What is Concierge Medicine?

AB: Hello, my name is Aurelia Byrne. Today, I am here with Dr. Jill Wade and Dr. Chowdhury. We are going to be talking about personalized medicine and what that’s all about. 

JW: Yes, Aurelia. We have lots of patients that come in. We co-manage patients with Dr. Chowdhury and it’s a wonderful result for the patients. We are not only focusing on their dental medicine, if you want to say, at our office but then she’s also doing the same thing in the medical world. Together we’re actually making a huge difference and progression in decreasing their inflammation, because remember, inflammation is the key.

AB: That is correct. Dr. Chowdhury, how are you today?

SC: I am fabulous. I just want to say to all the listeners, you don’t know these two ladies, they are dynamite. I just want to say thank you so much for inviting me to take part in this very exciting podcast because this is our lives, right, Jill? This is what we live, breathe, and eat. I’m so excited to share what I think is really a revolutionary yet common-sense way of taking care of a patient or all of us from head to toe. 

AB: Dr. C, can you tell us a little bit about yourself and have the audience get in touch with you, who you are, and what you stand for?

SC: Ooh, that’s a loaded question. How long have we got? Okay. Obviously I’m not from Southern Texas or anything.

JW: I know. We love your accent.

SC: My accent. I was born and raised in London in England of course. I moved here after I got married to my husband. My husband, my parents are all from a little dot on the map called Bangladesh which is right next door to India. Guess what? I moved from London to a place called Tulsa, Oklahoma.

JW: The world Metropolis.

SC: Exactly. But you know what? I love Tulsa.  It was such a lovely place. I met some amazingly different people, really, amazing. Anyway, a lot of our extended family live here in Dallas so I am in Dallas now and I’ve been here for 18, 19 years now.

AB: Oh, wow.

SC: Yeah. So a lot of changes.

JW: I didn’t realize it was that long.

SC: Yeah. My son, Aidan, he was barely eight, nine months when we moved here so he’s now a big old man.

JW: Where were you practicing when the kids were little?

SC: I had my son in the last year of med school and I had my twin girls in the last year of residency. I thought I was going to open up my own practice when I came out of residency. Then I realized, “Do I raise baby humans or do I raise a baby business?” I realized I could do the humans not the business. Then long story short, I started at temping or working part time for the City of Garland. They needed someone to help them with their employees. I said, “Okay, let me go.” Four months later I’m like, “Yes, I want to work for you forever and ever.” Because, I mean, talk about different, they wanted to help the employees of the City of Garland, the families, and the retirees and help them stay healthy. Because guess what? If you’re healthy, you’re not as expensive as a someone that is very sick.

JW: What a noble idea.

SC: Yeah.

JW: Back to our first episode which was the answer to the health care crisis actually keep people healthier.

SC: Oh, my God, there’s the concept.

AB: Preventive.

SC: Yeah. That was it. I worked for a guy who is in the Risk Management Department, Robby Neill—hi, Robby—who saw my vision or we shared the same vision of really helping people. What we found is that when you really know how to take the time, take care of patients, they stay healthier. If you’re talking about an employer, they don’t want to leave the job, and they are more productive, they cost less, and so on and so on. It was like a win-win situation. That’s what I was doing when the kids were small.

I was there for 10 years and I am so proud of that clinic. We started electronic medical records when people are still pushing paper. We had our own X-ray machine. Can you imagine, you’re going to a free clinic because it was free to the employees. They need an X-ray? They get an X-ray for free. We still maintained all the [inaudible 00:05:09], all the backups, and all that kind of stuff. That was when wellness started coming out so we had a wellness initiative, I think it’s C2W or something. Then that’s where the story begins about my journey. You want me to launch into that?

AB: Absolutely.

JW: Absolutely. I’m mesmerized.

AB: Keep talking.

JW: I’ve known you for a long time and I’m not sure I ever understood all that background.

SC: So go back quite a few years, it’s all because of my dad that I’m here of course in many, many ways than one. But my dad was a typical entrepreneur. He had several businesses. We’re from England and he owned all these Indian restaurants. They were all open till one o’clock, two o’clock in the morning. It’s like having a Broadway show every night. Things go on but show must go on. He would live that kind of life where he was always under stress managing this long hours, people, food, he never drank, he never smoked cigarette but he did have what we now know as metabolic syndrome which is the big belly and all that kind of stuff.

I remember this very clearly, he went to the cardiologists and had a stress test and he passed it. The stress test—if you remember, everybody—is when you get on the treadmill, you’re hooked up to an EKG, and you stressing the heart. You want to see if the heart is sending off signals that are interpreted by the EKG as its on the strength, way past it. Then he went to LA for business. In LA, he ended up having a GI bleed. He had ulcer in the stomach from all the late nights and what not and he bled. But as he bled, he collapsed on the bathroom floor, it affected the blood perfusion of the heart and whatever the situation was, it facilitated a heart attack. So he ended up having a heart attack in LA away from his family. They did all the work up and they found out that he had full vessels that would blocked.

But hang on, hang on, he passed the stress test. That was where the questions began. He survived. He ended up having a blood transfusion for the blood that he lost. Later on we found out he contracted Hep C from that. But I had some glorious years off the woods because we became closer but I still couldn’t understand why he had a heart attack if he passed the stress test.

JW: And so many people have that same question. Every year, it seems like somebody famous or somebody who’s this wonderful marathon runner or something just collapses before they hit the finish line and everybody’s like, “They were so healthy. They were so normal in cholesterol,” or they had a stress test on Thursday and then collapsed and died of a heart attack on Friday.

SC: By the way, I grew up and my mom will probably [chick chocolate 00:08:31] this, I never wanted to be a physician. Oops. I thought it was just too much hard work. But then I realized there was some answers that I didn’t have. That, I guess, in my subconscious is what pushed me. One thing I didn’t know, once I wanted to become a physician, I knew I wanted to be a primary care physician because I loved that variety.

JW: I don’t want to interrupt you but this is a great segue and what so many of my patients ask me and when I’m trying to explain to them, “Have you considered seeing maybe a concierge doctor?” They’re questioning us, “I don’t even know what that means. What is a concierge doc?” So I would love to hear you explain the difference between concierge medicine versus primary care medicine. What do you think the difference is?

SC: I can segue that into the rest of that story which is I was practicing primary care medicine which was you do the annual physical, take care of snotty noses, you do all those things. I remember I had one policeman and I had one fireman both lean physically fit, normal cholesterol, everything. They came back with a heart attack. The EKG was normal, everything was normal. Why? The thing is with primary care, you have a certain standard of care.

To your viewers, many of you have heard of the Bell Curve, and the majority of us fall under that bell curve. If you think about it, if you’re going to do medicine for a population, you’ve got to do what benefits the majority of people. But what happens to those people that kind of fall outside of that majority? What I realized was primary care is looking at populations and how to best serve the population but there are a lot of increasingly normal people that need more than that. They need an optimal level of care. That’s what I started specializing in. But I realized after learning about advanced cardiovascular disease prevention, by doing those special test that I know you know all about that it didn’t fit in the model of…

JW: Traditional standard of care.

SC: Traditional insurance and everything. Insurance wouldn’t pay for this and it would come out of you deductible. It was like, “This isn’t working.” Once you know the secret of how to prevent a heart attack, which you and I both know, it’s hard to go back.

So then at that time, this whole entity of concierge physician, direct patient care, started evolving, it was brand new. You know what that is? Basically it’s taking care of a patient but without insurance in the way. You’re going to say, “I have insurance, does that mean I can’t have that kind of care?” No. In fact many of my current patients have insurance. But they realized they need something more. That means they need someone just like a concierge at a hotel who is there for you at all times to help you with whatever, you need a physician who is going to be like your GPS in a car, it’s going to guide you. That’s what I say, “I’m time the guide.” We take time, we not rush because we don’t have to see hundreds and hundreds of people.

You basically pay a monthly fee for the access to this kind of care and for that, you get a physician that is available for you 24 hours a day, 7 days a week, and this is concierge medicine, that we’ll be able to use technology to enhance the communication so we can do texting, email, FaceTime, all of that.

But we at Diamond Physicians, our CEO Dr. James Pinckney II has worked with amazing team to build from scratch an app called DoctorLink. That is available to anyone basically for a fee. But they have a way to safely and confidently get in touch with their physicians for simple things like, “Oh, can you refill my medicine,” to “Hey, I have this problem, can you help me out?” It’s really good. There’s a big difference. It’s basically spending time with you, getting to really know you from a medical standpoint, how does it all fit in your busy lifestyle, and it’s available to everyone. It sounds all very cautious, we say in England, and really expensive but really it’s not. I have people from all walks of life that are members.

JW: I think it’s incredibly affordable. When you think about how much it could cost you down the road if you let a disease continue to take over, then you’re going from one medicine to two medicines to then a surgery or this or that, how expensive that can be.

Imagine how expensive a heart attack is, how devastating on your checkbook that can be to a family who has to endure those kind of medical costs somewhere down the road. If you just take your value, take your investment upfront, and basically stop the disease before it truly get started—because, I know we’ve talked about this before, so many people don’t realize that cardiovascular disease is reversible to some extent.

SC: Exactly.

JW: The general public does not understand that at all.

SC: Right. I think some physicians don’t understand that.

JW: I would agree with you on that.

AB: I just wanted to say that personally, I use Diamond Physicians, I use Dr. Chowdhury.

SC: In full disclosure.

AB: And I don’t have medical insurance. I do take a stand from my own well being. I do know that it’s important to do preventative care. I had other issues, I’m healthy, I’m fit, but I was having some hormonal imbalances and it was really draining me and I wanted to make sure that I was at my optimal care. But I just didn’t know where to go and I went to regular offices and they wanted to send me to the endocrinologist, they wanted to send me over here to figure out why I was feeling the way I was feeling and I get no answers. So I decided to not have insurance and  pay for it out of pocket and do personalized medicine. It’s worked perfectly for me.

SC: Thank you. I think you’re absolutely right. I think if I stand in the shoes of my patients especially those that take insurance and I go to the doctor and they say, “You need to go to the lab to go get this,” then you need to by the way go to the radiology facility to get an X-ray and then you have a question about hormones, then you need to go to the endocrinologist. I mean, do we not have a busy life as it is? Some of us are professionals, we don’t have time for that. 

I’m not claiming to be all things to everybody but I definitely can stop the work up. I think that’s where it’s valuable. I’ve had patients that have come up with multitude of symptoms and honestly it can be overwhelming. But then you just take your time, you break up the visits because remember they can come as many times as they want but they don’t pay any extra, they don’t pay a copay, it’s just that monthly fee. They can break it down into bite-size pieces and then I come up with what I call my wish list, these are the list of things whether they are blood tests, imaging, procedures, anything like that. Because we don’t take insurance, we actually make an invoice and say, “Okay, for this set of labs, this is how much it costs.” By the way, sometimes those labs are anywhere from 70% to 90% cheaper than if you paid through insurance. X-ray is a perfect example, you pay through insurance and it’s triple the price.

AB: There’s all those deductibles that need to be met. It’s ridiculous. You might as well just not pay and then get a supplemental like I have a supplemental accident. I had to pay out of pocket, I give my bill to them and then they pay me my copay back which is a little bit more affordable than paying a monthly premium…

SC: I think we’re getting to a point where people are beginning to feel the pain of all the changes that have happened. This was something that I used to try and educate people when people didn’t know what concierge direct patient care was. I said, “Listen, you are paying a premium to be a part of this insurance group. Great, you’re carrying a plastic card and it gives you a sense of peace at night. Then you go to the doctor’s office, unless it’s preventative, it’s going to cost you a copay.”

JW: It’s there for catastrophic.

SC: Okay, yeah. Remember I was telling you about the car, GPS? It’s like your car insurance, do you use your insurance to pay for the oil change and the tire changes? No. Those are out of pocket. But if you have a car wreck and you need something more, guess what? That’s when it kicks in. Yes, you have a deductible but you’re going to have a deductible no matter what. I’m saying to everybody, “Stop thinking about insurance as the only way to handle it which is now getting extremely expensive.” When you go to that doctor, you pay the copay and you say, “Okay, I paid the copay. I’m out.” Guess what? You’re going to get a bill because your deductible wasn’t met. And how much are the deductibles? Oh, my goodness. It can be anywhere from $2,000 to $10,000.

AB: Ridiculous.

SC: Yeah.

JW: I find that when you go beyond what we’re all, let’s say, used to like in the past, what we’re all used to, what we think insurance used to be, it no longer really exist that way anymore. Again, what we’re talking about is a system that used to be built upon chasing disease. You have this, let’s chase it but we’re not going to do anything ahead of time to try to keep it at bay or keep it from going, we’re actually going to try to diagnose earlier. For example, I’ll take diabetes for instance. All these people will come up and and say, “I just got diagnosed with diabetes.” I kind of just want to step back and say, “What happened to the last 15–20 years?

SC: What does it take? At least 10 years.

JW: At least 10 years for you to get to that point. Where would somebody diagnosing you with insulin resistance or pre-diabetes and doing something about it then? I truly believe that the way you practice, the way that we practice is a relationship based focus.

SC: Oh, absolutely.

JW: We know our patients, we get to know are patients, we look at them. We look at them and see their symptoms some in their energy level, sometimes physically, if they’ve began to gain weight but we also know what kind of stress have they been under in the last couple of years. When you think of this personalized medicine and just switch the word relationship-based medicine, then I think that’s where the value is going to come in to play.

SC: Two things, it’s interesting you bring up diabetes because everybody in my family pretty much has diabetes, everybody. I am damned if I’m going to get diabetes but I’m fighting with pre-diabetes. But what I tell my patients is, “Look, I’m here to diagnose you, not with the disease but with the pre-disease if I can.” Because then we can do something about it.

JW: And that’s where the genetics comes into play too. 

SC: You’re just taking all these words out of my mouth.

JW: I know, I know. But it’s my passion, it’s really combining philosophy that includes medicine, dentistry, and genetics.

SC: Did you know I have an undergraduate degree in genetics from University College London?

JW: I did not. Good to know.

SC: Yeah. That came in handy.

JW: Sounds like we can be really big goobers together over dinner one night.

SC: So genetics, you’re right. All my patients go through something called a complete health review. It isn’t just about post-medical history, [inaudible 00:22:04] being through it. Post-medical history, family history, such crazy. Big one is family history. I’ve had these generations of people that have had heart attacks in their 30s or 40s and guess what? They’re sitting there in their 30s and I’m like, “Oh, dear let’s start looking.”

JW: It’s so funny because we have the same type of questions on our medical forms at the dental office and so many people are like, “Why would you need to know my family history?” But we need to know if they’ve had periodontal disease because it’s so linked to heart disease, and the diabetes, and alzheimer’s and all those things.

SC: Can I give your listeners a very Texas analogy?

AB: Sure.

JW: Of course.

SC: Okay. So in Texas, we love our guns and barbecue but let’s not talk about barbecue right now. But guns, if you take a loaded gun and you put it on the table what’s it going to do? Nothing. It’s just sitting there. Cholesterol is like that. It’s not cholesterol that kills you. That’s why people with normal cholesterol can die of heart attack. Here’s the deal, you said it earlier on, it’s inflammation that’s the trigger. The combination of inflammation and cholesterol is what will give you an event. Where does inflammation come from? All over.

JW: All over, including the mouth.

SC: Exactly, which a lot of people don’t realize. I’ve even talked to dentists years ago and I said, “Did you know that this can be connected directly to heart disease?” They’re like, “No, I don’t think so.” I’m like, “Okay.” I’m glad to hear that more and more dentists and more and more physicians are beginning to understand that inflammation is the key.

JW: Agreed. That’s exactly why we started SimplifiHealth podcast because we really want to elevate the conversation just like we’re having here today. I hope, Dr. C that you will come back and join us again and just keep talking about this wonderful information. You have so much to offer everyone. We want to help give you a platform for everything that you know and that you can share with our public.

SC: I am honored to do that. Thank you.

AB: Thank you so much, Dr. C.

JW: Dr. C, if our listeners want to get 

in touch with you, how would you like for them to do that?

SC: Please visit our website, it’s called diamondphysicians.com and we have several locations, mine is in Frisco, we have North Carrollton, and we have Dallas, I believe we now have Fort Worth. My number is 214-945-DOC(362)-1.

JW: Thank you again so much for being here with us today. I want everybody to keep smiling from the inside out.

AB: Thank you so much, Dr. C.

SC: Thank you.

AB: For general information about this 

podcast, you can visit youniversityhealth.com. For dental professionals it would be relevancehealth.com. Thank you so much. This is Aurelia, smile with heart.