Return To Health (Pando Health Groups)

If America is going to provide insurance coverage for millions of more people than we do currently and we already can't handle the current load, then how in the world are we going to be able to do that? It seems so clear to me. The model must change and we must adapt to the reality. I think we could do it with a new model of care where the most common medical interaction is not one to one but one to many. Groups. Medical groups. Medical communities. Clans. That's what I learned in Fiji. Care can be delivered within a different model and one more suitable to caring for chronic issues. We can't continue to deliver care in the model we use; it does not work. People need more -- not more technology or more pharmaceuticals -- just more care and  attention. Attention to their whole being. Thoughts, beliefs, feelings, longings. These all matter. This cannot be done with cramming in more one on one appointments. We will kill the doctors and our society. It is an entire paradigm shi

A truly great man left our world recently. Lee Lipsenthal was a medical pioneer and one of the warmest, loving people I have had the pleasure of knowing. I met him through my affiliation with the Dean Ornish Program for Reversing Heart Disease. He was their medical director. He also was the President of the American Board of Holistic Medicine (ABHM) of which I am a member. He taught doctors how to find balance and happiness in their lives and careers (a noble and very challenging task). He exuded a warmth, love and kindness that is extremely rare in the medical world. He genuinely wanted to make medicine better and I strongly believe he did. He pioneered movements in patient care in the Ornish program (empowering patients through improving their daily lifestyles and addressing their emotional and spiritual lives) and promoted physician well-being during a time that this was just not valued by the modern medical world. These extremely challenging ventures were bold and strong but always

I read recently in a business magazine about the goal/concept of "cracking the chronic disease dilemma". The article spoke from a business/IT perspective and the focus was coming up with a technological or system solution to this major challenge (it is estimated that this single issue is largely responsible (maybe 75%) for the out of control efforts to finance our healthcare system). I believe that there is a fundamental error in this approach (technological or shifting the delivery model (i.e. to lower level providers such as nurse practitioners or physician assistants or nurses). Not that these are "bad" options; new technology is great and the above mentioned providers are great. The problem is that these efforts would still be in the same model; attempting to care for "complicated, multifactorial" (chronic) problems with an acute care mentality and perspective. The problem is NOT the providers or the technological support. Fixing these issues could h

I was just reading about a phenomenon called the Roseto effect. Apparently, the Pennsylvania town of Roseto (named after the Italian town) had a remarkably low rate of death from heart disease in the mid part of the 20th century. It turned out they ate worse, smoked more than other communities but lived long and healthy lives. The causative factor was discovered by the researchers (led by an MD named Stewart Wolf) to be a function of the social nature of the town 's people -- they were remarkably interactive and connected. This effect went away as the immigrant town "Americanized" and became regular in its values and behaviors. This was described in the 1960's. Why can't this be created again? Community is "buildable" even without it being the natural state of being. That is my opinion. It just has to be valued by the community and it happens. Build it and they will come.

In the part of Fiji I visited (rural and removed from the main islands), there were 2 options for medical care: (1) Getting a boat ride to a hospital on the main island (3 hour boat ride -- expensive and rarely done) or (2) Handling things on your own with the aid of your friends and relatives. In America, we have quite different and many more options. We are fortunate but the amazing thing is that they live nearly as long as we do and arguably with as good or better quality of life despite diffuse poverty and minimal resources. What can we learn from these joyous, loving people? How can we be the students as opposed to us being the givers? To me, it is all in their priorities and values. They focus on completely different goals than we do. For them, life is only about connection, community, God, family and giving. For us, it is about money, fame, power, productivity, and competition. The way they care for their people is a reflection of these values and principles. We all want to be

I would like to proudly announce that I now accept Medicare in my medical practice. I look forward to being able to serve my senior clients with this payment mechanism. I very much like helping this population and feel strongly that I have good things to offer that are not offered in the standard system (time, open discussions about options in managing the challenges of aging and illness and chronic conditions, alternative and complementary approaches, working with emotions and spirituality in relationship to health concerns, and frank conversations about planning a good end of life. Please call my scheduler Tarin @ (858)259-8333 to make an appointment or for any questions. She is available Monday through Friday between 8 and 5. She works for a medical device company so sometimes you get their voicemail.

One of the true highlights of my Fiji trip was sharing my friends Michael Rubano (massage therapist and Feldenkrais practitioner and general body-mind master) and Matt Szymczak (acupuncturist and Tai Chi/Xi Gong master) with the Fijian people. I had noted on my previous trip that the most common complaint was body pain (most notably low back pain) among these hard-working people. I wanted to give them more than just Advil and Tylenol (which they do appreciate) so I invited my good friends who have devoted their lives to studying the body and bringing people relief with "non-medical, non-surgical" means. Matt and Michael were huge successes. They worked incredibly hard and shared their gifts with many, many Fijians as well as members of our team. They worked on some people together double teaming them and the majority individually with needles, touch, body re-integration and their incredible wisdom in concert with their energetic and invigorating personas. They often worked

I truly appreciated Jenna's thoughts and words on Tai Chi. We practice Tai Chi at the start of all my senior groups and I truly believe the participants benefit in the ways described in her article. It is fun, different and challenging in a different sort of way. The NEW ENGLAND JOURNAL of Medicine even has an article on it this week for improving postural stability in Parkinson's patients: http://www.nejm.org/doi/full/10.1056/NEJMoa1107911 and an article last year showing benefit for people with fibromyalgia: http://www.nejm.org/doi/pdf/10.1056/NEJMoa0912611 . It is an incredibly empowering activity that can be done by anyone anywhere.

Tai Chi for Health Tai Chi is a secret weapon in the battle against the physical and mental demands of life. It has been able to help improve health in individuals with illnesses ranging from peritoneal mesothelioma to migraines . Its quiet and slow movements bring a calm balance to the mind. It also brings strength and balance to the body. Tai Chi demands very little from its participants. The focus is on body awareness and deep breathing. Its stretching is soft and fluid and its movements are low-impact. Young, old, athletic, or the rehabilitating can all gain better health with Tai Chi. Studies have shown that Tai Chi improves physical health . Although the movements are slow and require no added weight, those that practice Tai Chi become stronger in both upper and lower body. There is also proof that flexibility and balance are improved. The fact that the gentleness of this exercise has such positive results makes it perfect for the unfit, the elderly and for those recovering f

I am still fully "lit up" by my Fiji experience. What I am most struck by is NOT what we were able to do for the Fijians (although I am proud of our efforts and the good work we did). What is front and center in my mind is the fact that Fijians live nearly as long as we Americans do (72 as opposed to 78 years on average) while spending a fraction of their national dollars on health care that we do (2.6% of GNP as opposed to 16-17% in America). In truth, the discrepancy while enormous is actually bigger if you take into account the huge sums of money we spend on health in ways that are not even incorporated into the figures (drug development, device development, supplements, home health, etc). In point of fact, the Fijians where my team went spend almost no money on health as these people live so far away from the main center of Fiji that it is rare for them to EVER have any true healthcare. Shockingly, despite this amazing discrepancy, these people live well and live long. O

Perhaps the most striking thing about being in Fijian villages is not the poverty, not the simplicity, not the absence of modernity, but the absolute warmth and friendliness of each and every Fijian. Young and old, men and women, big or small, the Fijians exude warmth. The universal greeting of "Bula" is their hello but it implies much more than just a greeting; it conveys warm feelings and good wishes. That is just right off the bat before they have even met you. Walking through the villages, the Fijians peer out of their homes and always extend their greeting of Bula attached to their big, warm smiles. This is not the exception; it is the way. How amazing it feels to be immersed in such a world of openness and warmth. It changes you (at least it changed me). I felt a melting away of my exterior, my wall. I was not alone in this feeling. Our whole team felt it and loved it! It did not at all feel artificial or forced or because we were visitors or because we might give them

I just got back from a wonderful venture to Fiji. As part of the Loloma Foundation, I went on a combined medical/dental mission to the northern Yasawa island of Yangeta. Our team which was composed of 6 dentists (who were truly extraordinary), 7 doctors (1 pediatrician, 1 family practitioner, 3 internists, 2 medical residents training in internal medicine), a critical care and emergency nurse (RN), an OB-GYN nurse practitioner, an acupuncturist who also is a master in XiGong and Tai Chi, a Feldenkrais practitioner/massage therapist, and a devoted support team of 6 individuals who functioned as pharmacists, dental assistants and administrative/general support personnel. We were based on the island of Yangeta at a small resort called Navutu Stars. The dental team stayed on Yangeta and patients came via boats from neighboring islands to receive their care which varied from prevention and education to extractions and fillings. The medical team was mobile as we did not require equipment and