In today’s episode, we explore our vision for modern primary care that prioritizes a holistic, patient-centric approach and addresses the unsustainable trajectory of the current healthcare system. The true meaning of a multidisciplinary approach: fostering trust and collaboration between primary care providers, specialists, and patients. We talk about overcoming the fragmentation and disconnection that plagues the current healthcare system. We start addressing the economic burden of healthcare costs, including the staggering statistic that over 50% of American bankruptcies are caused by healthcare expenses. Our conversation embodies our "for all" mission: ensuring equal access to quality care, regardless of financial status or insurance coverage. We want to eliminate the stigma associated with "unassigned" patients and provide compassionate care to all; advocating for a laser focus on reducing the total cost of care while improving quality and patient outcomes and embracing our disruptive mindset to challenge the status quo and drive meaningful change in the healthcare system.

00;00;00;00 - 00;00;29;23

Liam

Welcome to the One Health Modern Primary Care podcast. One health is a value based primary care platform that enhances the patient experience, improves the health of individuals and populations, and reduces medical costs with a laser focus on provider wellness and care for all. In today's episode, Doctor Shaarawy and Doctor Cook will discuss the true meaning of multidisciplinary care, which should foster trust and collaboration between primary care providers, specialists and patients.

00;00;29;25 - 00;00;36;22

Liam

This embodies our for all mission and ensures equal access to quality care. Let's get started.

00;00;36;24 - 00;01;00;20

Dr. Sharawy

Yeah, yeah. I mean, I think just to to expand on, you know, we don't want to not really explain when we say primary care specialists. What what that what that means. Okay. And, you know, I think David said it earlier. We're not the expert in every subject that's there. We have to rely on our specialty partners. you know, to take care of them.

00;01;00;20 - 00;01;26;19

Dr. Sharawy

But when we take a, when we talk about a multidisciplinary approach, you know, that's that's a term that's out there, that people can resonate with. Here's the real reality of that. It's it's multi dysfunctional approach. Okay. in, in today's world because the reality is it's it's what we how we define fragmented care. And I think it's really important for, you know, for folks that listen to this many people listen to it are going to resonate and understand it.

00;01;26;19 - 00;01;50;02

Dr. Sharawy

But but maybe the consumer, the patient that's out there to understand, what does it mean for me to have somebody that's my primary care doctor, that they know that they can trust, that will create a multidisciplinary approach. The multidisciplinary approach should start from the core, and that's that relationship between the primary care provider and the patient. No offense to the specialists.

00;01;50;05 - 00;02;12;10

Dr. Sharawy

Again, when we say this we're never doing that okay. But but that core trust relationship has has been built between the primary care provider, the primary care specialist and the patient that you're taking care of. Where else should it start and end from. So what we've got to do when we talk about multidisciplinary care is we've got to be at the forefront of that.

00;02;12;12 - 00;02;25;29

Dr. Sharawy

We're not the expert. We're not the one that's going to take the breast mass out. We're not going to do that. But we are the one that's taking to the forefront of the mind. Let's make sure that that patient doesn't feel like they're in a black hole. They haven't heard anything. You know? When am I going to see that specialist.

00;02;25;29 - 00;02;44;09

Dr. Sharawy

You know, I've got questions about that chemotherapy that they that they, they talked to me about. We've got to drive that care. it is what we're supposed to do. So it's not anything new. It is what we're supposed to do. And anybody that is trained in primary care knows that that's what they're supposed to do.

00;02;44;09 - 00;03;02;04

Dr. Sharawy

And by the way, that's what they want to do. We have created a system over the many, many years that has created brick walls and barriers to those things. Not any specific person's fault, okay, for doing that, but it's like anything else. You just look back and you say, well, what in the world have we created here, you know, what is this?

00;03;02;04 - 00;03;29;10

Dr. Sharawy

So, at One Health, you know, we tell our team this all the time. If not us, then who? Okay, it sounds like a daunting task, right? Maybe it is a daunting task. Okay, but we believe very, very strongly that if don't believe us. You know, Google it. You know, look at it that that that health care is on an unsustainable pathway.

00;03;29;12 - 00;03;46;

Dr. Sharawy

I'll tell you, as a physician and I know this guy next to me, believes the same thing. That's unacceptable. Okay. We we're not in this to glide through an unsustainable path. we're not there to just say, hey, you know what? I'm getting kind of old. You know, I got a few years left in me.

00;03;46;16 - 00;04;11;17

Dr. Sharawy

Let me just let it pass. you know, to to do that. Not a chance. Okay. Not a chance. What we've got to do is really, really push forward. This is part of why we want to have these conversations. Because we want to get the word out. And here's the thing. I'm very optimistic. And by nature, Doctor Cook is very optimistic.

00;04;11;19 - 00;04;46;03

Dr. Sharawy

We're going to continue to create the environments that are based on the core of taking care of the populations of the patients that we serve. And we're going to disrupt the other institutions within that that are doing great work. We're doing great work, but we've all got to be focused on change the environment. Does it take anybody to understand if people all over the place are describing health care's on an unsustainable path, then shame on us if we don't create solutions to turn it back to a sustainable path.

00;04;46;06 - 00;05;12;11

Dr. Sharawy

Okay, now that's how that's hard when you're in a disruptive. We like to call ourselves disruptive. we are disruptive. Okay. disruption is a word that if you look it up in the, in the dictionary so people will look at and say, man, disruption has a negative connotation to it. We're actually okay with that. Okay. If some people see this as, as negative because we're not you know, it's really about being very, very positive.

00;05;12;14 - 00;05;42;06

Dr. Sharawy

to disrupt in a way that doesn't knock over the work of doing things. Because unfortunately, in order to sustain, you got to do those things, but at the same time creates environments that you can impact change. And what we hope for is five years down the road, we look back and we say, wow, you know, through incremental success, through teaching by example, through learning from others, through bringing people together towards common purpose.

00;05;42;06 - 00;06;01;20

Dr. Sharawy

We say it all the time when when we took a leap of faith, and left, you know, an institution that, that, that certainly was trying to do the right thing. But we felt like in order for us to make an impact, we had to create environments where we had more autonomy for decision making and, and bring like minded providers and physicians together.

00;06;01;22 - 00;06;26;02

Dr. Sharawy

When we did that, we never did it to say, hey, listen, we're going to do this on our own and forget about everybody else. Not a chance to do that. But we have all got to get the payer, the health system, the patients, the population, the providers, the pharmacy, the government, everybody that's involved in trying to do the right thing to deliver great health care in this country.

00;06;26;02 - 00;06;43;28

Dr. Sharawy

We all got to get together towards common purpose. We've all got I mean, that's what David and I, you know, from the start when we when we did, we did we didn't it wasn't, it wasn't to create antagonism was create actually strengthen partnership to do that. So that's, that's probably a long winded way of saying.

00;06;43;29 - 00;07;16;16

Dr. Cook

I'll say it the way health care is now. It's not a system. It's it's different components. And what does that lead to? Well, that leads to the individual even even those that have great health care insurance going through a system that becomes expensive and duplicated testing and non connected, components. you know, I've seen many patients in office that were multi-disciplinary, a type patients who had seen functional medicine physicians, preventative physicians, wonderful people.

00;07;16;24 - 00;07;38;26

Dr. Cook

They had seen specialists of multitude of different ones. They came on with a sack full of supplements and medicines. And yet they they were still not where they needed to be. And they've just spent lots of money. They had the resources to spend that money. and then you ask this individual, you bring them down, you look at their whole self again.

00;07;38;26 - 00;07;58;17

Dr. Cook

I always say you're looking at the soul of an individual and you're treating their, their, physical being, but you're looking at their soul. And if you treat their physical being and their mental emotional health and their behavioral health as one unit, that's modern primary care. But is that, as I said, it takes all of us to bring that together.

00;07;58;17 - 00;08;28;10

Dr. Cook

And how does that fit into the finances of health care? Well, if if it's a just a transactional, multidisciplinary approach or we call it a medical home for a patient, yet it's just the medical home is a primary care based program disconnected from the specialty care that's that's not really transformational. That's transactional care. When we talk about modern primary care, the pillars of integration, and, specialty and facility connectedness are huge.

00;08;28;13 - 00;08;52;09

Dr. Cook

While we're with a health system, we felt it very important. We never wanted to leave the first system we were with. We feel it important to be a part of a health system. So you have the really the whole spectrum of care delivery, and you can affect it, no matter how difficult that may seem. But when you talk about the cost of care, you think about it, it again, you're going to the fact checked all these, but I'm going to get as close as I can.

00;08;52;11 - 00;09;26;17

Dr. Cook

Over 50% of American bankruptcies are caused by health care. Over 50% of American bankruptcies are caused by health care, the expense of health care, the loss of, of ability to to function in work. It's a complex but problematic issue. The cost of health care continues to go up. you know, I think Don Berwick himself, he has even said 30 years after he started this wonderful movement to create change in health care, that not a lot has changed.

00;09;26;17 - 00;09;51;16

Dr. Cook

00;09;51;19 - 00;10;19;27

Dr. Cook

We know that millions of Americans have no insurance in one of the richest countries in the world. And I think one of our core for all missions is that every human being deserves equal access to equal care. I'll stand by that forever. that that they must. And that there's many Americans that are underinsured and many Americans that have insurance have to make the decision between, buying groceries and paying their deductible to health care.

00;10;19;29 - 00;10;50;18

Dr. Cook

So what we've done is we've turned the the system into this economic machine that doesn't always focus on longevity, human experience and reduction in suffering, that sort of comes over to the side. And so as we look at the spend in health care and we look at how to make it a for all mission for health care, creating a real value in health care, lowering the health care spend, improving the quality is the way we're going to develop that for all.

00;10;50;20 - 00;11;05;21

Dr. Cook

And but you have to have the for all mission. Again, the for all mission has to be at the forefront. That means anybody that walks through your door, you're never looking at their insurance. You can't look at it until you go to do things for them. Then you have to be really cautious about, okay, is this gonna be really too expensive?

00;11;05;23 - 00;11;11;01

Dr. Cook

I'll get it done, but let me figure out a better way to do it. But you never judge them on how they can pay when they're coming in.

00;11;11;03 - 00;11;29;04

Dr. Sharawy

Yeah, I think it's in the core of all of us. You know that when, you know, when we went into medicine, when, you know, think about the sacred bubble of your residency that you're in, you would be ashamed if you thought that you would turn away somebody to the door. You know, they came in for care and do those things.

00;11;29;04 - 00;11;50;22

Dr. Sharawy

It's in the core of. It's our Hippocratic oath of what we believe in. And I'll just give a story about, you know, from OBGYN standpoint, kind of tied to the economics, you know, so so, you know, they're terms that we use in health care that that that segment populations and, and probably even segregate populations. And one of these terms is the word unassigned.

00;11;50;29 - 00;12;13;06

Dr. Sharawy

Okay. So you know from it let me explain it in basic terms because anybody listen to us should understand that. So let's say I'm an on call at the hospital as an Obstetrician, taking care of pregnant women as they come in, when somebody comes in the door and they're not attached to a provider or even crazier than that, they are attached rather than attached to me.

00;12;13;06 - 00;12;38;00

Dr. Sharawy

We label them as unassigned. Okay. I can tell you, in my 30 years of being in the business, there is a total negative connotation to that word and that patient honestly, subconsciously, and people don't mean it and that I'm not judging anybody, but they are judged when they walk into that, to that room. Now, what will happen, I'll give you an example, is I'm going to take an extreme example, but it's real.

00;12;38;03 - 00;12;57;15

Dr. Sharawy

You have somebody that has doesn't have the means to get in and get proper prenatal care. And let's say they're 28 weeks pregnant. They have twins and they come in to the hospital. What will happen is that unassigned patient routinely, whatever hospital we go to, whatever they came into the hospital for their care for that moment, and then they're just sent back out.

00;12;57;22 - 00;13;26;02

Dr. Sharawy

Okay. On the way. Here's what I'll maintain to anybody listening. Nobody's going to stop those babies from coming. Okay? That doesn't take a doctor to figure that out. Those babies are coming. Okay. And so the care will be given at some point in along that journey of that quote unquote, unassigned patient, bad things can happen. Okay. Now what does that do from an economic standpoint for that person that is quote unquote unassigned.

00;13;26;04 - 00;13;53;26

Dr. Sharawy

It increases costs exponentially. So the difference between creating care for that patient may be the difference between preventing and or not preventing an early delivery of twins that may sit in a hospital for months at a time and cost in the millions of dollars. So even that economic argument doesn't make sense. Okay. It doesn't make sense. So so so in and and I'm focus just for a moment on the economic argument because we should take care of them anyway.

00;13;53;26 - 00;14;13;21

Dr. Sharawy

So at one health the second and unassigned patient comes through the door, whether it's through our clinics, whether it's through the emergency room, whether it's through the hospital, whether it's a 28 week pregnancy twins, or it's a 65 year old, person that just crossed the border, they're assigned, okay. The second that they see us, they're assigned.

00;14;13;22 - 00;14;37;04

Dr. Sharawy

Now, we would hope that they want to continue to get care with us, but we're privileged to take care of them. And then to David's point, we'll work out all those social determinants. It's another word that's out in health care. Social determinants of care. the most important social determinant is seeing the patient okay. Access to care. Then let's figure out those things and we'll have to be judicious about it.

00;14;37;06 - 00;15;03;23

Dr. Sharawy

it should drive the care because the reality is you ought to take people to proper venues of care, whether they have insurance, no insurance over at short. That's the problem with health care, is that we take people to higher cost venues, almost on a subconscious level sometimes. So even for the person that comes in and hasn't had care established to the person that you've been here for 15 years and they might be a CEO of a company y'all take care of in the same way you ought to.

00;15;03;23 - 00;15;24;25

Dr. Sharawy

00;15;24;25 - 00;15;37;20

Dr. Sharawy

That's an amazing opportunity. People are doing it. Okay. I don't want to say like, we got this thing. We figured people are doing it, but everybody needs to do it. Have a laser focus on with duction and total cost of care. That's good business.

00;15;37;27 - 00;15;50;29

Liam

Thanks for listening. Please follow our Modern Primary Care podcast and visit us at One Health Modern Primary Care on YouTube, Facebook, Instagram, LinkedIn, TikTok and X.