DMHC Enhances Its Subspecialty Expertise - 

Welcomes Professor Cheryl L. McNeil, MD

Clinical Neurologist

DMHC is proud to announce that neurology luminary Cheryl L. McNeil, M.D. will join our practice starting August 15th after serving for ten years on the teaching faculty of two world-class academic institutions.

Dr. McNeil was attracted to DMHC because of her passion for providing care to complex, underserved patients - the focus of DMHC's pioneering practice. "I want to work where I'm needed and appreciated," says McNeil. "I always thought my highest contribution would be in academia, but DMHC changed my perspective. It gives me the opportunity to take on new challenges while also achieving a better balance between professional and personal commitments - a goal that was particularly important to me at this point in my career," she admits. "I can even continue my teaching activities, thanks to the cooperative arrangement Dr. Alan Kronhaus, the CEO of my new practice, worked out with the Chair of my Department at UNC."

A Triangle native, Dr. McNeil did her undergraduate studies at UNC-Chapel Hill, then continued at Wake Forest University for medical school and her residency. Consistent with her zeal for scholarship, Dr. McNeil also completed a Neuro-Oncology Fellowship at the University of California, San Francisco. With this outstanding training and Board Certification in Neurology and Psychiatry, Dr. McNeil accepted a prestigious faculty appointment at Wake Forest University, where she directed the Outpatient Neurology Department.

After living in Winston-Salem for five years, Dr. McNeil decided it was time to come home. In 2006, she accepted a faculty appointment in the Department of Neurology at UNC-Chapel Hill, where she became heavily involved in teaching neuroscience to medical students and neuropathology to residents, while supervising clinical activity in the outpatient neurology clinic.

In recognition of her teaching accomplishments, Dr. McNeil was awarded the Hyman Battle Teaching Award and the Neurology Resident Teaching Award in 2010. When she announced her decision to join Doctors Making Housecalls, her Department Chair cajoled her into continuing her teaching activities by promoting her to Associate Clinical Professor. Dr. McNeil is delighted to be able to keep one foot in academia while spending the majority of her time seeing patients as the Neurology Consultant to DMHC's 23 primary care clinicians.

According to Dr. Kronhaus, "having Dr. McNeil on our clinical team will enhance our status as the nation's "gold standard" in home medical care. It will also improve our ability to bring the best medicine has to offer to our patient's in their own environment. By improving access to such high-quality care," Kronhaus continues, "we can function in a more proactive, prevention-oriented fashion, instead of reacting when a patient deteriorates."

Dr. Kronhaus contends that crisis-oriented care leads to unnecessary ER visits and hospitalizations, which are all-too-common these days. "There's a ton of evidence," Kronhaus contends, "that we serve our patients better by keeping them out of the hospital and emergency room. Unnecessary admissions not only drive up the cost of care, but also put patients at risk for untoward events," he says. "When we can keep patients living at home, on an even keel, everyone wins."

Dr. McNeil cherishes the time she spends with her husband and two young children at home as well, but also needs to be practicing medicine. "There's nothing more important to me than family, but I have to be taking care of patients to feel truly fulfilled."    

New Research Questions Accuracy of Office-Based Blood Pressure Readings

Writing in the Annals of Internal Medicine, Duke University researchers report that "white coat syndrome" is real and may lead to the overtreatment of hypertension in some individuals.  They define the syndrome as the temporary elevation of blood pressure caused by aggravations associated with the office or clinic experience itself -- like languishing in the waiting room, sitting in a cold exam room clad in a skimpy paper gown, or trying to grab enough time with an overworked physician.     

The report raises the perennial question of how best to measure blood pressure - an important question considering that 30% of the U.S. population is considered hypertensive, and hypertension is an eminently treatable condition.  Moreover, the consequences of under- or untreated hypertension account for billions in healthcare expenditures. 

If we can't agree on how to measure blood pressure (BP), we will all be in trouble when it comes to deciding what level of BP is abnormal and how aggressively to treat patients with high blood pressure. 

According to the article's principle investigator, Benjamin Powers, MD, "Blood pressure normally fluctuates from hour to hour, and from day to day . . . even knowing this, we were surprised to see how big the differences were between clinic and home readings."

Because hypertension is almost always asymptomatic, it generally goes unrecognized and untreated until discovered during a trip to the doctor's office for some other problem.  Therefore, office-based blood pressure measurements become the standard by which hypertension is defined.  However, this research suggests that overly aggressive treatment of the problem may be also be a problem if physicians rely on BP levels that are artificially elevated by the office environment.

This research "supports recent calls for increased use and reimbursement for home blood pressure monitoring," said Dr. Powers.  By shifting from clinic-based to home-based blood pressure monitoring, we could explore new practice models and "create new efficiencies in care."

Dr. Shohreh Taavoni, Chief Medical Officer of Doctors Making Housecalls, agrees with Dr. Powers, and suggests that patients would be better served in many ways if physicians cared for them at home.  "We get a more accurate picture of our patients when we see them at home" says Taavoni. "They're more at ease and forthcoming with information that is clinically valuable.  Once you become accustomed to seeing patients the way we do, it's hard to imagine practicing any other way."   

Concierge Practice:

What's Your Perspective?

 The Debate Continues

A recent Medscape article about Concierge Medicine deemed the practice model unjust.  The argument goes as follows:

There aren't enough primary care providers around to begin with. We have too many specialists, not enough generalists, and not enough primary care providers in the United States. If you take a significant number of them out of the pool available to every patient and make them available only to people who can pay additional fees, it results in a bigger workload for the rest of the providers who are doing primary care. If you allow providers to take the concierge route, the remaining primary care physicians are going to be burdened with more work and provide a lower quality of care.

Consequently, concierge practices foster a two-tiered system of care that is inherently unjust.  

How does this argument resonate with you? Many suggest that dramatic disparities in the quality of care and level of customer service provided by different healthcare organizations already exists.  Is concierge practice a legitimate, understandable solution to a broken system, or a way for doctors to avoid their full obligation to serve, and for the  privileged to buy their way to better service? 

Please let us know your thoughts on the blog area of our website.  DMHC provides all the benefits and advantages of concierge medicine, without an annual fee.  Our goal is to be as affordable as possible, but still financially viable.  If our unique practice model is not financially sustainable, we will not be around to help anyone. 

Physicians made a Faustian bargain when they agreed to accept government insurance.  In exchange for patient volume, we agreed to accept whatever the government decides to pay. Those payment decisions have forced physicians, and even mid-level practitioners, to opt for specialties that pay multiple times more than primary care. 

These days, it's not a matter of greed, it's a matter of survival.  Plumbers and electricians earn about as much as primary care physicians who have invested 11 years more in their education, and accumulate an average of $135,000 in debt by the time they start their first real job.  Over the past couple of decades, the cost of practicing medicine has dramatically increased, while the pay rate of primary care physicians has barely budged.   

So, those are some of the facts and a bit of the backdrop to the debate over the model. We are eager to hear what our patients, constituents, and friends of the practice have to say about concierge medicine.  We look forward to hearing from you.

Alan Kronhaus, M.D., CEO
Doctors Making Housecalls