Latest / The YMyHealth Podcast | Wellness and Healthcare Insights for Millennials / The Value of Primary Care
Transcript
- Transcript Episode 2: The Value of Primary Care Melissa Schenkman (00:42) Thank you so much for joining us. Dr. Jeremy Neuman is with us today of Ally Primary Care in Atlanta, Georgia. We're going to talk about primary care and the incredible importance of primary care in our lives as millennials. The way this episode came up, even though of course I know how valuable this is, but I kept talking to people in our YMyHealth contributor supporter circles saying to me, people are missing the boat on this and need to learn more about why primary care should be a part of their regular care routine and how much it can do for them, especially in preventive health. So I thought, what better way to showcase this and talking, hearing it directly from the source to talk about it. For you, what made you say when you were in med school, primary care is the path I want to take. Like, what was that wow factor? What is that wow factor still about this field? Dr. Jeremy Neuman (01:42) Primary care is beautiful. It does not close doors. opens it. Primary care can mean diagnosis. It can mean relationships. And so I get to have the fun. I get to not just kind of look at one organ or one system, I get to look at the whole person. I get to see how can I help this individual? How can I help them now with what they're dealing with? How can I help them in the future? So I get to hear people's stories. I get to know people, which is very rewarding for me, especially seeing them over time grow and prosper. And I get to be the diagnostician. I get to have the fun medical puzzles myself. For us in our generation, growing up watching House MD, you know, with all the medical puzzles, I get to have that fun. I get to be the one when people come in saying, I can't get out of bed, I'm so tired, or I'm having this terrible pain. I get to be the one who uses my head and to think and try to figure stuff out. And so it's been very rewarding to be able to help people in multiple different dimensions and over time. Melissa Schenkman (02:35) That's absolutely beautiful to hear. And tell us, I know you have had the exciting journey of creating Ally Primary Care, which is just incredible. And I was going to have you talk a little bit about the practice and some of the things you're doing. Dr. Jeremy Neuman (02:51) Yeah. So most people haven't heard of what's called direct primary care. Direct primary care is emerging. It's about 10 years old, but it's the roots of concierge, which is kind of related, go even farther back than that. This is a type of model of the clinic where people pay me directly. And I used to work at some of the kind of like big box hospital based outpatient clinics where it felt very processed. There was very short appointment times. Was very little human contact. There was very little of that relationship building that I love to do. And I'm somebody who's very thorough. I'm somebody who likes to help with multiple different things. And so that system, while it could work for some people, did not work for me and didn't work particularly well for a lot of the clients who were caught up in that system. And so I decided that the way to kind of reclaim the power to be able to be in control of how long appointments are, what the interactions look like, what the relationships look like, what we even talk about was to be able to open my own clinic. And so I never imagined that I'd be here. I never imagined that I'd be a business person in medical school. Whenever they talked about money or business, I put my head in the sand and say, no, I'm just here for the medicine. Not going to think about all that stuff, but here I am and much happier for it. And so I created Ally Primary Care with the intention to develop relationships with folks over long periods of time, to give them a lot more time and to really kind of be like that. The old timey doctor that maybe the generations ahead of us remember where they could actually call somebody and get a human being who would come to the house, who would know you, know your context, know what's going on, and could really look at you as a person instead of as a bothersome kind of roadblock to them getting to their next client. Melissa Schenkman (04:25) That's really, really interesting to hear because it is quite a journey. And I think so many of us are searching for that doctor-patient relationship. That has gotten lost in the complexities of the system. so I really, really appreciate you saying that very much. And yes, the business side, that's a whole other, as we both well know, there are so many millennials out there that want to do in all different fields, entrepreneurship. That's a whole other world in addition to wanting to serve, which is where the heart of your practice is and primary care. Absolutely. As far as primary care, I feel like the definition as we've grown up has just expanded even more. And I was going to have you talk a little bit about how you define primary care and kind of the expansion that you've seen even in your years of experience. Dr. Jeremy Neuman (05:14) If you have a problem, you come to me. That's primary care. And that problem could be something going on now or it could just be, hey, how do I make sure that I'm around and healthy 10, 20 years from now? Primary care is the first step in figuring out what's going on. It is not the last step. is not a field defined necessarily by depth, but a field defined by breath, by trying to know a little bit about a lot of things so that even if I'm not exactly sure about what's going on with something that's rare or complex, I know who would know that. And it's my job to be that catch-all, to be that person, that face, that guide for when people have anything going on that can help them know what to do, can be their ally to kind of figure out what's going on. And so for a lot of people, what their primary care can mean, especially in big cities with a lot of specialists, it could be a referral service for them, it could be somebody they see once a year for their annual, but truly the power of good primary care can be pretty limitless. Melissa Schenkman (06:16) In terms of, you know, in our age group, I feel like there are sometimes, it's really split, but sometimes misconceptions, if you will, about primary care. And I was wondering, you know, what are some of the ones that, that you believe exists amongst your 20s, your 30s, your 40s that we're today as we talk, going to turn on its head very quickly as we already are. Dr. Jeremy Neuman (06:37) Yeah, I think that that's a great question. Primary care is defined by the container it's in. We are more of a gas or a liquid than we are a solid. And so not every primary care doctor, not every system is gonna be alike. And it's hard to speak kind of with de-generalization. So I want to put that disclaimer first, knowing that there are some times where, you know, I say that this is a common thing that I do that might not be available at your local primary care office. There are some misconceptions. I think one misconception is that if I feel well right now, that means that I have nothing to gain from seeing primary care. I think that there is certainly some truth to that. There's some truth to low intervention. And if you're doing well, continuing to do what you're doing. But I don't think that's the full truth. And I think that there's a lot of people who could benefit in the long term and wish when they reflect back that they had done just a little bit more in the long term, that might surprise them with how little it takes to kind of push the boundaries of health. And so I think it is not fair to say that just because you feel good right now that there isn't anything that could be improved in particularly long term. Some of the biggest things of my job, especially when I see people in our age demographic who are doing relatively well, is to look for the things that wouldn't show up. Look for blood pressure, cholesterol, sugar, things that can put a lot of strain on the heart. But by the time that the human who's in that vessel knows it, by the time we get symptoms or some complication, it is very late in the game and it becomes either…something that interferes with quality of life or something that's very hard to reverse if reversible at all, where it could not have been that case if we had gotten to it sooner. And so part of my job is to put out fires right now and some people who don't have fires, they don't come in. But part of it's also to say, hey, that electrical wire is exposed and we might want to do something about that instead of just chance-ing it by the toaster. Melissa Schenkman (08:34) Great. Excellent, excellent analogy. Very true because it is very much split between people coming in with symptoms and people, you're saying, in our age group are just going along fine, but there are these underlying things that are happening at the same time they don't realize it yet. In kind of in your years of experience, are there some stories of patients who you've had who primary care has caught something early preventatively and by making that catch, it's changed the quality of their life, changed the trajectory that their life would have had had it not been caught. Dr. Jeremy Neuman (09:09) Every week, every week. And I want to preface this by saying that these stories are impactful. These stories are wonderful, but they also can cause some harm to remember that there are some risks to all the things that we're talking about and that it really does take an ally to kind of navigate these things. So for example, I had a 38 year old who came in with headaches. They happened after work. They were kind of in the temple, you know. Just kind of assumed maybe I should be hydrating and maybe I should take an ibuprofen, but they didn't go away and they started to get a little weirder. They started to feel a little more fuzzy and we decided to go for an MRI and they had an aneurysm that was about to rupture. Wow. There's somebody who they were 30. They're not, typically we start mammogram screening for breast cancer at the age of 40, but their family history suggested that they should be screened earlier. They had an aunt and a grandma who had it at a very young age and we found a stage three breast cancer. That was last month. There are plentiful stories, but I want most people to know that that's not the usual. And if you come to the doctor with a headache, please do not assume that you're going to have brain cancer or aneurysm. But at the same time, this is why it's great to have somebody in your corner who knows you, who can help you sort through these things so that when you are having these questions or these anxieties and chat, GPT spits out, it could be…dehydrated or could be tuberculosis, you can have somebody who can say, well, here's the reasons why it's not tuberculosis. Melissa Schenkman (10:39) excellent point because it is. It's almost like we're walking in terms of the pai..on the patient side, say sometimes a little bit of a tightrope. We've got Google at our fingertips, which has its pluses and minuses where you're reading your reliable versus unreliable information. And so being able to take that to someone like yourself, you've developed a relationship with and have that knowledge of a person's history and not only family history, but history with you as a patient makes such a difference. To your point, yes, not every symptom is something that is a serious diagnosis, but one of the many reasons, and I know as you're mentioning, we'll agree, with primary care is you can preventively catch it, but at the same time, you can also come home with that reassurance that you've been checked out, you're good to go and here's why you're experiencing this. And I think there's so much power in that and helping us to kind of maintain our own wellness. And I want to talk about, you were starting to allude to this a little bit in the beginning and even now, the important concept of continuity of care, which you bring to the stage. And if you could talk a little bit about primary care's role in that continuity of care and how that benefits people in our age group long term. Dr. Jeremy Neuman (12:02) If that person had come in with a headache and they said it was fuzzy, it would have taken, and they went to a different doctor and a different doctor, they would have heard, go home and take some ibuprofen until they died. For me, having the context of knowing that something has changed, that something didn't work, that I know this person's pain tolerance, I know when they would complain about something, it allowed me to help guide them towards the diagnostics that have kept them alive today. Knowing somebody's situation, even, and I'm somebody a little unique, like I even ask, you know, tell me about growing up, tell me about your family, tell me about your social circles, tell me about your hobbies, and even knowing those things can really help me when people even come in for knee pain. And so having somebody who you trust, who knows you and can help you with the complete picture is, in my opinion, beneficial, instrumental for having all the information to help guide you as correctly as possible. Melissa Schenkman (13:07) Absolutely. Absolutely. Very well said. Julie Woon (13:12) Now we’d like to take a minute to talk about today’s sponsor. Diekman Dysautonomia. Have you or a loved one been struggling with symptoms like fainting, a racing heart or crushing fatigue only to feel dismissed or unheard by doctors? You may be experiencing dysautonomia POTS or long COVID. Dr. Sarah Diekman understands because she has been there. As someone who faced POTS during medical school, Dr. Diekman knows firsthand the frustration of searching for answers. That's why she's turned her fight into a mission to help patients with these conditions live fuller, healthier lives. 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Dr. Jeremy Neuman (14:41) Yeah, that's a great question. I liken the relationship of a doctor and a client to that of best friends on a bus. The person sitting next to you on a bus might not be your best friend. You might have a working relationship, but knowing that there's going to be different people for different folks and there are some Providers whose styles are short and sweet and to the point there are some providers who are more thorough and so there's not a one-size-fits-all and it really is something that I encourage people to try and do their research and meet people and find some of that they feel where their style matches and resonates with them. For general advice that's kind of applicable across the board I would say that to me what I define as a good doctor which is a very kind of you know, it's hard to make that example but I'll try my best to reduce it would be three things somebody who knows their stuff who can communicate their stuff in a way that's understanding, that's nice, that puts it in a way that's actionable, that you can understand, and somebody who has the time to both express and to share the stuff that they need to share. And so they could be the smartest and most empathetic physician in the world, and if they have five minutes with you, that might not be a very effective provider. They could be the most empathetic, best bedside manner, and have all the time in the world, but if they don't know... medicine, they don't know you, then they might be getting things wrong or might not be thinking of everything and they could be the smartest doctor with the most time. But if they don't know how to piece together three sentences or how to say things in a way that resonates with people and that's digestible for people, then it won't hit home. And so those are the three pieces that I encourage family when they're looking for care providers to look for. Melissa Schenkman (16:14) That's excellent advice for us to hold on to as we're doing that search because making that established relationship is just so important because now's the time. Now's the time for prevention as much as we can in this age group for sure. And kind of as a general rule of thumb, know guidelines on everything under the sun I feel like are always changing. We're all trying to keep up. So what would you say in terms of frequency for somebody who, as of this moment, has, they already know, of course a lot of people we know, once they hit their 30s start to get the diagnosis of different chronic conditions, but let's say they already have either had that diagnosis or don't have anything that's been officially diagnosed, they're just getting checked for wellness, they want to keep up with what they should be getting screened for, all that kind of stuff. How often? Yeah, good. be going because they're the guidelines. Like I said, they change everything. Dr. Jeremy Neuman (17:11) That's why people pay me money is because it is so hard to keep up with the guidelines. And so you're just googling it is it's hard to kind of determine where you fall and what needs to what could benefit you. The annual physical. Yeah. Is based on an insurance model that allows for one free visit a year. Health doesn't happen like that in wellness doesn't happen like that. There are times where people have low spoons and low bandwidth. And even if I wanted to talk about clot burden throughout people's lives or plaque burden, we know that people's cholesterol can turn into plaque in their arteries and that can lead to heart disease, heart attacks and strokes. And that starts when we're younger, way younger than the millennial generation is right there can be a lot of benefit to changing that fate and throughout time. But if somebody doesn't have bandwidth to really engage in those conversations, and they're just trying to make it through each day, then it might not be worth their time to kind of look at that versus somebody who is still very healthy, but has a lot of time in the desire to change things to optimize to get healthier to fix some problems that are going on. They could benefit from seeing somebody twice a month, you know, twice a week, right. And so the once a year was made for insurances to provide a template or the kind of industry to provide a template of things that we know saves the system money and protects people that that then would benefit everyone for people to get done things like cancer screenings things like heart disease screenings but but true health comes in waves and there are some times where people are going through depression or they're going through pains that I see them twice a week for four months right and then I don't hear from them which is wonderful hopefully for the best of reasons, because they're out there enjoying their life and they couldn't be healthier, right? And so I would say that for most people, if you asked me a question and you said, hey, you have to pick, I'd say, yeah, like once a year visit could be a good minimum for people. Then again, if somebody's 18 years old is doing great and doesn't have a lot of time or interest to work on things, then maybe every other year would be most appropriate for that person. And there's not going to be a time where people say, “Well I, you know, I'm doing pretty well and I want to push the envelope, but do I really need to come in more than once a year?" And I say, do you want to come in? Do you want to work on some of this stuff? Do you want to hear about how we can use factors to make you healthier now and in the future? And so it's a really tough question. Melissa Schenkman (19:34) It's okay. I'm very curious. I was very curious to hear your thoughts on it, because I know that's something that people kind of struggle with, if you will, of how to best kind of navigate and do it. And the other one I would say, and I'm very curious to hear your thoughts on as well, is for women. It's a little different than it is for men in that for women, a lot of women are going to that yearly gynecologist as well and having the primary care and kind of how did those two, would you say, kind of fit together? Because both, as I know well, are incredibly important to do that. I don't know if other women, let's say in their 20s, realize that at this point, what.. What are your thoughts on that as well? Dr. Jeremy Neuman (20:20) It's a great question. To clarify a little bit, primary care is not necessarily one specialty. It's an approach. It's saying that we are the first line of defense for things and that our job is not just putting out fires but preventing them as well. Gynecologists do practice primary care, but there are gynecologists who don't practice primary care and are subspecialty gynecologists. There are obstetricians who just deliver babies and don't practice primary care. So pediatricians, family medicine doctors like myself, and internal medicine doctors and gynecologists are the traditional specialties or the kind of mode of training that people have after medical school that filter into primary care. Some of my classmates who are in family medicine don't practice primary care. I practice primary care. The gynecologic visit is one that is very commonplace for people with uteruses and for people specifically with cervixes. The cervix is the disc that is between the vaginal canal and the uterus. And that's the thing that you hear in the movies that people say it's dilating this much for the baby to come out. That is the little door that dilates. And there's a virus that can go in that door called HPV, human papillomavirus. And through a series of years, if you are unlucky, it can induce damage and that damage can turn into cancer. We used to do yearly exams for that. Now the guidelines have changed. We have both Gardasil, which is a vaccine that protects, and you should ask your doctor about that. So we have Gardasil, a vaccine that protects against that virus, which then protects against that cancer. And for people who are 30 years and over with the cervix, we now also test for not just the cancer cells, but the virus itself. And so instead of a yearly exam, those recommendations have changed to every three to five years if people have a healthy and normal result from those exams. There are still many people and there's even still providers who would advocate for a yearly exam to check anatomy, but that's not necessarily consistent with the most updated guidelines. And so I also do that. So I'm not a gynecologist, but I do pap smears as part of primary care. And in fact, anyone who does primary care should feel confident in doing all the primary care kind of cancer guidelines. And it's okay if they don't feel confident in doing that and they can refer to somebody else. But..And likewise, a gynecologist who does a pap smear might also not necessarily be trained in a lot of the other primary care things. And so it really takes somebody who wants to buy into the concept of helping people with everything they come in with and preventative medicine. And when people hear about primary care, and particularly when we're talking about these screening guidelines to catch things early, we're really talking about prevention. you can't necessarily, based on the specialty, you can't really figure out if that person is going to spend five minutes, 10 minutes, if they're going to do all the prevention and so even going in and saying, like what are some of the things prevention wise that we should be talking about right now? Melissa Schenkman (23:04) No, absolutely. It's a great thing to go in with and also I really appreciate you kind of going through and explaining and distinguishing because I think that is something that a lot of people don't fully realize or is not fully, I guess, common knowledge really. The difference. Where those differences lie. And so I really appreciate you explaining all of that very much. And the other thing, just kind of wondering any exciting things coming up. I know you're super busy. The practice has been expanding in lots of different directions. You're what now? A little over a year, I feel like, which is amazing. Congratulations. Yes, congratulations. And any exciting things that you would like to share with the audience that are kind of like on the horizon we may not know about since last time we chatted. Dr. Jeremy Neuman (23:55) Yeah. Every day is a dynamic and wonderful. It can be a little intimidating because folks, I mean, this is why people watch this is like, what's the newest, you know, and what should I prepare myself for? But it's also exciting. Science should be reevaluated. Guidelines should change. We, our understanding of the human body and of different conditions changes, we should be having those changes. And for example, there's been a lot of exciting things even last month. There was a new schizophrenia medication that got released, FDA approved just two weeks ago. We have not had a new class of medicines for this disease in 40 years, about 40 years. And so the first one that's new just got approved two weeks ago. So we're really excited about that. We found out that Terzepatide is also called Mounjaro or...Zepbound is now going to be one of the best medicines that we could do or best treatments we could do for sleep apnea. And so we're really excited about offering people with sleep apnea another big tool. Things change all the time, and it is a delight to have more tools in my toolbox to give folks. Melissa Schenkman (25:01) Absolutely. Well, any final message that you would like to put out there for our audience when it comes to primary care and the incredible importance of it in our lives and helping us live our best lives, our best and our healthiest lives. Dr. Jeremy Neuman (25:19) Yeah. Check out Direct Primary Care. I'm biased. I have a Direct Primary Care clinic, but it is a model that I fully ascribed to because it allows us to have so much more time. And there are local clinics that are popping up. Used to be, in 2016, there used to be less than 200 clinics. There are now more than 3000. And so if you want to find a primary care doctor who has time, who has a business structure that doesn't incentivize you getting out of their clinic, but a business structure that incentivizes you staying healthy and happy, Google direct primary care near me. Melissa Schenkman (25:50) Thank you so much, Dr. Newman, for your time, for your unbelievable insights and knowledge that you've shared with us today. Lots of exciting things. I can see how every day is exciting. I really can. And the more we know, the longer and healthier we're going to get to live in this generation, thanks to you and your colleagues. So thank you. Dr. Jeremy Neuman (26:14) Yeah, you’re welcome. When everyone who listens to this podcast turns 80 just remember that I was the reason why. Melissa Schenkman (26:19) (Laughing) Exactly. Dr. Jeremy Neuman (26:20) Yeah, of course. Melissa Schenkman (26:23) Exactly. No, well thank you for all of your hard work in building Ally. It's just incredible and so excited to see it continue to grow. So everybody definitely check out Ally Primary Care as well. We'll see that in the show notes. So yeah, for sure. Dr. Jeremy Neuman (26:39) Thank so much. Melissa Schenkman (26:40) You’re so welcome.