Asheville Direct Primary Care

Flow Like A River

Yesterday, as I read through the paper, I found myself feeling a bit despondent.

Over the years, I have been taught to “sit with my emotions” in order to better understand them and observe my reactions. I find this very helpful as a coping strategy. It takes time, but giving myself this space of non-judgement, allows me to move forward relieved of resentment and anxiety. For the most part, once I can understand why I feel what I do, I can work to move on. And, yes, like everyone seeking a better quality of life, I work to improve my mental and physical health.

Reaction to outside stimuli, like the paper, TV, a friend with a different opinion on FB, is natural, but if you find yourself suffering from the anxiety provoked by your surroundings and your reactions, you may want to evaluate whether or not you have the ability to control these reactions. There are many ways to work on this, but I have long suggested the method which is nimbly explained in “Non-Violent Communication,” by Marshal Rosenberg, PhD. This method is not the same as positive thinking. Positive thinking, a different technique, involves a level of non-acknowledgement of the ills of this world. A different coping strategy all together, positive thinking has its place, but may not be satisfying to those seeking more answers at that moment in time.

This morning I read a beautiful parable which felt relevant at this moment when the news cycle is so jarring to many. Here is the link and I have cut and pasted it below as well. To me this represents a coping strategy more aligned with non-violent communication. We don’t have to react to every poke and prod. Sometimes we just need to flow like a river.

http://www.thedailyzen.org/…/28/zen-story-flow-like-a-river/

“JUN 28, 2015 BY CHARLIE AMBLER

Zen Story: Flow Like A River

There is the story of a young martial arts student who was under the tutelage of a famous master.

One day, the master was watching a practice session in the courtyard. He realized that the presence of the other students was interfering with the young man’s attempts to perfect his technique.

The master could sense the young man’s frustration. He went up to the young man and tapped him on his shoulder. “What’s the problem?” he inquired. “I don’t know”, said the youth, with a strained expression. “No matter how much I try, I am unable to execute the moves properly”. “Before you can master technique, you must understand harmony. Come with me, I will explain”, replied the master.

The teacher and student left the building and walked some distance into the woods until they came upon a stream. The master stood silently on the bank for several moments. Then he spoke. “Look at the stream,” he said. “There are rocks in its way. Does it slam into them out of frustration? It simply flows over and around them and moves on! Be like the water and you will know what harmony is.”

The young man took the master’s advice to heart. Soon, he was barely noticing the other students around him. Nothing could come in his way of executing the most perfect moves.”

 

 

Female Internist Asheville

WELCOME TO THE ASHEWELL MEDICAL GROUP BLOG!

I am Carly Brown, MD, an Internist and the founder of Ashewell Medical Group. I am a wife and mother of 3 children and 2 dogs.

When we moved to Asheville, I decided to make a change. For many years I have been in private practice Internal Medicine, seeing 25 patients a day, limited by traditional practice style, where the quality and quantity of patient care is dictated by a third party. I knew there had to be a better way, and wanted to work in collaboration with patients, caring for my community in increments not limited to 15 minutes. I wanted to focus on preventative care and I knew my patients wanted convenient timely access to me. I want my care to be affordable and for every patient to leave my office feeling a bit better than when they entered. Hence, Ashewell Medical Group…

Nothing is perfect in this world, but we cannot give up trying. I created Ashewell because I know the joy of caring for others. I am honored to be a physician trying to do what I believe is best for my community. I hope you will evaluate our services and call us if you have questions as we are honored to open our doors to you. We can only accept 500 patients per physician because this ensures the highest level of care. It is our guarantee.

Thank you for visiting. Stay tuned for information about matters of health, our medical practice and community and sometimes just thoughts about life and all it has to offer.

Most importantly, Be Well…

Warmly,

Carly Brown, MD
Ashewell Medical Group

Female Internist Asheville

CONFUSED ABOUT THE FUTURE OF HEALTHCARE? YOU ARE NOT ALONE

Rest assured Ashewell Medical Group will provide shelter from the storm.

If Obamacare goes away or some version of it remains, our service will be unaffected.

You can count on exceptional, personalized and convenient care regardless of the current political environment.

Think of it like this, we don’t use our auto insurance for routine maintenance like oil changes – we use it for accidents or other major issues. Why should our health insurance be any different? With our model, your health insurance will continue to protect you in the event of a hospitalization or major medical event but you won’t waste money on a deductible you will never meet.

Did you know that 95% of patients never exceed their deductible and that 40 cents of every dollar of primary care spending goes to insurance company costs rather than to patient benefits?

Direct Primary Care saves you money by eliminating the out of pocket expenses you have when you use your health insurance for preventative care, emergency care, and chronic care management. Ashewell Medical Group offers all of the above, in the comfort of your doctor’s office.

Female Internist Asheville

HEALTHY EATING AND THE INTERNET…INFORMATION OVERLOAD!

Educating my patients about healthy lifestyle changes is the foundation of my medical practice. As an internist I am an expert in disease, diagnosis and medication management, but most issues of primary care are caused not by rare medical problems, but by relatively simple issues such as poor diet, stress, and inactivity. My goal is to simplify the constant stream of data about these topics and focus on the individual needs of my patients.

I use the following sources to stay up to date. I want to encourage you to explore these sites, ask me questions, and incorporate what works best for you into your life. Make the data work for you, and not the other way around. To be clear, I have no financial relationship with any of these companies, I just happen to think they are really good!

1. The New York Times Health Section: If you follow us on Facebook you will know I am an avid reader of the New York Times. I particularly like the Health Section which has wonderful articles on the newest research in diet and fitness, recipes, and disease diagnosis, management and therapies. I love this gem from writer Aaron E. Carroll, “https://www.nytimes.com/2015/04/21/upshot/simple-rules-for-healthy-eatin….”

2. I would be remiss if I did not mention one of my go to sources for recipes https://cooking.nytimes.com/. You can set up an account and file all of the recipes you like which are easy to sort by meal type and cuisine. On a special occasion look for Nigella Lawson’s Chocolate Guinness Cake which is sinfully spectacular and not hard to make.

3. As a busy mom, I like the recipes from King Arthur Flour which can be found at http://www.kingarthurflour.com/recipes/. If you are gluten free they have a wealth of recipes to choose from, and you can read the ratings and tips before you try them out.

4. To find food with the highest amount of nutrients check out World’s Healthiest Foods: http://www.whfoods.com/index.php. If you want a list of foods which contain calcium you simply search “calcium,” and scroll down to “nutrients.” It produces a list of 10-20 foods with name, calories and percent of DRI (daily recommended intake.) This is terrific in tailoring your needs and getting nutrients through food rather than through vitamins.

5. Dr. Weil. If you don’t know who this bearded wonder is, then it is time for you to get acquainted. Dr. Weil is an MD and the guru of holistic health and integrative medicine. Find out more with his website: https://www.drweil.com/diet-nutrition/. I don’t subscribe to all of his practices but I like how he re-imagines the food pyramid placing the most “inflammatory” foods at the top and the least at the bottom.

6. The Nutrition site for the Harvard School of Public Health offers another another good source for evidence based diet and nutrition information: https://www.hsph.harvard.edu/nutritionsource/. They also have their own version of the food pyramid called the “Healthy Eating Plate.” This site is filled with expert articles, tips and solid basic principles of diet and nutrition which are up to date and patient friendly.

I go back to these sources over and over again. Check them out. If you find a great recipe or something sparks your interest, let us know! We love to get your feedback!

Female Internist Asheville

MEDICINE CAN BE LIKE WINE: EXPENSE IS SOMETIMES A FALSE SIGNAL OF QUALITY

Many of you will ask why as a physician I am sharing this? It’s critical of my colleagues and recommendations we make daily.

I am sharing because as physician we must continue to question the prescribing practices and recommendations we make daily. We must be able to conclusively evaluate the data before us and ask ourselves…is this best for my patient?

At Ashewell there is a reason we pass our medication, labs and medical imaging on at cost. There is no markup because we want to de-incentivize our practitioners from reward based prescribing practices.

Your physician is trained to answer your questions but may lack the time to adequately do so. Most of your physicians want to have the time to sit with you and explain the risks and benefits of interventions whether they be medicines or procedural. There are many forces at work here and not all are related to physicians and hospitals making money. Limitations are everywhere in the current medical model. This is the reason we only see 500 patients per physician at Ashewell. Less patients allows for more time per patient and more time for questions, care and nurturing. Wait did I just use the word nurturing? Yes, something we embrace with pride in our office.

https://www.theatlantic.com/health/archive/2017/02/when-evidence-says-no…

Female Internist Asheville

I AM VERY CONCERNED ABOUT THE USE OF PESTICIDES

I am very concerned about the use of pesticides on our produce. I am writing in response to the following article in the New York Times.

https://www.nytimes.com/2017/05/15/health/pesticides-epa-chlorpyrifos-sc…

Chlorpyrifos is … widely used in agriculture and routinely sprayed on crops like apples, oranges, strawberries and broccoli… Chlorpyrifos belongs to a class of pesticides called organophosphates, a diverse group of compounds that includes nerve agents like sarin gas.” “When you weigh the evidence across the different studies that have looked at this, it really does pretty strongly point the finger that organophosphate pesticides as a class are of significant concern to child neurodevelopment,” said Stephanie M. Engel, an associate professor of epidemiology at University of North Carolina at Chapel Hill. Dr. Engel has published research showing that exposure to organophosphates during pregnancy may impair cognitive development in children.”

I am not trying to make a political statement, but simply advocate for individuals on behalf of good science. Do yourself and your children a favor. This is a list of produce which should always be purchased organic or at least from local producers who never use pesticides such as these on their produce.

This is the dirty dozen: https://l.facebook.com/l.php?u=https%3A%2F%2Fwww.ewg.org%2Ffoodnews%2Fdi…

Female Internist Asheville

WELL NO ONE EVER EXPLAINED IT LIKE THAT!

Sometimes when I hear a comment over and over it sticks. Over the years I have come to realize that one of the reasons I love practicing medicine is that I love to teach. I like it when I have the chance to explain a complex topic. This week I explained lots of difficult to understand medical concepts like the mechanism of an SNRI and the importance of mammogram in early detection of breast cancer. I explained how the same symptoms can be caused by two very different etiologies and why it is important to check certain labs and not others.

I also like to tell my patients about things we just don’t understand. Likewise, I ask a lot of questions and try to understand why patients feel the way they do about medical concerns so I can understand what I need to teach them allowing our patients to make good decisions for themselves based on their beliefs.

I believe patients should have autonomy. After all it is your body. I see myself as a tool, like a compass. I can point North but ultimately your feet have to move you down that path.

I share all this because patients are increasingly interested in getting to know their doctors and medical providers. Patients are smart, and they have choices. At Ashewell, we think communication is the bedrock of medicine and if it takes us more time to help you understand why we recommend the things we do, we will take that time.

Yes, we do things a little different but my compass pointed me in this direction and I have found this path is one of pure fulfillment.

Thanks!!

Carly Brown, MD

Female Internist Asheville

PATIENTS ARE ALWAYS ASKING ME ABOUT EGGS?

There seems to be some confusion about the egg’s effect on cholesterol and heart disease. This is a result of the fact that the data on this is somewhat mixed but generally between 1-6 eggs are safe per week in most patients.

The exclusion might be patients with Type 2 Diabetes. The data is very limited but there might be an increased risk of heart disease and stroke in this population even with a small intake of eggs. This doesn’t make much sense because we know that eggs can be rich in omega-3s. Pasture-raised chickens get a terrific amount of omega-3s when they are fed clover and alfalfa. Non-pasture raised chickens are given supplemental omega-3s which also boost the omega-3 content. We know that foods rich in omega-3s raise the HDL or good cholesterol which is heart protective and that is why this topic confuses doctors and patients alike.

I really like eggs and eat a lot of them. I especially like it when my patients bring me their pasture raised eggs from their farms 🙂 So again the answer to this wonderful question is that one size doesn’t fit all. For some, eggs work and for others eggs are to be eaten sparingly.

I think the reason we are even asking these questions is because as a population we are so inactive. For those getting plenty of daily exercise eggs are unlikely to be the problem. So the question we should really be asking: are we active enough?

I recommend a minimum of 30 minutes of exercise to my patients, 5 days a week. I like to tell them this is the only fountain of youth I have ever found. Anyone can drink from it. Casual walking won’t cut it. If you don’t have to shower after, you haven’t pushed yourself enough. Of course, we need to get here gradually, safely but you would be amazed at how your body remembers and adjusts. Personally I love that we can take control over much of our health through diet and exercise and try to empower my patients to discover this joy. For those who suffer from joint issues, chronic injuries, etc the weightlessness of a pool is a magical thing and even if you need to invest in a YMCA membership I would say it is worth it. Don’t like to swim? Have you though about running in the water? Google it…

Which gets us back to fuel. Your body is a machine and your health is directly effected by what you fill it with. The car analogy ends here though because even a Dodge Pinto can be a Tesla with the right fuel and roads to run on. Get it?

At Ashewell, we know your diet is your health. To prove it we sponsor the North Asheville Tailgate Market. I will be there tomorrow answering your questions about Direct Primary Care and encourage you to come out and support our local farms and craftspeople.

Have a wonderful weekend!

Ashewell Direct Primary Care

IN-HOUSE PHARMACY IS A KEY COMPONENT OF DIRECT PRIMARY CARE

Medications at cost, just one benefit of being a patient of Ashewell Medical Group. We have an in-house pharmacy, a key component of Direct Primary Care. Our medications are 95% less than market value. This means savings for you.

Why would a practice run an in-house pharmacy when they don’t make money from its sales? When we were building Ashewell Medical Group as it is today, I too was unsure about adding the pharmacy. Today I see it as essential.

If we just gave you access to affordable care it would not be enough. The cost of medications are astronomical and what good would I be to you if I diagnosed hypertension or hypothyroidism, but couldn’t treat you? What if I recommended medication but couldn’t get labs to monitor its effects on your health? What would be the good of counseling you on the importance screening tests such as mammogram if it cost too much to have?

We include these services because direct primary care attempts to be as comprehensive as possible. We want to remove the barriers that prevent our communities from having preventative care. Now I couldn’t imagine Ashewell without a pharmacy. It makes the care of our patients seamless and for this I am very grateful.

Ashewell Direct Primary Care

WHEN I SAW THIS PHOTO IT REMINDED ME …

When I saw this photo it reminded me of a patient I saw today. She struck me as particularly brave, a woman who persisted against the odds. Since opening Ashewell, I have noticed that many more individuals like this woman have come into my life.

As a child this woman had an infection which resulted in heart disease later in life. She was not a woman of privilege and continues to work for $9/hour cleaning despite a history of multiple heart operations. She has not qualified for disability because she has continued to work and she has not qualified for medicaid because in NC she makes too much to do so. Thus, she has gone without insurance because through the exchange her subsidy would still leave her with a premium of over $500/month which she cannot afford.

So she came to Ashewell. She heard about us on the radio and told me that at that moment thought, “Thank god.” She told me that she had not had medication which she required for several years. She told me she had an abnormal mammogram several years ago and was unable to afford a follow up study. She has never had a primary care doctor.

Today we welcomed her as a new patient and listened to her story. We reviewed her medical history, ordered a full set of blood work for $15 and examined her. She explained that the same tests were done a few years earlier for several hundreds of dollars. We arranged for her medication which is only $9 for 90 days, set her up with an organization in town, associated with Mission Hospital, which provides free mammograms. She has gotten much needed care over the years from our local hospital and cardiologists and we can’t forget how important this institution and its providers are for our community.

This patient will return for a physical and pap-smear and in a few months we will have caught up on years’ worth of missed primary care.

My day was brightened by this interaction and thus I wanted to share it with you. So many of our neighbors live in the shadows with regard to their routine care. It is important that we shine a light on their situations and their resilience.