, or too little?

You’ve heard the scenario.  Or maybe you’ve lived it.

“…and they ran all these tests on me…”

Or some variation on that theme.  A reference to “all that lab testing”, a “whole bunch of lab tests”, or something similar.

What the general public generally doesn’t understand is that so many symptoms overlap.  A single symptom could be a manifestation of a whole cluster of health conditions.

For example, “fatigue” could be anything from low thyroid function (hypothyroidism) to adrenal fatigue to mitochondrial dysfunction to a nutrient deficiency to a chronic bacterial/viral/fungal/parasitic infection to venous insufficiency or other cardiovascular dysfunction to malabsorption syndromes to autoimmune disease to anemia to…

…well, you get the point.

As a doctor, I assume a certain (significant) amount of responsibility for getting people well.  After all, that’s my job, and if I don’t do everything I can to reach that goal, then what’s the point of coming to see me?  If I didn’t do my job, I’d be incompetent, and those who set foot in my office would continue to suffer.

Who wants that?

I don’t suspect that anyone would raise their hand and say, “Oooh!  Me!” (I’ll take the time to insert the visual of a sympathetic wry grin here, because I don’t want to come across as a sarcastic jerk, because that’s not where I’m going with this.)

Rather, I take the health and the trust of my patients very seriously, like I’m sure that the vast majority of doctors do, even if they don’t always get around to saying so.

Taking someone’s health and not failing their trust means that I use everything I have available at my disposal in order to get to the root(s) of their current concerns as efficiently–but also as thoroughly–as possible.  There are extra points for speed, but not at the sacrifice of accuracy.

The tools I have at my fingertips include:

Lots of questions, either asked and answered on intake forms or during consultations 

Clues acquired during observation and a thorough physical exam 

Lab tests, every one of which tests for only one thing, never telling the whole story, and thus, necessitating panels made of multiple tests

Diagnostic imaging, including plain film X-Ray, ultrasound, MRI, and the like 

None of these investigative tools are perfect.  Some are more specific than others, and if we’re lucky, the diagnosis can be nailed down fairly quickly, after just a handful of procedures.

But I’ll repeat: very few of these procedures and lab markers are perfect.  The older ones–the ones that insurance companies tend to actually pay for–are indeed older, often inferior, less specific, and often, quite vague.

This is why I must often resort to either:

1 – Larger panels of these vague, non-specific markers, and/or 

2 – Newer, more specific, specialty functional lab testing (which unfortunately, is tougher to get covered by insurance, save for a few lab companies who have the resources to negotiate)

What people need to understand is that for every test a doctor doesn’t order, they’re having to make a guess.

Some guesses are safer to make than others; those guesses are ones that I’m more comfortable making.  It’s in those situations that I’ll forgo the lab test and make an assumption or two.

(But even then, one must proceed with caution; you know what they say about the word “assume” and how it’s spelled and all that.)

Why is it so important to order enough testing?

Well, because if you have the fatigue symptom I used in the earlier example, and I make the assumption that it’s because your adrenal glands have fallen asleep (figure of speech), and I start giving you licorice root or something to get them going again, and I haven’t even tested your adrenal function yet, I’m taking a gamble.

And if you’re my patient with the fatigue, I’m gambling with you and your health.

If we get lucky and the root of your issue really is adrenal fatigue, then congratulations to us – we won.

But so often, that wouldn’t have been the case.

Thyroid dysfunction is much more common in my office than adrenal fatigue.  So is unrealized autoimmunity–the people walking around with autoantibodies to their bones, brain, intestines, nerves, heart, thyroid, tissues, you name it…without even realizing it.  They have no idea they have these problems because no other practitioner had bothered to look.

I can hear the (understandable) protests of many people now: “but they just ran all these tests!”

I know.  But let’s look at what they ordered.  What follows is a true story of a real patient.  I’ll use the terms “they” and “them” to maintain their full anonymity, including gender.

This person came in with a whole host of health concerns…and a whole battery of tests.  Tests that sounded extensive and impressive, but actually revealed little.

“Let’s look at your body’s functions,” I suggested, and began to briefly explain each.

“Oh, I’ve already had that done,” they said.  They passed me the stack of lab results, and I took a good look.

“Checking adrenal function” amounted to a single blood cortisol reading.  At least they noted the time the sample was taken, which prevented the test from becoming utterly useless.

But what about the free fraction of cortisol, the form in which cortisol actually exerts effect on the cells of the body?

Not ordered.

What about the other three readings that other labs offer in a preset panel in order to provide a readout of the daily rhythm?

Not performed.

What about the other adrenal hormone, DHEA, which is so important to compare cortisol levels against in order to get the whole story?

Not done.

Let’s move onto the next test this person came in with…

“Checking thyroid function” meant checking TSH only, without regard to any of the other hormones, and none of the hormones that are actually made in the thyroid gland itself.

T4, the main thyroid-made hormone?  T3, the bioactive form of thyroid hormone?  Reverse T3, the “dead” form of thyroid hormone that provides a red flag that something might be amiss in the body?  T3 uptake?  Others?

Nothing else had been done.

What could I glean from that test?

Nothing.

Ok, moving on to the gluten sensitivity/Celiac panel.

Negative. 

Not really, but that’s what the page said.

I say “not really” because the standard marker they ordered is an immune system protein that starts declining in our 20s and 30s, giving rise instead to a different, related reaction protein that the test panel doesn’t include.  And this person was older than that.

What information could I use from that test?  Did it rule anything out or answer any questions?

Nope.

This person was in their late 30s to late 40s.  How accurate was that panel?  Should they avoid gluten or not?  Do they have Celiac Disease or not?  How serious should they be about eliminating gluten from their diet?  Would they ever be able to eat gluten again?

We’ll never know.  I have a test that could have answered all those questions, but because it wasn’t covered by insurance, the person declined it.

The last lab result in the stack was a stool test, to screen for infections in the GI tract.

Also negative.

Except that it was a culture-based test, as opposed to DNA analysis (in which the equipment screens for the non-human DNA of microbes).  And stool cultures can only test 3 bacteria.  Only 3 species–Lactobacillus, Bifidobacter, and E Coli–will grow in culture.  And they’re hardly ever the bad guys you’re running the stool analysis to screen for.

Yet another test that sounded similar to those which I order…

…but come up extremely short.

Everything had come back “negative” and “normal”, but was it really?  Could I trust it?

Nope.

So, even when it sounds like a bunch of tests have been run, the usefulness might be limited.  Very limited.

I often feel like a schill for the lab companies, because practically every patient will eventually need plenty of testing.

But if I actually had stock in or got kickbacks from these lab companies (which would be highly illegal and unethical, by the way), I might have updated my 16-year-old pickup truck by now, yes?

But although these folks understandably feel pretty alone (they’re chronically ill, after all), what they don’t yet know is that they’re not.

I’ve seen issues like theirs before.  (In fact, that’s my specialty, so my practice is exclusively made up of those people.)  And what they also may not realize is that, since I’ve been doing this for a few weeks now (wink, grin), I already know what evaluations we’re going to need to do.

This ain’t my first rodeo.

So did the patient’s previous practitioner order too much testing, or too little?

Well, the answer is, they ordered the wrong or incomplete versions of each.  They missed the point of all four, and ran cheaper, shoddier variations of all of them.

They ran too many of the wrong tests and too few of the right ones.

Why did I tell her we needed to check these areas and functions again, using my lab test selections?

Because if I had kept mum about mine and continued to feel our way in the dark, and it came to light later that I had something better up my sleeve, not only would this person have continued to suffer (and remember what I said in the very beginning about what’s the point of going to a doctor if they’re not going to be able to help you?), but they also would have demanded to know why I didn’t speak up about the superior versions of testing.

And they would be 100% correct.

And I would have no excuse.

This does put doctors in an interesting catch-22 predicament:

If we order the testing we know people need, we’re accused of committing overkill.

But if we neglect to run a test, and it turns out that it would have been useful after all, then we’re accused of incompetence and malpractice.

So when faced with the dilemma of giving the illusion of “overkill”, versus committing negligence and malpractice…

… I think I’ll choose “overkill” and let everyone criticize me for being too thorough.

I’ll go the distance.

And I guess everyone else will have to either deal with it or visit a practitioner who’s comfortable with the mediocrity/incompetence option.

ūüôā

Posted in 5. New/Seasoned Docs, 8. For Patients / Public | Tagged , , , , , , , , , , , , , , , | Leave a comment

This blog is not dead.

Please be rest assured: I haven’t abandoned this blog.  I’ve merely been sorting through various facets of professional and personal life.

On the personal side, I run several (very) different blogs.

On the professional side, I’ve been taking post-doctoral training from about three different sources and studying for about as many (big, expensive) exams.

The practice continues to grow, albeit at a slow pace.  That’s OK.  One reason for the slow growth is that we’re becoming more choosy in terms of the types of patients we’re accepting.  Given some of the horror stories from our first few years in practice, that’s probably not surprising; in fact, it had to happen.  It was only a matter of time before we either wised up or folded in.  And I was not about to do the latter.

Our five- and six-year anniversaries of being in practice came and went, and now we’re approaching our seventh anniversary.  Go us!  What that means is that the first major hurdle is behind us.  Apparently, nine out of every ten new businesses fail within their first five years.

That doesn’t mean we’re out of the woods yet, though; of the businesses that survived the first five-year chopping block, there’s a similar attrition rate during the next five years.

It’s a jungle out there.  We’d been doing fairly well until around the spring of 2015, when the Affordable Care Act mandates finally hammered down on the Last Men (People) Standing without insurance, and the final round of holdouts felt their arms being twisted.

Nobody told them that there’s no actual penalty for not getting insurance and not paying the tax/fine/whatever-we’re-calling-it-this-week.  Mainstream media and government-related websites sorta forgot to disperse that memo.  And the public didn’t seek-and-find for itself, either.

As those insurance rates continued to climb (skyrocket is more like it), our prime population found themselves with less disposable income (duh), and when combined with the subsequent job losses over the past few years, the scene was pretty dismal for a while there.  We haven’t fully recovered and resumed our previous encouraging trajectory yet.  But it will come.

Anyway, I know that our life story isn’t particularly captivating, but it’s where we’re at, and I know that we’re not alone.  I also plan to try and write posts on here a little more often, even if not by much.  I’m trying ūüôā

Posted in Uncategorized | Leave a comment

“But Functional Medicine is so expensive!”…or is it?

We hear this all the time.  In fact, it’s probably one of the most common objections/comments we hear (second to “you saved my life”, of course) <grin>  (True story, actually.)

If you’re a non-insurance doctor yourself, you’re probably tired of hearing it.  If you’re a patient who has sought Functional Medicine care, you’ve probably said it.

I wouldn’t blame either one of you.

On its face, Functional Medicine requires the patient to spend quite a bit of money up front, even if the doctor isn’t asking for the nebulous multi-thousand-dollar, all-inclusive care plan (I hope none of the doctors reading this are doing that – it’s tacky and pass√©, and ethically shaky at best).  But anyway, even if the Functional Medicine program in question is structured to be pay-as-you-go, it’s still going to cost plenty to get started, if you have a chronic condition and the Functional Medicine provider is doing his/her job.

I’m going to make a bold statement: Functional Medicine care is actually, probably, ultimately, … the cheapest way to go.

Wait–what?

Yes.  To understand why, one must look beyond the (sometimes-shocking) price tag.  To do that, one must consider another factor, one that is less obvious: Value.

Value, in this case, can be defined as the results, improvement, satisfaction, or any other positive effect gained from the expenditure, comparing it to said expenditure, and making a judgment call.

But one must also do the same for the other available avenues of health care.

When someone says that Functional Medicine is so expensive, they’re probably comparing it to conventional medicine.  After all, it’s only a $30-50 copay, right?

Wrong.

What about that check that you write out every month to the insurance company (or, alternatively, what about that massive deduction that gets whacked from your paycheck every pay period)? 

And what about the ever-increasing deductible you have to meet each year in order for insurance coverage to start kicking in?

I encourage all of us to go back over our bank statements and paycheck stubs and total up the actual costs for a single year.  I recommend using 2016 as your model year, because the costs aren’t going to go down; they’re only going to go up from here.

If you’ve noticed, I’ve only talked about price so far.  I haven’t even begun to holler about value yet.

Let’s go there now.

What do people get in return for their thousands of dollars annually?  If they’re not sick and they don’t have an issue all year, then they get nothing except peace of mind.  (Peace of mind is worth something in itself, however, and it is indeed part of that intangible value.)

For people who do have health issues, most of them derive some benefit from their conventional medicine-based insurance.  The benefits themselves are somewhat questionable, however.  

Sure, that statin drug sure keeps that cholesterol down, but apparently nobody got the memo about the cholesterol myth having been debunked.  The side effects of those drugs are pretty real, though, and they do lead to a lot of scary problems.  Wouldn’t it be wiser to find out why the cholesterol levels are high in the first place?  (Hint: it’s not a statin deficiency.)

Sure, that corticosteroid saves those joints from being eaten by the immune system, but behind the scenes, those drugs ultimately tear tissues down on their own.   Wouldn’t it be wiser to try to figure out what keeps the immune system angry in the first place?

But finding the reasons why something might be amiss takes investigation, which takes a doctor’s time.  And insurance doesn’t pay for that, so conventional doctors don’t tend to do it, unless they have specialized knowledge beyond med school (rare) and exceptionally generous hearts (except that a good heart doesn’t pay the office staff).

So, a doctor has two options:

Option A is that they choose to play by the insurance-dictated rule book.  This allows them to band-aid the most pressing immediate problem in a three-minute visit, and easily pay the bills.  Fair for them, not fair to chronically ill patients in the long term.

Option B is to tell insurance to pound sand, operate outside of their rule book, and form a partnership with their patients, thinking and working outside the insurance box in order to do the necessary investigation and make the necessary recommendations for serious long-term improvement.

If the symptom is a crack in a wall that we all know from collective experience is actually a destabilized foundation underneath, what has a lower price tag: a can of spackle to cover up the crack, or calling out a professional team to come dig under your foundation and stabilize it from the source below?

The spackle at the home improvement store costs less, hands down.  But what did it really do?  You don’t see the crack in the wall anymore.  It looks a lot better.  You might even forget that it was ever there.

Until more cracks form, because the root cause of the issue was never addressed.  Maybe this time, it affects a door frame.  Would some wood glue help?  That’s got a low price tag as well.

But the foundation underneath continues to shift and stray.  What happens when a nearby window cracks?  Replacing the glass is certainly reasonable.  It’s a logical solution with a swallow-able price tag.

But then, the floor starts to slant.  Pens resting on the desk in the home office spontaneously roll off onto the floor.  We could get really creative and pile a few books under the lower desk leg(s).  There–that’s better.  The pens don’t roll off anymore.

This sounds absurd, but it happens every day, with the most important asset we have: our own bodies.

Consider the person who schedules regular visits with their endocrinologist, their rheumatologist, and their gastroenterologist.  After all, they need insulin for their diabetes, steroids for their joints, and Nexium for their GERD, respectively.

That’s a really typical scenario.  And it’s equally absurd.

Sure, their insulin, steroids, and proton-pump inhibitors are all covered by insurance.  So are the every-six-month doctor’s visits.

But those doctors are never going to resolve any of those problems.  They’re just going to refer the patient back to their endocrinologist when their hair starts falling out and they start gaining weight uncontrollably, because it’s probably a thyroid issue.

They’re right about that.  But they’ll never get ahead of the problem.  “It’s just life,” they’ll say, or they’ll blame it on genetics because the patient’s mom had thyroid problems and their dad had diabetes and their sister has nodules on her joints.

When the patient finally gets depressed about it, the psychiatrist will be right there with Prozac in hand.  And when the patient “complains” of a low libido shortly thereafter, another specialist will be right there with Viagra at the ready.

Spackle, wood glue, and glass replacement – all of it.

The underlying problem remains.  And it doesn’t stop.

Nobody ran an autoantibody test and even if they had, they wouldn’t know what to do with the results.  Conventional med school doesn’t cover that.  Neither does insurance.

Decent Functional Medicine training does, though.  A decent Functional Medicine doctor will test for reactive foods, stealthy infections, immune reactions to chemicals (and any FM doc who isn’t doing these things, shame on them).

The Functional Medicine doctor who is worth their salt will investigate the drivers, the factors that destabilize the foundation.  And they’ll work to eliminate them.

So…was the medical version of the spackle, wood glue, and glass replacement all that much cheaper?  It didn’t even look at the foundation!  Was it really all that great a deal?

(No.)

But in our scenario, the proverbial homeowners insurance plan covered it.

But they’re not going to cover the work done by the foundation professionals. 

Why?

“Lack of evidence,” they say.

Never mind that there are decades’ worth of well-done research papers written on the subject.

Functional Medicine actually has the capability to look under the foundation and stabilize and repair it.  Functional Medicine can stop the damage path from growing longer and wider.

But to dig under a patient’s foundation and address the real problem, the patients have to be willing to let go of the tendency to let the insurance company dictate every decision, consider the cost versus the value of each avenue, and contract privately with a foundation pro. 

I honestly figure that for every $1 spent in Functional Medicine, a patient will ultimately save $10-15 over the next 10-15 years.  And even those next 10-15 years will treat them much better.

Posted in Uncategorized | Leave a comment

For Docs: How to stand out as a top-tier doctor

Although I’m speaking mostly to my follow Doctors of Chiropractic (DCs) here–after all, that’s the discipline with which I’m most familiar–much of this could apply to any type of doctor or other healthcare professional. ¬†And although I haven’t been in practice too long (only about 4.5 years as a doctor and 6 years before that as a neuromuscular massage therapist), I’ve been blessed to encounter gifted individuals and take what they had to say to heart. ¬†Today, I’m attempting to paraphrase them all into a single blog post. ¬†Please bear with me…

Top-Tier Tip #1: Know Your Anatomy

This becomes more important the more you work with the physical body. ¬†Chiropractic doctors, physical therapists, massage therapists, etc, this is especially important for you, especially if you’re a DC or DO who performs joint manipulation (LMTs, don’t even think about it!! ¬†I know some of you do–stop now), or you’re an LMT who attempts to help people with any kind of pain management beyond a simple relaxation massage. ¬†(However, even those LMTs who “only” give a basic Swedish massage will give a much better massage the stronger your anatomy knowledge.) ¬†Adjusting DCs, I know it’s tempting to focus on the spine, but don’t get stuck there–know your muscles, your nerve routes, and just about everything else. ¬†Don’t forget your general family-practice-related internal medicine, either, because someone’s thoracic pain may be a pancreatic issue, or their low back or shoulder blade pain could be a gallbladder problem.

Top-Tier Tip #2: Know Your Physiology

Study up on all the general functions of the human body. ¬†It’s daunting, I know. ¬†Despite its relatively small size, it’s a pretty high-performance, high-maintenance little organism. ¬†If you’re weak on your cardiovascular system, nervous system, endocrinology, immune function, digestive tract, kidney and blood pressure regulation systems, mitochondrial function, liver biotransformation, etc, your patients will eventually suffer. ¬†Brush up on these subjects regularly and keep them fresh in your mind so that when a patient comes in and describes a problem to you, you don’t overlook anything.

Top-Tier Tip #3: Stay Current On Your Information

It hasn’t even been 5 years since I graduated and already, medicine–and our collective body of knowledge thereof–has changed dramatically and grown exponentially. ¬†The research landscape 5 and 10 years ago is nowhere near what it is now. ¬†We’ve been identifying gene polymorphisms, the impact of various species of intestinal microbiota, newfound significance of various nutrients, isolations and functions of phytonutrients, and well, you get the idea. ¬†Even those of you who are recent grads would do well to subscribe to a healthcare-related research journal or two because even though you just graduated, things have changed already, and believe me–the information we learned in school was about 10-30+ years out-of-date when we learned it! ¬†In other words, we were never current; that’s why it’s good to hit Google Scholar and have fun, because if what we do works, it’s important to try to know why.

Top-Tier Tip #4: Back Up Your Claims…

…preferably with research. ¬†I’m not going to be a narrow-minded stick-in-the-mud that preaches abstaining from utilizing any experimental treatments/remedies/interventions until they’ve been “proven”. ¬†Sometimes, a remedy works, even if we don’t know how or why. ¬†Aspirin was in use (in its natural form) 700 years before we figured out its mechanism (which we only did about 50-70 years ago) and yet, we still used it–and benefitted from it–before we knew how and why it worked. ¬†However, if you’re going to make a claim, back it up. ¬†Did you read it in a research article/study? ¬†Who published it? ¬†Is it a respected journal? ¬†Or, did you find it on a website like Livestrong or Mercola? ¬†Did those authors cite their sources? ¬†Where did they get their information? ¬†Alternatively, is this remedy something you found via trial-and-error, either using yourself as the trial subject (guinea pig), or through clinical experience with your patients? ¬†Did you learn it at a seminar? ¬†Where did they get their info? ¬†If you can’t back it up, and you think it might still help your patient, go ahead with it, but disclose the fact that it’s experimental. ¬†I have no problem telling a patient that what I’m about to do with them is uncharted territory for me or that I have nothing to back it up. ¬†(I can absolutely back up most of my remedies, but occasionally, like everyone else, I find myself at a loss.) ¬†Most patients are absolutely fine with that. ¬†They’re more comfortable having been properly informed, and they don’t get too bent out of shape if it doesn’t yield the results we hoped for. ¬†They’re patient and they navigate those confusing waters with me, because I’ve been honest with them.

Top-Tier Tip #4: Don’t Be Afraid To Refer

DCs are notorious for not wanting to refer patients to other practitioners, be it an MD, LMT, or other DC. ¬†We’re afraid the patient will visit another practitioner and decide not to return to us. ¬†This is inaccurate, and it can be devastating. ¬†Since no doctor can specialize in everything, the patient gets cheated out of the opportunity to get relief from the knowledge of another practitioner. ¬†We cheat ourselves too, because we look like idiots when we don’t refer when we should. ¬†Our fear is unnecessary. ¬†If a patient likes you, trusts you, and benefits from your service, and they visit another practitioner for either help with the same problem or relief from a separate problem, they will come back to you. ¬†Diversified-based DC, someone might need the BEST technique or Activator protocol for a little while. ¬†Or maybe they have an intestinal issue. ¬†Don’t be afraid to refer to the appropriate provider! ¬†If they like and trust you, they’ll come back for their Diversified adjustments when they’re ready/able. ¬†And even if they don’t, you never know–maybe they’ll talk to their neighbor at a block party next year and end up referring them to your office, even if they’re no longer a patient themselves! ¬†Don’t sweat it.

Top-Tier Tip #5: Take As Many Classes/Seminars As You Can!

The best docs (and other practitioners) never, ever stop learning. ¬†Never figure you’ve taken a bunch of classes on a subject already and you can sit tight and rest on your laurels for a few years. ¬†Remember what I said above–things change, and they’re changing fast. ¬†And as time goes on, the change only happens more rapidly. ¬†So, don’t get lazy. ¬†Take time to stop and smell the flowers, but don’t take a nap in the garden! ¬†My first year in practice did not leave much disposable income. ¬†Guess what–I took classes anyway, taking advantage of the First-Year Doctor discount offered by many seminar institutions. ¬†I used the free tech support offered by several lab and supplement companies. ¬†I bought textbooks in my field as I could afford them (they were cheaper than some of the seminars, which I slowly saved up for and then finally attended). ¬†Google comes with only the cost of an internet connection; use it liberally! ¬†Double-check accuracy, of course, but it works well as a superb jumping-off point.

Top-Tier Tip #6: Ask a Lot of Questions

This tip can be divided into 2 sub-parts. ¬†One, ask a lot of questions of your gurus, mentors, instructors, etc. ¬†If you simply can’t go to any seminars, call up your former professors at school, or the doctor you shadowed during your internship. ¬†Don’t be shy! ¬†If something doesn’t make sense to you or causes confusion, speak up!

The second sub-part involves your patients. ¬†Ask them a lot of questions, too. ¬†People will forget to tell you things, or perhaps they never gave what seemed to be a minor symptom a second thought. ¬†Or maybe they’re just not the forthcoming type when the subject involves body functions or pain. ¬†Maybe they don’t want to volunteer info about their intestinal gas or low libido. ¬†Maybe they don’t want to come off as a “complainer” about their pain. ¬†However, most of these people will disclose this information if asked directly. ¬†So again, speak up.

Top-Tier Tip #7: Go the Extra Mile

This can mean a lot of things, whether in terms of customer service or extra time put in behind the scenes researching a puzzling issue presented by a patient, or perhaps just putting in a few hours studying up on general information on a Saturday. ¬†Either way, it’s worth bearing in mind that there is NOT a wide berth separating the Top-Tier docs from the average docs; often, it just involves one more step. ¬†Take that extra step, and you can propel yourself into the top 1% of your profession. ¬†Sometimes, it’s a tough step to take; it may involve a financial chunk, or a time-consuming project. ¬†Other times, it’s an easy step to take–so simple that you scratch your head wondering why others don’t take it.

Top-Tier Tip #8: Hire Good Staff–and Keep Them

Ahhh yes, the thorn-in-the-side for many. ¬†This can be a difficult one in the process, but afterward, the rewards are huge. ¬†Basically, it goes like this: hire slow, fire fast. ¬†Hire for personality, because the rest can be taught. ¬†You can teach skills and computer systems and phone scripts and all that, but you can’t teach personality characteristics like genuine, nice, helpful, or motivated. ¬†You can’t teach someone work ethic–they either have it or they don’t. ¬†You CAN influence morale, however. ¬†And I highly recommend doing so, and in a positive way. ¬†A fat benefits package isn’t necessarily a slam-dunk guarantee to boost morale, either. ¬†Good morale results when you¬†realize you’ve hired someone¬†competent, and kept¬†your Hands Off, letting them do their job. ¬†It comes from being recognized for jobs well done, from being respected as a human being and not just a machine. ¬†It comes from being made to feel like a real part of the team and not just an outsider. ¬†Profit-sharing, even a small percentage, may help immensely, but a simple treat to lunch on Secretaries’ Day or a warm smile and a “you handled that situation perfectly” works, too.

Top-Tier Tip #9: Follow Through With What You Say

This one is simple. ¬†If you say you’ll do something, do it. ¬†If you claim to do/know/offer something, be genuine. ¬†(I.e. if you say you practice Functional Medicine and you’re really a garden-variety general practice family MD or you’re an MD/DC who only plans to focus on thyroid dysfunction or diabetes or something similar, note: that is NOT Functional Medicine. ¬†You only practice Functional Medicine when you consider–and evaluate–ALL major aspects of body function; that’s why they call it Functional Medicine. ¬†That’s part of a rant that will probably get its own post!) ¬†I digress…

Anyway, if you say you offer sports chiropractic, or Functional Medicine, or nutritional counseling, or weight-loss help, or primary care, or a pediatric/pregnancy focus, or an integrative cancer approach, or what-have-you, then be prepared to deliver. ¬†If you say you’re going to consult with a colleague about a patient’s case or look into something for them, follow through. ¬†Be impeccable with your word; your word should mean something.

Well folks, that about does it. ¬†Notice that I didn’t say, “offer free screenings at Walmart” or “give them free x-rays with their New Patient exam”. ¬†That doesn’t get anyone real far. ¬†What DOES, though, is simply being a good doctor, with your patients’ best interests in mind, and with confidence in yourself. ¬†Now get out there and take that one more step. ūüôā

Posted in 5. New/Seasoned Docs | Tagged , , , , , , | Leave a comment

Open Letters (a Rant)

The field of chiropractic and those who practice it get hit from all sides.¬† Those of us trying to actually help our patients with problems beyond the Holy Chiro Trinity of (say it with¬† me now) “back pain, neck pain, and headaches” are under attack from multiple angles, and for different reasons.¬† This post is meant to openly call them out and launch a little fire in return.

I’ll address each group individually.

Open Letter #1: To the Medical Mafia

I’m speaking here to practitioners of conventional medicine who have all the power and glory forever and ever–the self-proclaimed cultural authority on all things medical.¬† This does not include all conventionally-trained practitioners; it is aimed at the most narrow-minded who seek to obtain and maintain a monopoly on the practice of medicine.

Medical Mafia, by helping patients with their metabolic problems and chronic conditions, we’re not trying to do what you do.¬† We’re trying to do what you’re FAILING to do, which is care for people with chronic conditions.¬† The 3-minute visits that result only in prescriptions for symptom-based drugs do very little for those with chronic, multifactorial problems.¬† I dare say in many cases that approach does NOTHING.¬† I have the luxuries of time and energy and would like to simply have the legal and uncontested right to serve the suffering public out there by picking up the slack and trust me–there’s a lot of slack to pick up.¬† I am properly educated to do what I’m doing and I supervise my patients properly and frequently and because of that, what I’m doing isn’t harming anyone.¬† Of course, there’s the possibility that it could–hell, too much water can kill you–but my methods pose no greater harm (nor anywhere near the harm) that one of the almighty prescription meds do.¬† And I see my patients every 2-4 weeks (on average) instead of every 2-6 months, in order to supervise them properly.¬† So move over and leave a little room for the qualified, licensed holistic healthcare approaches and practitioners out there because they’re keeping what you deem “problem patients” anyway OUT of your office.¬† Don’t worry–given the state of healthcare in general Western society, you’ll have plenty of med-seeking patients left.¬† You’re not hurting.

Open Letter #2: To the Chiro Mafia

This is aimed toward the many people with whom we went to school who bemoaned having to take Biochemistry and Neuroscience because they “just wanted to adjust”.¬† It’s also aimed at the “above-down-inside-out” “Principled” DCs who cry and pout that “(nutrition/acupuncture/homeopathy/other) is ‘not chiropractic’!” and that we shouldn’t be doing those things.¬† These folks continue to hang onto the outdated idea that all someone needs is an adjustment and that an adjustment will cure any ailment.

To those DCs, I say, if you don’t feel confident in yourself to do more than find the high spot and knock it down (known in fancy terms as “detect and correct subluxation”) (a feeling which is understandable given the sorry state of some of the schools out there), and you feel that my kind of “intellectual elite” (your term) is, underneath, a threat to you or the field, then I call upon you to focus on yourself and not me.¬† If you are truly comfortable and confident in what you do, then what I do does not matter to you.¬† You’ll be too busy to pay attention to me.¬† Sharpen your own skills.¬† Develop your own niche.¬† Don’t try to silence us, outvote us, bust us, or otherwise eliminate us just because deep down, you’re afraid we’ll look better than you or increase the public’s overall expectations of you.¬† You hold the doctor title and with that title come expectations; so grow a pair and act like one.¬† If you’re lazy or have a poverty/inferiority complex, seek professional help.¬† I can’t help you and getting me to go away won’t help you either.¬† I know you’re against DCs prescribing medications.¬† I know you don’t think people need nutritional supplementation.¬† I know you failed to show up for 7am Biochemistry and you squeaked by with a 72 in Neuro class and promptly dumped all that info because you “just wanted to detect and correct subluxation”.¬† If you don’t want to prescribe meds or recommend supplementation or do neurological rehab, that’s fine–don’t–but cease and desist with the *death threats* that some of you lobbed against some of my more-educated, progressive colleagues who have testified as expert witnesses in court that these modalities could arguably fit under the umbrella of chiropractic practice.

Open Letter #3: To the Texas Medical Association (and others pulling the same crap)

You’ve taken the Texas chiropractic board to court, attempting to sue to whittle down our scope of practice into practically nothing.¬† You’ve been ruled against again and again.¬† Truth be told, this all started with the infamous Wilk vs the AMA case in 1976, a case in which five “lowly” DCs took on the monstrous American Medical Association and ultimately kicked your ass.¬† You didn’t learn.¬† Did you get that memo?¬† So now the AMA wants to take things to the state level, using Texas as a prototype through which to set a dangerous precedent.¬† The TMA is powerful, one of the more potent state medical associations in the country.¬† The AMA figures that if they can win here on a state level, that a victory here will open the door to utilizing the same strategy in other states until they fall like dominoes, one by one, into the original goal to which they’ve clung all along.

I fail to see the legitimacy of a private professional association bringing a lawsuit against the regulatory board of another (that would be like the Texas Chiropractic Association suing the Texas Medical Board to take away your Manipulation Under Anasthesia rights–which should really have been kept under chiropractic, because we’re the manipulation experts, after all), but you keep doing it.¬† Even after the last judge said, to paraphrase, “knock this shit off”, you keep appealing.¬† Which is NOT appealing.

Open Letter #4: To the Chiropractic Schools:

NOT all educational institutions are created equal, and this holds doubly true for chiropractic schools.  Some are cutting edge and extremely sophisticated, while others have firmly planted themselves in 1895 and refuse to budge.  This open letter is intended for the latter.

“Straight” schools, you’re LYING to your prospective students. Actually, that’s not *entirely* true; rather, you’re promoting/quoting chiro gurus who lie to your prospective students.¬† Your rah-rah motivational speakers at the assemblies and “extravaganza” seminars sound encouraging to the naive and eager hopefuls who see chiropractic as the end-all-be-all of careers.¬† Hell–to hear these gurus speak, you’d end up thinking you could walk on water…after you’ve turned it into wine.¬† It’s not until people get INTO school that they realize that while there are a lot of encouraging and utopic claims out there and many of them are probably true (hell, I’ve lived several of them myself!), few have bothered to take the time/effort/energy to write them up and get them published in a respected journal.¬† Few have taken the time to quantify the successes or explain them scientifically.¬† And the insurance companies didn’t get the memo that we can help with things like ear infections or a sluggish immune system or high blood pressure or what-have-you.¬† They still think we’re not good for anything but back pain, neck pain, and headaches (see a theme here?) and that it only takes six visits to cure and they’ve shrunk chiropractic coverage drastically in the last 20 years.¬† Yet, you ill-prepare students for that.¬† Sure, there’s a half-assed business class or three, but they don’t tell you what you really need to know or how to actually get it done.¬† In one breath, you’re telling students that they shouldn’t “lose their identity” by merging with mainstream medicine and becoming more accepted, and in a second breath, you’re telling them that they can cure all that ails (way beyond the musculoskeletal system), and in the third breath, you’re teaching “business” (Medicare and insurance coding) classes that require a 739.x ICD-9 code in order to be legit, get paid, and keep your ass out of hot water.¬† At this point, students scratch their heads, shed some frustrated tears, and wonder, “what happened to the ear infections?¬† The high blood pressure?”

Other business classes talk about revenue and reimbursement, that Medicare only pays $34 an adjustment, and you’re imagining an office with way too much square footage dedicated to an office for your full-time insurance biller, and you’re wondering what happened to the guy in the 1930s in Montana who adjusted out of his cattle barn and had 1200 people lined up across his field (true story, if you went to the motivational seminars!)

Meanwhile, you’ve taken Lab Diagnosis and other scientific classes out of the standard curriculum and replaced them with yet more philosophy.¬† Way to prepare us for being real doctors.¬† I can form my own philosophy, thank you.¬† Part of that philosophy is the observation that chiropractic boards in some states set their scopes of practice based on what the average schools are teaching, and limit DCs to performing those tasks; if Lab Diagnosis is no longer required, this provides massive ammo for the medical associations to push for the abolition of lab work freedom for DCs.¬† You’re taking steps backward, not forward, offering the opposition more fodder along the way.¬† Thanks heaps.

Open Letter #5: To the Vendors

Yes, makers of chiro-toys and providers of chiropractic practice management groups, I slither my cross-hairs over to you and let’s face it–you come into really clear focus through my scope.¬† Because you’re the DCs who graduated and either never started practice or failed out of practice, went down into the basement or up into the attic, fiddled with some gizmos, maybe hired a college whiz-kid, and came up with a toy you can market to the struggling DC looking for the next revenue-generating buzzword.¬† Or maybe you headed into your home office instead and dreamed up some way to rehash cornball 1950s hard-sales techniques into something that looks shiny and new and you PREY upon newly-graduated, uncertain, desperate, deeply-indebted, broke new grads or those without business sense.

I know that you’re in bed with the schools because I see you there, in paid seminar booths, or you’ve claimed naming rights to some building in exchange for a hefty “donation”.¬† I also know you’re in bed with the trade mags that tout the chiro-only crap because I see you there, too, with all the full-page, full-color, high-gloss ads.¬† Hell, some of you switch camps along the way–Ben Altadonna started out in chiro-advertising and then once he’d chewed up and spit out all of his customers on failed doorknob coupons-for-chiros, he took a sabbatical and invented the Vax-D machine that made a heavy commercial splash a while back and trained his salespeople to tell their prospects that the procedure was covered under insurance codes that it was NOT, sold the machines to docs for six figures a pop, and then dunked his head back underground when those docs got busted for insurance fraud.¬† Who knows where he’ll pop up next, but I’ll be sure to steer clear.

Open Letter #6: Conventional Yes-men of the Medical Establishment who think that everything besides drugs and surgery is quackery

You’re going to get your own post.¬† You’ve been warned.

A final thought…

I am purposefully trying to avoid making sweeping generalizations here.¬† These rants are intended only for those who are guilty of being an asshat as described in each Open Letter.¬† If the shoe fits, wear it (and then try to take it off, of course, by changing your ways).¬† If the truth hurts, tough.¬† If these Open Letters do not apply to you, please don’t take offense.

My intention is NOT to condemn all DCs with deeply-felt old-school philosophies, it’s to call out those who act against us within by seeking to limit the scope for all of us.¬† It’s NOT to condemn all MDs or DOs at all, it’s simply to criticize those who seek to attack us such that we DCs “wither on the vine” like the AMA itself originally wanted.¬† It’s NOT to punish all technological entrepreneurs or management services, it’s to nail those who provide dubious products or services that promise the moon and end up chaining us to a wall while the company’s owners and salespeople get off scot-free.¬† It’s NOT to slam ALL schools, it’s to shame those who fail to prepare their students to be DOCTORS, or attempt to brainwash students into believing that resolving the Vertebral Subluxation is our only purpose and responsibility.

Last but not least, it’s NOT an attack on chiropractic.¬† Rather, it’s a desperate attempt to save it and propel it into the 21st century, properly-adapted and well-respected.

Posted in 4. Chiro Cleanup, 5. New/Seasoned Docs, 6. Students/Prospective Students | Tagged , , , , , , , , , , , , , , , , | 5 Comments

FAQs, “For The Record”s, and Final Thoughts of Maximized Living

This might very well be a dead horse.¬† And I’m going to beat it one more time, in what I hope is the LAST time.¬† In fact, I wasn’t going to write another post on the chiropractic Maximized Living franchise, but I do feel I might need to clarify and reiterate a few items, in response to some of the themes of feedback I’ve gotten on my previous posts on this subject.

First, I want to thank EVERYONE for their comments, whether they agreed with my viewpoint or not.  My intent in writing these articles is not to stir any pot, but rather to disseminate information and provoke thought.  Your contributions, from no matter which side of the fence, enrich that discussion and add to the overall thought-provoking that is taking place.  It is for that reason that I have censored hardly any (if any at all) comments, regardless of content (other than spam or over-the-top ridiculousness Рwhich might have amounted to 1 or 2 posts in all, if even that many).  I feel that to minimize censorship of opinions allows for a greater variety and deeper discussion, which benefits everyone.  So again, I thank you, and I encourage the discussion to keep rolling.

Where I will draw the line from here on, however, and consider NOT approving some comments, is when the commenter appears to have a reading comprehension issue.¬† This usually follows a theme of, “How can you hate nutrition/exercise/chiropractic??¬† How can you be against an organization that promotes health??”

The answer to the first question is, I’m not against those things at all.¬† A chimpanzee probably has enough sentience to realize that proper nutrition, exercise, and appropriate chiropractic care is a much-needed (and much-neglected, to our peril) foundation for achieving and maintaining good health.¬† When I ask the commenter where in my posts I said that nutrition/exercise/chiropractic were unnecessary or a scam, I usually receive <crickets> silence in return.¬† Because the truth is simple: those commenters have put words in my mouth; I never said them, so they cannot be quoted.¬† It is from here on that such questions will be discarded without approval, because they don’t add anything to the discussion–they are meritless – not because I disagree, but because I’m having to defend myself against something I never said or did.

Thus, if you are going to disagree with me on a particular point, I’m only going to approve the comment if: 1) I can validate that I said what it is you’re taking issue with, or 2) you provide the quoted text above your comment.¬† I thank you for your efforts in advance, and I appreciate them.¬† I have absolutely no problem with people disagreeing with me; all I’m asking now is that they back it up.¬† I can own what I’m putting into print, and I’m asking the same of everyone else.

The answer to the second question (“how can you be against an organization that promotes health??”) is, Very Easily.¬† Not because it promotes health – that’s not the issue at all – but rather, the way in which it is done.¬† As I have stated in some of the discussions below ML-related posts, *no* DC knows for sure that you’re going to need 80 visits when all that doctor has done is the initial exam.¬† Thus, to design an 80-visit treatment plan right out the gate is ridiculous.¬† Chiropractic is much like other types of medicine/therapy in which the doctor/practitioner gains a greater insight to the patient’s expected progress (and estimated timeline thereof) during the course of the treatment plan itself.¬† If the patient is progressing faster or slower than expected, then the doctor can make the appropriate changes/adjustments to that treatment plan.¬† But 80 visits from the git-go?¬† No doctor has a crystal ball that good.

I also realize that not all ML-based doctors practice the same way.¬† Some are more aggressive in terms of salesmanship than others.¬† Some are more genuine than others and take a more ethical, individualized approach toward each patient’s needs.¬† Simply because a doctor is part of the Maximized Living franchise does not make him/her a bad doctor.¬† Heck, different doctors have different reasons for even signing on with the franchise itself.¬† This is because like our patients, every doctor is also different.

But for the record, seriously – if you found a doctor who connects with you, makes progress with you, addresses your needs, gives you relief, and helps you achieve what you could never do before, who cares if they’re an ML doc or not?¬† The fact is, they’re a good doc, and if you’re comfortable with them, you should stick with them!

So my beef is not with chiropractic.¬† It is not with exercise.¬† It is not with nutrition.¬† It is not even with long treatment plans (hey–some patients legitimately need longer plans than others – to get better overnight or after one treatment is not usually a realistic expectation, but it doesn’t mean that chiropractic is a failure or a fraud in any way).¬† My beef is not even against all ML docs!¬† My beef is with the way some/many of the ML docs practice – the sales techniques/hard-sells and the gimmicks (such as free exams and x-rays – you get what you pay for – and if you truly are getting something for free now, it’s because you are indeed expected to pay later!)¬† At any rate, I think these gimmicks degrade medicine in general, including (and especially) chiropractic.

Some people think I might’ve been brainwashed.¬† It’s been claimed I must’ve gone to a “mixer” school in order to think this way.¬† At that point, I must ask – what does my alma mater have to do with anything?¬† I’m not so brainwashed that I’ll simply believe anything any school, mentor, guru, or seminar feeds me.¬† And neither should you.

Sure, I’m absolutely a mixer.¬† I think that these days, it’s the only rational approach, because today’s problems are hugely multi-factorial and thus we need multiple therapeutic routes, not all of which involve chiropractic, per se.¬† But I don’t think that where one went to school should really matter in that regard – by the time we enter school, we’re well into adulthood, and by then we can make philosophical decisions for ourselves.¬† What if I told you I went to a “mixer” school?¬† What if I revealed that I went to a “straight” school?¬† Would what I have to say be any different?¬† Would my opinions and experiences be any more or less valid?

Some comments took issue with the fact that I came this-close to calling Maximized Living a cult/scam.¬† Actually, if you look closely, I didn’t.¬† I purposefully put a question mark at the end of that post title – a question mark means that the answer is ambiguous and could go either way; it is not the same as a statement.¬† If I put an exclamation point at the end of that post title, these commentators would certainly have a point, because at that point, I’m making a solid claim that can be confirmed or refuted.¬† It looks a bit silly to disagree with a question, especially when I didn’t exactly answer the question.¬† Semantics, I know, but important.

When confronted with shortcomings of the chiropractic profession, many well-meaning people go on the defensive and say, “but–but look at those dirty white-coated medical doctors over there, pushing toxic drugs and invasively cutting into people!”¬† Yes, I know.¬† It’s tragic.¬† And I’m with you, I really am.¬† But it’s not an excuse for those DCs who are practicing unethically.¬† Think of it in this (crude) way – if I have piles of dog poop in my back yard, I’m responsible for that.¬† If my city’s Code Enforcement Officer stopped by to cite me for it, I’d be liable.¬† It is not a legitimate defense that my neighbor has twice as much dog poop in his backyard as I do.¬† That doesn’t get me off the hook; I still have to clean up mine.¬† Well, same thing goes for chiropractic.¬† We have to stop pointing fingers at our conventional medicine neighbors and just clean up our own dog poop already.

Lastly, I want to reiterate that my posts about Maximized Living were based on three items:

  • Our own, firsthand experience
  • The firsthand experience of a respected colleague whom we personally know
  • Allegedly internal documents leaked to me by a commenter (whose comment I did not publish in order to protect his/her identity) – and I admit that since they came to me in comment text, I cannot verify for sure whether or not they’re authentic.

This is not a case of “my cousin’s friend’s sister’s boyfriend knows this kid who has this neighbor who saw Ferris Bueller pass out at 31 Flavors last night”; this is first-hand stuff, especially the first two items.¬† I’m not feeding into any anti-ML frenzy; I’m simply writing about my experiences so that others who are curious or skeptical can find some information during their research.¬† I have no vested interest in entering into a pissing context with Maximized Living.¬† I have no stake in any competing interest.

You may disagree with me.¬† Your experiences may have been different than mine and if they were, I’m happy for you.¬† However, please do not insinuate that my experiences were somehow less valid than your experiences/opinions.¬† That’s why I posted them on my blog.¬† If you have a life-changing story to shout out and you feel passionate about it, start a pro-ML blog and write a post that counteracts mine.¬† It’s a free world – in which lies its beauty.

OK, I think that dead horse probably went through about three more lifetimes.¬† It’s done ūüôā

Posted in 5. New/Seasoned Docs | Tagged , , , , , , | 4 Comments

Why Genova Diagnostics is now on my s**t list

Once upon a time, there were two major functional/specialty diagnostic laboratories.  They each offered some unique test profiles, but there was also a lot of overlap between the two.  The overlap, however, was not perfect duplication Рfor example, both labs claimed to offer amino acids testing, but one analyzed urinary output, while the other took a direct blood measurement.

The most pivotal test offered between the two labs is the comprehensive stool analysis.  Both labs offered a similar panel, but their methods differed greatly.  One utilized the DNA-based PCR method, which is highly superior, while the other utilized the standard culture method, which misses a lot.

Unfortunately, the lab using the inferior technologies (Genova Diagnostics) bought out the other lab (Metametrix Clinical Labs), due to Metametrix’s owners/directors aspiring to retire.

Practically every good Functional Medicine doctor began a journey on eggshells.¬† As Princess Leia from Star Wars would gravely say, “I have a bad feeling about this.”¬† But, trying to think happy thoughts, we went with the flow, praying that the merger would take the best of both labs and produce a wonderful hybrid.

However, our gut intuition told us otherwise, and it turns out we were right.  The labs underwent about a year-long transitional period beginning in summer 2012, in which the retiring owners of Metametrix agreed to stay on for 1 year to ensure a smooth transition and harmonious blend between the marrying labs.

Heh.

Genova behaved itself for the duration of that year, appearing to listen a lot (to us docs, who were not shy with our comments) and changing little (another relief, because Metametrix’s tests were fantastic just as they were, with little need for alteration).

Almost as soon as the door had closed behind Metametrix’s exiting owners, however, Genova took over like a tyrant.¬† It was as if they said, “Now that you’re mine and you have nowhere else to go…”

They began changing things, and not for the better.  Sure, we appreciate the increased insurance coverage and all that.  However, when you start discontinuing tests or changing up the remaining tests, those of us depending on you get a little perturbed.

So I started poking around my pools of colleagues, and found that they shared my same sentiment.¬† This sentiment grew a little more, um… intense… after talking with the lab directly.¬† Their list of “crimes” is as follows:

They discontinued the Male Hormone Panel, something I found quite useful.

They left Metametrix’s (better) version of the Amino Acids panels off the revised and integrated price list.¬† We had to call for test codes and pricing.¬† They were hesitant, and it appears that they want to get rid of them altogether, outside of the ION super-panel.

Their communication and documentation have been CRAP.  Policies got enacted or changed, major popular tests got *fundamentally* changed, and prices got increased, all without any prior notice.

Helpful informational articles on various tests have disappeared.¬† Back when Metametrix and Genova were bitter competitors (don’t worry, Metametrix, you were far better all along), Metametrix wrote an article comparing the superior PCR microbial testing to the inferior culture-based testing.¬† Of course, now that Genova has taken over and since Genova does culture and not PCR, they couldn’t have a disparaging article circulating out there.¬† (There are ways to obtain this article – dump the URL of the PDF article into a website called the Wayback Machine and get it anyway!)

Genova raised the prices on ALL of their testing – some prices didn’t go up much, while others became downright cost-prohibitive.

They fundamentally changed Metametrix’s stool analysis test in several ways.¬† First, they decided to “split off” the four major pathogenic bacteria from the original panel.¬† Now, if you want to test for those infections (which are common and you don’t dare NOT test for them!), they cost extra.¬† Second, they’re substituting inferior culture-based methods where superior PCR-based methods used to be.¬† And this is all after a price increase.¬† And all without any warning.

Genova outright lied to its clients, promising that they would.  Not.  Touch.  The Metametrix test.  All of the changes in the above paragraph were made to the Metametrix version of the test.  Way to build trust, Genova.

Perhaps the most disturbing is the fact that regarding that stool test, Genova is now going to do away with certain types of abnormal results and report them as “negative/normal” instead.¬† Yes, indeed!¬† We heard this directly FROM THEM.¬† Sometimes, microbial analysis will return abnormal yeasts, or parasites that cannot be classified.¬† That doesn’t mean they’re not there, or that they’re harmless, it just means that there’s no known NAME to attach to them.¬† What they’re going to do now is take the undetermined sample and attempt to culture it (yay) one more time and if they can’t make a specific determination, they’re going to report a “negative” (i.e. normal, no problem) result.

That, and dealing with their company is horrendous.¬† Calling their customer service does nothing; they refer you right to their “rep” (hint: Metametrix didn’t have “reps”).¬† These reps, while usually nice and personable and all that, are very poorly trained and have few real answers.¬† So you’re given the run-around, time and again.¬† (Some of my colleagues weren’t so lucky; they actually got treated RUDELY to the point where the Vice President had to send them a letter of apology for the phone operator’s rudeness.)

It’s important to understand that I was a loyal Metametrix customer for years.¬† I was also more than willing to give Genova the chance.¬† I offered suggestions and constructive criticism.¬† I shared hour-long conversations with my area rep in which I felt a good rapport had been established.¬† I was told very specifically that they would not change certain tests.

I was lied to.

The good news is, I am also a relatively influential force in my community.  I gave that lab (Metametrix and now Genova Diagnostics) a LOT of business, despite my low patient volume.  And my volume is only growing and will continue to do so.  Thus, they may likely notice a slight drop in business if I give them the proverbial finger.

I’m also quite vocal, including social media outlets.¬† I start conversation.¬† I get people thinking.¬† And I can rile people up and call them to action.¬† This isn’t an ego trip, I promise (my ego is actually below average).¬† But I’m sending a warning to Genova that they can’t lie to their clients and jack them around and expect us not to notice or get upset.¬† I am the type of person who will seek out a comparable lab just to spite these folks and show them that their practices are NOT OK.¬† And I do have several other options on the list; Genova is not the only fish in the pond…

Posted in 5. New/Seasoned Docs, 7. Current Events | Tagged , , , , , , | 15 Comments