Investing in a Healthy Lifestyle: Mary Lamb, M.D. | Episode 5

Confluence Financial Partners­­ – Investing in a Healthy Lifestyle: Mary Lamb, M.D. | Episode 5

Greg:    The best investment you can make in planning for your retirement is living your healthiest life. Imagine that. Right.

Greg:    This is Greg Weimer with Confluence Financial Partners and I have the privilege today to be with Dr. Mary Lamb, the owner and founder of Lamb Medical & Aesthetics. Welcome Mary.

Mary:    Thank you. Happy to be here.

Greg:    We are delighted you are here. So, Meredith, to start off, would you just give an overview of your model of care versus the typical family practice that people would be familiar with. You have personalized — comprehensive, personalized care. How would you describe that to someone?

Mary:    Yeah, so the way that I have the model set up is very different from insurance-based care. So, it’s called a direct care or concierge medicine. There’s a little bit of a nuance of a difference. But the way it works is that the patients, I treat many fewer patients. So, in a traditional practice I had over thousands of patients, over 3,000 patients. In this practice, you limit the patient population. Patients have a fee to be part of the practice where they pay a small amount, either monthly or yearly, to be part of the practice. For example, children are around $50 a month, adults around a hundred dollars a month. And different cities and different places vary in terms of that amount. But it’s a nominal fee to be part of the practice and what that gives you is unlimited access to your personal physician. So, everyone gets my cell phone. There’s HIPPA-compliant apps that we use to communicate. People can do virtual visits any time. There’s no limit in the number of visits that people can have. And they also participate in a comprehensive, executive physical exam every year. So, you get lots and lots of care, lots of access, lots of convenient, easy comprehensive care that is just undoable in the traditional practice.

Greg:    It is absolutely essential. You not only have a financial plan, but you also have a plan for your wellness. And just like financial planning, your advisor is your partner in your financial plan. It is essential also that you have a healthcare professional to be a partner in your wellness planning.

Mary:    If you don’t have your health, you can’t enjoy your wealth.

Greg:    Right.

Mary:    Health is the cornerstone of enjoying your life.

Greg:    Actually, we found a stat that confirms that. More than 80% of today’s retirees say good health is the most important ingredient for a happy retirement*. So, there it is. Right?

SOURCE:               *According to a Merrill Lynch study, more than 80% of today’s retirees say good health is the most important ingredient for a happy retirement. Imagine that.

Mary:    There it is.

Greg:    So, here’s the three things I thought we could talk about for the listeners. One is, you have a very different practice and I’ve experienced that firsthand at the age of 54. And understanding your practice more in the last year. It’s unique. And so, I thought we’d do a couple of things.

One, talk about the traditional practice. How you’re comprehensive, personalized care is absolutely different. Where we think the industry’s going on being a physician and family physicians. So, that’s one to wellness.

Two, and you’re right, it’s, you can’t maximize your life without wellness. So, what are some of the things we can do? There’s a lot we can’t control, but there are some things we can, we’ll talk about that.

And then diagnostics. I feel like the diagnostics and the tests that you can run, it’s really remarkable. And is there any innovation there? Which ones should we think about? Which ones shouldn’t we think about and where’s, where’s it going?

So, so first why don’t you just tell us the change of where you’ve been because you’ve had a lot of experience over your career and you’ve just made this change how long ago?

Mary:    Almost three years.

Greg:    So, what’s the difference, biggest difference between what you’re doing and the traditional family practice model?

Mary:    Yeah, I’ve done a little bit of it all, I think in primary care. So, I did, I did some teaching in a residency program and then I did urgent care. And then I tried to establish a comprehensive, progressive primary care practice. And in the traditional model, it’s just very difficult to give the type of care that I wanted to give. And it, it was apparent to me that in order to do that I needed to have a different model, different model of care, different way of actually engaging with patients. And so, this direct primary care or concierge payment model is different in that I don’t accept insurance. And in doing so it, it changes things dramatically. So, lots of my time, instead of being served by insurance companies and having to perform in their programs and provide their documentation, I can actually spend in patient care.

Greg:    So, like you just said to me, before we started, you just whispered, “Hey, did you get your stuff done?” I had a couple of things you needed me to get done medically. And so, it’s like, “Hey, did you get it done?” And I just think that interest that, and I remember what you said to me one of the times, “When you go to the hospital, the cardiologist may know about more about your heart, but when you go to the hospital, I know more about you.” So, so you can be the quarterback, which is interesting. That’s what we talk about, being the quarterback for our clients with their accountant and their attorney, their attorneys know a lot more about estate planning than we do. We can be the quarterback because we understand your family and what you’re trying to accomplish. And that’s what, in our family we’ve really been able to see.

Is that the new frontier? Do you think that’s the new trend? What you’re doing?

Mary:    Well, the, the medical system is broken. I think we can all agree about that. And the fix is not easy. I think that’s also the issue, but the big players are the insurance companies. They really do dictate so much of the care that, that we receive. And so, this whole direct primary care movement is, is a backlash against that.

Greg:    Is it a movement?

Mary:    It is.

Greg:    I still bring it up to people, and they are like “what?”

Mary:    Yeah, most people in smaller cities don’t know what it is, but larger cities they’re quite prevalent. So, New York, DC, especially Florida, there, there are several practices like these.

WHO:   And I’ve mentioned like what it costs typically around here for that versus other cities, and the delta’s gigantic. So, it feels like in Pittsburgh it’s still relatively new,

Mary:    Right, it is. You know, so for example, $50 a month for kids, $100 a month for young adults, $150 a month for older adults. So, it’s pretty affordable for the service that you get.

Greg:    It’s an entirely different service model. I mean it feels like, I mean the days of sitting in a waiting room for two hours with a bunch of other people, who could be germy.

Mary:    Right.

Greg:    To wait around and it just doesn’t feel comfortable. So, this really is different.

How does the single payer solution with insurance? How does this effect the typical patient and the care they’re going to receive from an ordinarily family practice?

Mary:    I think the difference is that you know that the, we’re in a traditional system, you’re required to see a certain number of patients in order to meet overhead or in order to meet insurance guidelines. And so, you really have about five minutes with patients, seeing 30 patients a day and trying to—

Greg:    So, wait, how many patients do you see a day?

Mary:    30.

Greg:    30?

Mary:    30, yeah. Most primary care doctors do between 25 and 30 a day. Yeah.

Greg:    So how much time can you prep going in? She’s just like read the chart you’re going in.

Mary:    I would try and get up very early in the morning and try to go through everybody’s chart and see what they need and do a lot of pre-visit planning just because you don’t have so much time during the visit. So, I tried to go in there knowing the plan and knowing what to do. But it’s the follow through and the details and the quarterbacking, talking to other doctors, arranging tests, making sure the patient knows where to go, what to do, all of that stuff just gets lost.

Greg:    How do you do that for 30 patients a day?

Mary:    Well that was it, you don’t.

Greg:    No, in that world.

Mary:    You don’t.

Greg:    But that’s the world, right? The new frontier of what you’re doing is different. But that’s the world.

Mary:    And that’s why there’s, no news as good news. That’s why there’s, here call this and you, you arrange all your testing. That’s why there’s a lot less follow through and support for the patient going through difficult things or going through diagnostic workup for something that’s important. So, the difference is, you know, in my practice I can, I can lead all those things. I can really guide the patient and then I can also see the patient in, in all avenues. I can do home visits if they need it. I do that for hospice patients. It’s one of the most meaningful things that I do. I haven’t been able to do that for years.

Greg:    Kid calls us from college and says like, “Hey, what do I do?” I say, “Skype Doctor Lamb.” Done!

Mary:    Right? There’s my cell phone, there’s virtual, there’s this, you text, you can call — you can actually get me for the needs that you have.

Greg:    So how many patients would you see in day?

Mary:    So now, I see approximately, anywhere from about 10 to 15, so half.

Greg:    Half.

Mary:    But I spend so much more time, like my time allotment is better. My follow-up is better. I can, I take time, intersperse that I can coordinate care.

Greg:    So that’s where our worlds are different. Like if I, if I would have three meetings a day — now we’re on the phone a lot. We’re doing research, we’re doing portfolio management. But like three’s like, that’s like about it.

Mary:    That’s a lot.

Greg:    Yeah. Just for like pre-work, follow up. Absolutely. It ends up being a lot. So now the, so the single payer though, is that going, I mean, does that help the situation of a typical family practice? Does it hurt?

Mary:    You mean you mean if somebody has insurance or—

Greg:    No, if we go to single payer. If there’s one insurance company owned by the government in the United States of America.

Mary:    Oh gosh. Well, there’s other countries doing that, right? And usually the care is just, is not the same for sick care. So, in the U.S. we’re very good at taking care of people who have illnesses. Right. We have great testing. We have great, we have great services, we have great treatment for very ill people. We don’t have great preventative care. That’s our, that’s our weakness. And so, some of those single-payer, the national health care systems, they’re very good at preventative care. But boy, if you get something bad, it’s not good.

Greg:    It’s interesting the folks that rely on insurance, I know some other family physicians and when I hear them talk about, and I watch them talk about their practice, some of them are not enjoying it as much as they should. They’re brilliant people. You don’t get to be where you are. Right. UVA, Princeton, you don’t get to where you are unless you’re brilliant. And then you get there and it’s not awesome. But then I see you talk about your practice and your face lights up and what you’re doing and it’s like really fun. Right. And what did I say to you? I said to you a couple of weeks ago, I said, what’s the biggest difference? So, what’d you say? Like freedom or something like that. What’d you say?

Mary:    Freedom to take care of people the way I think they deserve to be taken care of. And I did not have that freedom before, someone else told me how to take care of people. And I I’ve gone my whole life training, learning how to take care of people. And if you can’t join them and you can’t take care of the whole person and you can’t do it in the way that you feel is right, it doesn’t sit well morally with you.

Greg:    So, what you were saying is, if I’m not putting words in your mouth, you get to decide what’s right for your patient, not an insurance company from a faraway land.

Mary:    The patient and I get to decide. Because I have the time to actually talk with them about it. Right? So that, so it’s a shared decision making. It’s not like, this is what you need to do, because I’ve got 30 seconds to talk to you about them, right? It’s, it’s really about, Hey, what’s important to you? This is what I see. Let’s make some decisions together.

Greg:    Well, God willing, that becomes not only the new frontier, but the new standard.

Mary:    It would be great if it takes off.

Greg:    Wouldn’t it be great?

Mary:    There’s a lot of roadblocks against it, but, yeah.

Greg:    We’ll see. So, let’s go to the second — people want to maximize their life and the statistic I shared, that 80% of today’s retirees say good health is the most important thing for happy retirement. You know, we think about that a lot. If we just help people with their money, but then when they get to this magical time, which I think there’s a risk of waiting so much for retirement, you don’t enjoy your life, but that’s a different issue. But if someone gets to be 62 or 65 and retires and all of a sudden thinks they’re going to have fun and then they just don’t have the energy or the health to enjoy that. Let’s talk a little bit about wellness because you said something to me. I said, what’s the biggest thing? And what did you say? Like the middle years, if you could repeat that. The middle years of one’s life?

Mary:    Yeah, the middle years of one’s life, are, I think, are the most neglected in terms of their health. Because they’re so busy, they’re busy with their careers, they’re busy with kids, they’re busy with their families, they’re sandwiched generation of elderly parents. There’s so many demands on their time that they don’t have time to take care of themselves.

Greg:    You’re saying middle age, like—

Mary:    Gosh, 30 to 50, 30 to 55.

Greg:    Okay. So, I don’t need to take care of my health anymore. I’m 54. That ship has sailed. I’m actually wonderful. So, let’s go through a couple of things because, I know, I think people try, right? Right. Like this new diet. There’s the — I may mispronounce them — but there’s like the “whole 30,” the “Quito,” eat fruit, don’t eat fruit…

Mary:    Yeah, right.

Greg:    Is any of that sustainable? When you say things that control is die, a big part of it?

Mary:    Oh my gosh. So that, you know, the tenets of wellness really are, the habits that you create every day. You know? So, things like, having a regular schedule, things like, making sure you get adequate sleep. Things like, eating a healthy, well-balanced diet, things like, trying to fit in exercise as much as you can, you know, whenever you should.

Greg:    Meditation, is that something—

Mary:    Sure, well that, in my mind, that encompassing stress-relief so some kind of stress techniques to make sure that your stress level is controlled in a way that’s healthy, that isn’t in a way that’s not abusing drugs or alcohol or tobacco. It’s, it’s more meditation, exercise, you know, support with friends, time with family, things like that. Getting away from work and balancing your life in a way that, yeah, that helps you guide—

Greg:    What do you think of the diet stuff?

Mary:    So, some of the diet stuff is very faddy. Yeah, for sure. And I think it helps people focus on their diet again and focus on, on ways to lose weight. But a lot of it isn’t sustainable, but it brings it to the forefront of people’s minds. So, if they’re paying attention, they’re usually trying to improve their health. You really get in trouble — most people — when they’re not paying attention at all, and they’re just not watching portions and they’re not really making good choices because they’re busy and they, you know, frankly don’t have time to deal with it or don’t have the right resources in place to make sure they’re eating that way. So, I think it has a place in helping people. But gosh, for the long haul, I usually don’t recommend it. I, I definitely am more of a moderate approach, you know—

Greg:    And some of it’s confusing and some of it feels conflicting.

Mary:    It is. And, and some of it you just plain don’t like—

Greg:    Yeah. Like we hired a nutritionist, she’s like, “Don’t eat fruit.” I’m like, “Fruit! Can we not have an apple?”

Mary:    It’s about as close to nature as you get!

Greg:    I thought that’d be a good thing.

Mary:    Right.

Greg:    She’s wonderful by the way.

Mary:    I’m much more about moderation. I think people need to, you know, tracking tools, things on your phones now are very interesting. You can really gain a lot of information just by tracking what you’re eating and how many calories you’re eating and what food groups you’re missing. So, I do that. I sit down with patients and look over those things and try to find some strategies where they can actually reach their health goals. So, there’s lots of—

Greg:    What about water? Like, do you drink a lot of water? I hear conflicting information about that also.

Mary:    Water is important. I think people don’t, they under-drink because your thirst mechanism isn’t quite there in terms of telling you how much you need.

Greg:    Yes. I heard we were in the desert once and, and the person was like, you know it was a tennis thing — I don’t play tennis but, that happened to be a tennis thing. He said, “By the time you’re thirsty, it’s too late.”

Mary:    Right. So, your thirst is just a delayed and not really adequate measure for you. Especially as we age, it gets worse.

Greg:    So how many ounces of water a day? People say a hundred. That’s like a lot. A hundred ounces of beer is easier. Hundred ounces of water, somehow—

Mary:    If you had a hundred ounces of beer, you gotta do a hundred ounces of water you won’t get out of the bathroom if you’re doing that.

So, anything dehydrating, you’ve got drink something hydrating, right? And so, people think, Oh, if I’m drinking soda, if I’m drinking coffee, if I’m drinking something, then then that’s going to replenish my needs. It’s not.

Greg:    So, like if you’re drinking coffee in the morning, you have three cups of coffee, go coffee, water, coffee, water. Is that right?

Mary:    Yeah.

Greg:    Or if you’re out and you’re having dinner and you’re with your spouse and you’re having a mixed drink or glass of wine, have water also. Make sure you drink the water.

Mary:    Definitely. Yeah.

Greg:    Yeah. I do feel better when, as you and I both sit here with a glass of water. I do feel better, right when I drink water. And we actually read some statistics on, on alertness and productivity. So, we bought everybody in the firm these Yetis and we have them all drinking water and how many, how many ounces a day. And at least for me, I hope for everybody else in the firm, it was really, really helpful.

What’s the one, what’s the—

Mary:    Helps people feel better for sure.

Greg:    Then when you get used to it, you start craving water.

Mary:    Yeah! You’re more like, oh, I need it. And I think it helps with hunger. I think it helps fill people up, I think it helps in a lot of ways.

Greg:    Okay, so there’s a takeaway for the listeners. Drink water.

What’s the other big one you mentioned? Another big one. And I’ll say see if you say the same thing, if not, we have two more. What’s the biggest thing people could do?

Mary:    In terms of their, in terms of health?

Greg:    Their health.

Mary:    I think really paying attention to those years where they neglect it, you know, or go to the doctor, make sure you’re getting your blood pressure checked, make sure your vital signs are in check. So, your BMI isn’t too high. Yeah. Making sure you’re getting your screenings that are age appropriate. All that stuff is so important just to pick up things that we can treat quickly.

Greg:    So that’s very close to what you said to me. You said, “Get a physical.” And I’m sure there’s people listening right now, by the way, you’re very kind. We don’t like going to see you.

Mary:    I get that every day.

WHO:   So, going to see your doctor, it’s not, I mean it’s just, not— Now yours is a more pleasant experience given the environment —

Mary:    Yeah, we try to create a nice experience.

Greg:    —you wear a robe; you think you’re at Nemacolin. It’s all nice. You’ve got great music, but it’s still going to see a doctor. So, in fact, I said to my wife’s grandfather, I said — he died at 90 some years old — and I remember saying to him, “What’s the key to living that long?” He used some curse words, so I’ll take those out. He said, “Don’t go to a doctor.” Because they’ll find something. I’ll go find something.

Mary:    He rolled the dice and got lucky.

WHO:   But that’s it, right? So, how often do you suggest someone comes in and gets a physical?

Mary:    For my practice I do yearly, there’s so much that can happen in the span of a year in someone’s life that I think it behooves them to really talk with me and really go through how are they’re doing, things that happened, changes in their health status. I have so many questions I always like to ask, you know, there’s so many—

Greg:    That’s one of the things I appreciate about your practice in that you get paid whether we come in or not.

Mary:    Yeah.

Greg:    And you’ll get the email. Where are you for your physical, right?

Mary:    Yeah.

Greg:    And I mean it’s a lot of other good information on raising teenagers or you know, or if something’s going on in the community with, you know, a virus or something, you do a great job of keeping us up to speed. But the annual physical is something that so many people don’t — In fact, what we’re thinking about doing, what we want to do, is actually, in the next 12 months, give people bonuses in our firm, if they get their physicals!

Mary:    A lot of employers are doing that because they recognize there’s value in that.

Greg:    We want healthy associates that aren’t worrying about things or having nagging health issues. Do you see a lot of folks that go — I’m just the people listening to this, I bet someone’s like, “Uh-oh, I drink water, but I better go get a physical.” But it’s true. Right? Do you see a lot of people when they first come to your practice?

Mary:    Oh my gosh, and they haven’t been seen by doctor for years.

Greg:    I was one, I don’t know if you remember that. I was one and you looked at my chart and you’re like, where? Like what? Like what? You went off the radar.

So be moderate. Be careful in your middle years. In your middle years. it’s probably true that we still feel like we’re going to live forever.

Mary:    You have that mentality, yes.

Greg:    So, we still felt like we’re going to live forever. And so you just probably come a little less when you’re younger, maybe you’re more active and then when you get older, you become more aware of your mortality and then in the middle and you’re right, you’re, busy and you’re like, I’m gonna live forever. I got 30 more years now, I don’t have to worry about it. And then you get to be 60 years old and it’s too late.

Mary:    It’s too late.

Greg:    Unfortunately, as we’ve talked about before, there’s a lot of things you can’t control.

Mary:    Right.

Greg:    And that’s very unfortunate, but there are things we can control, so thank you for that information. The last thing I wanted to touch on is innovation and diagnostics. Yeah, I mean, you said when we were talking, you said, we should talk about cancer markers. And I’m like, or tumor markers. That’s right. No, no, no, no, no, no, no, no, no, no, no, no. We’re not talking about that. But just want to explain some of the new diagnostics and the benefit?

Mary:    And there’s some places, it’s interesting. It’s a catch 22, sometimes. There’s some places that will do, you know, full body MRI or full body CT scan. We have the capability of doing those kinds of things and there’s people that offer it at just, you know, pay out of pocket cost. Sometimes it just runs into some trouble. If you find some things that really aren’t that important in terms of your health and your future, it can lead you down a path of emotional turmoil. As you’re looking at those things. The body makes all kinds of benign things, cysts, lesions, things that aren’t really concerning. And so sometimes doing a lot of testing can be a problem. Other times there’s incredible value, valuable information that you can find. So, if you do tumor markers and they’re elevated, it just allows you to look at that area much more carefully and see if you can find a cancer before it’s spread, before it’s more of a problem.

We can treat cancer in its early stages very well and very easily. It’s always the later stages that’s the problem. So, we’re constantly looking for things to screen the population in order to find a cancer at a time where you can treat it. And that’s why it’s so important to get things like your mammogram and a colonoscopy. Prostate cancer screening is still controversial —

Greg:    Yeah, I remember you saying that.

Mary:    But yeah, but there’s things that we can do to look and see if people are at risk for the most common cancers. The thing I think that’s the most interesting recent development has been screening the genome. Just, just sequencing the genome. So, there’s all this genetic testing, there’s even genetic testing for cancer now. So, if someone is diagnosed with a cancer, treatment is actually based on the biology of the tumor and the genetics and immunology of the tumor. It never used to be.

So that’s a whole new advance that’s fascinating. But when you get your genome sequenced yourself, you can find out all kinds of information, things that you’re at risk for, things that may be troubling to hear. So, it’s a good idea to have a good relationship with your physician who can go through those kinds of things and watch out and come up with a plan for you. How do you, how do you deal with that information over time? You know, and what do you need to do in terms of follow up? The other thing that some of these companies do is once your, once your genome is sequenced, they will go back with new advances and new things that they find and re-sequence those people or re-test those people against a new mutation or some kind of disease that they uncover to see if they have it. So, I just got notified by a company just last week that a patient of mine was positive for a new genetic sequence that they didn’t know about.

Greg:    So, is that the thing that’s going to change medicine? Because that’s what I hear, right? The sequencing of the human genome. So, when I was over at Children’s Hospital, you know, I’m involved over there. And so, I had the privilege of being in the lab and they were talking about the advancements in treatment and the new standard of care based on being able to sequence the human genome. And I will get the numbers wrong, but I think 10 years to sequence once genome was tens and tens of millions of dollars and it took months and months, now it’s a thousand over the weekend.

Mary:    Right.

Greg:    Or it’s, it’s or hundreds over the weekend. That’s how much.

Mary:    Yeah.

Greg:    So, when people say like medicine’s changing like, right now, right?

Mary:    Right now, it’s changing absolutely.

Greg:    It’s right now. So, I guess the good news is if someone is diagnosed with something as you’re suggesting, there’s hope on the way.

Mary:    Oh, for sure. Yeah. And there’s so much you can do in terms of personalized medicine too, again, I feel blessed to be practicing medicine this way because I can practice really personalized medicine. It doesn’t have to be just population screening, which is what insurance does and what the traditional model does. It’s really about you and about what your risks are, what your needs are, and how I can best keep you functioning and living your best life.

Greg:    Like, like for example, just as a quick example, I mean, I know you were telling me about an blood test that actually you can do and it’s not 100% by any means, but it actually says, it’ll actually inform you on which foods are likely to agree with you and which ones aren’t.

Mary:    Right. Yeah, yeah. So, there’s a newer test that looks at inflammation rate based on the foods that you eat. So, it’s, it’s different than an allergy. So, there’s another other blood tests that can test for allergens in the blood. So that’s a true IgE-mediated sort of allergy specific test. This one is inflammatory based. So, you can measure inflammation in someone’s body, in someone’s bloodstream when they’re exposed to certain foods. And it’s really fascinating. I’ve had some real breakthroughs of it.

WHO:   So, I think it’s, it’s like, it gives you, and it’s just simple, right? It’s like, here’s the red foods, here’s your yellow foods, here’s the green foods. My red food was a banana.

Mary:    Yeah.

Greg:    Like if I had had an upset stomach, I would have ate a banana. And like that’s the one thing that not so good.

So anyhow, Mary, thank you so much. As always, wealth of information. I absolutely love your passion for wellness, your passion for creating a new standard of personalized care. So, thank you so much for your time. We truly do appreciate it. Thank you so much for having me. Appreciate being here.

Greg:    Thanks for listening. If you’d like to hear other subject matters that may be of interest to you, please check us at ConfluenceFP.com/podcast.