Why “Wellness”?

Welcome to Synergy Rheumatology and Wellness! As I kick off the first monthly blog, I’m excited to share insights and updates from the world of autoimmune/rheumatologic diseases covering specific disease updates, concepts, new treatments, and other news relevant to you, whether you’re a (future) member of the practice or just someone interested in the field. This blog and accompanying mailing list aim to provide valuable information to help us all lead healthier lives, completely free of charge.

The theme for my inaugural post is a special one about “Wellness” and why this is important enough to be part of the practice’s name. While it might seem like a buzzword, its synonyms – wellbeing, fitness, robustness, strength– paint a clearer picture. We strive for each of these states: we need wellbeing, a feeling and state of being well, not sick. We need fitness: our joints, muscles, mind all need to be in proper shape to function in this world. We need to be sturdy and robust just to survive what our environment, lives, stressors, neighbors, coworkers, politics, etc challenges us with. We need to be strong to excel in that environment.

How we best improve our wellness, i.e. our wellbeing, fitness, etc, is the bit that gets too often overshadowed in both primary medicine and rheumatology. In medicine, despite our initial training and best intents, we’ll often ultimately slip into a primarily diagnostic and medication-driven approach targeting the serious players in your health history i.e. the heart failure, dementia, rheumatoid arthritis, back pain, etc. The just-as-important factors that contribute to our wellness, like the complete picture of our metabolic state (including diet and weight!), exercise habits, social habits, and sleep – well… they often fall by the wayside.

  • Put yourself in this scenario for a minute: You’re a family practice physician seeing your long-standing patient, Mrs. Smith, for an annual exam. She’s one of your favorites – you’ve known Mrs. Smith about 4 years now and you both share a love for Golden Retrievers. You work for a health system where your appointments are fixed 30 minute intervals in the best of cases, but in reality the average is far closer to 15 minutes. She has a typical length medication list for someone who’s 75 years old, say 6 medications. The visit could go something like this:
  • 3 minutes: You greet Mrs. Smith and ask her how she’s surviving with yet another Golden Retriever puppy at home (this is her third one!).
  • 6 minutes: She shares that Dr. David, her cardiologist, gave her a new medication at their last visit for a new heart condition that she has to update you on. You look for interactions and need to adjust the dose of one of her other medications to compensate. You listen to her chest and check for swelling, a known side effect. You update her chart.
  • 6 minutes: Mrs. Smith has a new pain in her right hip. You explore the symptoms further, help her onto the table, and do a proper back and hip examination to hone in the issue. She’ll need an X-ray since you’re suspecting some osteoarthritis – you order this for her and ask her if she’s able to do this at a nearby facility. You quickly send a message to your assistant outside the room to send the order over to the imaging center.
  • 2 minutes: You review her vital signs with her, noting her blood pressure is well-controlled where it is. You spend a quick 30 seconds reminding her it’s best to be checking that pressure at home three times a week. You remind her the proper means to measure this.
  • 2 minutes: You review her medication list and send refills of each to her pharmacy. Her pharmacy changed, so you get the new address of that and send.
  • 7 minutes: Mrs. Smith had labs done before coming in that you reviewed before she came in. There are a few abnormalities like her cholesterol being a bit too high and it looks like she might be newly anemic. You ask her about any symptoms that might be related to the anemia or related to its cause.
  • 3 minutes: You complete the rest of your physical exam and cover any other systems not already checked.

We’re at 29 minutes if you’re keeping count. The visit has 1 minute left if we’re playing with the optimistic, 30 minute visit lengths. We covered a few issues and accomplished a fair amount, sure, but what didn’t we get to?

  • What about the cholesterol, what are we doing about that? How much time would it take to talk about what cholesterol really is and what factors can be changed lifestyle-wise before talking about medications? What about the medications, what are her choices and what are the possible side effects? (It doesn’t just start and stop at “statins” anymore)
  • Is she exercising? How is she exercising, how much, how intense, where, who with? This is a huge factor in that arthritic hip since exercise is one of the best means of pulling back some of that pain, not to speak of benefits to her metabolic status that becomes associated with her cholesterol.
  • How well is she sleeping? She lost her husband 2 years ago and you wonder if her sleeping is back to normal.
  • How’s her social support? Does she still have friends and family she can confide in or call for help? She hasn’t mentioned her children in the last few visits, they used to visit her regularly and you wonder if they may have moved away.
  • Mrs. Smith is overweight and mentioned last visit she’s been having some trouble losing weight, but that visit ultimately had to shift focus to a new breathing issue. It wasn’t addressed this visit. Is there going to be any time next visit, or the following visit?

This isn’t specifically a complaint about short visits (it’s that too): in my journey through residency, rheumatology fellowship, a year of primary care medicine at Scripps Clinic and my three years of rheumatology practice in the Bay Area, the recurring challenge during patient visits has been time — or the lack of it. I’d say 3 out of every 4 patient visits, there’s something else that could’ve been talked about. We’ll always prioritize the most serious or dangerous issues to the top of the conversation stack even if that’s not always aligning with the individual’s priorities. “I hear that you’re having sleeping troubles, but we really need to focus on your high blood pressure today.” When time runs short, we’ll shirk these other issues either to other physicians, other allied health like nutritionists or physical therapists, or simply say we’ll get to them next time (Do we always get to them next time? From experience, no, we don’t).

Health, maybe defined as the absence of disease or at least control of disease, is only one side of the coin and ignores the entire other half. If all we’re getting in our doctor’s appointments are half the coin, are we getting the best health care? Shouldn’t we aim for the whole coin, the whole picture, not just half?

This is where I want to give a different experience at Synergy Rheumatology and Wellness.

This practice is designed to be about rheumatology care and wellness without compromise or restriction. It’s about achieving our best state of health, i.e. personalized rheumatology care that incorporates pillars of wellness (diet/metabolic state, stress, social connection, and sleep), not pushing them aside. It’s about access, i.e. reaching your doctor directly when you need them, not reaching a call center. It’s about same or next day appointments when issues arise. Having the time and ability to address the whole picture at the start and when the need arises is what’s missing in traditional medicine practices and it’s what I’m building this practice for.

What’s the price if we don’t address the whole picture? A few surprising facts off the cuff – irregular sleep promotes insulin resistance, obesity, and is a leading force in centralization associated with fibromyalgia (insomnia in an astounding 70% of those with fibromyalgia!). Inflammatory foods in our diet (particularly looking at you, processed carbs) trigger flares of our lupus or our psoriasis, even osteoarthritic pain in some. Suffering from obesity is a pro-inflammatory state and feeds our autoimmune diseases, making controlling that inflammation harder if you’re not looking at the whole picture. These are are all critical pieces of our puzzles that need to be considered just as carefully as choosing the right biologic therapy for you and your autoimmune disease. If these aren’t being considered in your rheumatology care, it’s a great time to make a change and start.

I’d welcome you to join my email list (no charge, ever!) – I’ll continue with monthly insights on a range of ideas focusing on rheumatology and medicine topics relevant for all of us. Share with friends and/or family who might benefit!

Right now, the practice is under construction with open date planned January 1st, 2024. By joining the mailing list, you’ll be first to hear updates in the next few months regarding opening and how to become a member in addition to seeing fresh blog content. For now, this mailing list is doubling as an interest list/waiting list for the practice with forthcoming details coming around December about how we’ll initially connect to determine whether my practice might be a good fit for you.