DOCTORS DIVERSIFY
( continued from page 11)
patients with complex medical conditions but often with fundamentally better health literacy and lifestyle behaviors.
What struck me most profoundly was trading the familiar struggle against deeply entrenched health behaviors rooted in generational poverty and limited education for patients who arrived with color-coded folders full of medical records, researched questions and genuine partnership in their care management. Another striking experience from both the physician’ s and the patient’ s perspectives was that longer appointment times allowed for thorough evaluations, consultations and personalized attention, as well as the coordination of care, streamlining the patient experience and avoiding the“ ping-pong” effect of being passed between specialists. During my fellowship, I also completed service months at the University of Florida Shands Hospital, which brought me back to the reality of health care that I was accustomed to. Although the complexities of the conditions and their treatments were often similar, the comorbidities, often related to their lifestyle, especially metabolic syndrome, produced a significant impact on their condition and overall well-being.
During my final fellowship year, I had a rotation at Mayo’ s Pain Rehabilitation Center, working with patients suffering from chronic pain and fibromyalgia. This intensive, multidisciplinary program included medication management, typically deprescribing pain medications, extensive patient education on chronic pain science, lifestyle interventions, mindfulness training and collaboration with physical therapists, occupational therapists and psychologists. The focus was on physical reconditioning, nutrition, biofeedback and cognitive behavioral therapy, to help patients regain control over their lives. Those three weeks were eye-opening for me. I watched patients who were told before they arrived at Mayo that their fibromyalgia“ wasn’ t real” or that their symptoms were“ all in their head,” make remarkable progress in both reducing their pain and improving their outlook on life. Many of these concepts and methods could and should be applied to general health management, regardless of the disease process, age or literacy level.
However, when I returned to traditional practice after completing my fellowship, reality hit hard. There’ s a significant shortage of rheumatologists in the U. S., including Kentucky, with patients experiencing wait times of six to 12 months for appointments. We’ re spending more time on documentation and prior authorizations than ever before. We have sicker, more complex patients living longer with multiple comorbidities, taking more medications to manage these conditions, yet often experiencing poor quality of life. The focus shifts to disease management and survival rather than optimal, functional longevity— helping people live longer and better, with an emphasis on maintaining health through lifestyle, physical fitness, mental sharpness and disease prevention. The shortage of rheumatologists and extended wait times have made many practices adopt policies not to see or treat patients with fibromyalgia, even though we are the ones trained to diagnose it. This frustration led me to start“ Mind Your Fibromyalgia,” a podcast initially designed to educate and support my patients with practical, non-pharmaceutical treatment guidance. What began in 2021 as a resource for my patients that I had to refer back to primary care for treatment has evolved into an international, top-rated podcast with almost 150,000 downloads across 132 countries, demonstrating the global need for comprehensive, evidence-based approaches to chronic pain care.
In 2024, I took the leap that many physicians are now taking: I opened my direct specialty practice – Whole Health Rheumatology. It eliminates insurance intermediaries and operates on an affordable membership model similar to Direct Primary Care( DPC) practices. The direct care model is not concierge medicine— it’ s accessible, evidence based medical care, delivered as it should be, with adequate appointment time and easy access to the doctor, comprehensive evaluation and treatment decisions based on clinical judgment and patients’ needs. I manage the full spectrum of rheumatologic conditions, from rheumatoid arthritis, to lupus, vasculitis and ankylosing spondylitis, utilizing the same evidence-based medications and treatments as any rheumatology practice, but with the luxury of adequate visit time that enables deeper patient relationships and more comprehensive care by incorporating lifestyle and integrative medicine.
At Whole Health Rheumatology, I utilize a whole health approach— a philosophy that’ s actually not revolutionary at all. It’ s similar to what I learned during my rheumatology training at the Mayo Fibromyalgia Clinic. The Department of Veterans Affairs health care system has adopted this person-centered approach to care, focusing on what matters most to veterans and empowering them to take charge of their health and well-being. It goes beyond traditional disease-focused care by incorporating personal health planning, self-care and complementary and integrative health approaches. To me, it’ s simply traditional medicine as it’ s meant to be practiced— the old-fashioned, thorough approach your parents’ doctors used: taking the time to know the complete person, not just the presenting symptoms.
My board certification in lifestyle medicine, combined with practices I learned during my integrative medicine fellowship, further enhances my ability to address the multifaceted nature of chronic conditions through evidence-based approaches that honor the interconnection between physical, emotional and lifestyle factors. Integrative rheumatology combines conventional rheumatology with evidence-based complementary and alternative therapies to treat rheumatic and autoimmune conditions. Instead of viewing these treatments as“ one versus the other,” integrative rheumatology seeks to incorporate the best aspects of both to create a comprehensive, patient centered treatment plan. I tailor patients’ diets, such as anti-inflammatory, whole-food plant-based or Mediterranean, to reduce inflammation, improve gut health and enhance overall well-being. I may use prescriptive supplements and
12 LOUISVILLE MEDICINE