On Doctoring for Doctor’s Day 
A poem by Dr Brie
We lean on each other
In a silent life raft
Of support. It wasn’t always that way.
There was a time we competed-to get into school, to take the MCAT, to get into residency.
Then there was intern year, we bonded.
Everyone was still a little afraid they knew less than everyone else.
Until you realized at one point, you really didn’t know anything yet. Nor did any one.
Yes wide eyed - residency at once blew your mid, beat you down and built you up.
By the end you had some true friends.
You realized, we are in this together.
Suddenly in the washing machine of doctoring you got out “on your own” and got all mixed up again.
Nervous to make independent decisions, looking things up constantly and calling friends, teachers, mentors.
Mentors, you know who they are. The doctors that made you feel like, “Yes, that is my dream, that is who I want to be one day.”
You hung on to those ones.
One day you turn around and you realize, you don’t look things up as much anymore. You know a lot in a way that is a deep knowing, like driving home the same way every time and easily moving to miss something new in the same familiarity of the road.
You enjoy challenging cases, new people, mysteries (not like COVID), new treatments, new ways of looking at things you were taught.
You might not call your friends that often anymore, because life in medicine is busy. You don’t need to reach out all the time. When you need them, your life raft of friends, colleagues and mentors is there.
Never have we needed each other more. Never in my career in medicine have I had my heart silently break for my doctoring family day after day. I read your posts, hear your truth and echo your angst - it hurts in my heart too.
I love that we love what we do. Even if we hate parts of it. Rise up and fight back when the system tries to break you again, you are too strong for that now. Use your voice, your integrity and your intellect to ask for what you need over and over again (PPE PPE PPE).
Let’s tie our silent life rafts together, lift each other up, keep each other safe. Together yet apart. May we take a deep breath, close our eyes and hope this chapter ends really really soon.
Happy Doctor’s Day (3/30/20)
#InThisTogether
💜Dr Brie

​Check out or share Dr Brie's Learning Laboratory Video #2:
Checking your temperature at home.  
Featuring Zack and Fiona Seefeldt,
budding actor and actress in doctor-kid home schooling efforts.  

DOPC has been offering TELEHEALTH and phone visits for two weeks now and we are in the groove with it. We can now send you a link to log on to a video visit directly to our Cerbo medical record system. No downloaded apps or programs required! (If you got the Spruce App last week, you can delete it! Times change quickly these days!
Remember to visit our Members Page (it got a face-lift) to access all of your membership benefits including:

• CERBO PORTAL: 
  • Send a secure, non urgent message in "Secure Messages"
  • Request a refill under "My Medications"
  • Update your pharmacy in "My Pharmacies"
  • Schedule a Telehealth or phone visit! 
    • Scheduling is under "My Appointments", all listed appointments are phone visits but we'll invite you to a video visit if it feels appropriate for you want to discuss!  Be sure to let us know what your visit is regarding when you are scheduling
  • You can also fill out Questionnaires if you have concerns 
    • If you are feeling depressed and anxious and you aren't sure if it is a "normal" reaction or something that needs our help, fill out some of the mood questionnaires
    • If you are worried about COVID-19 symptoms, fill out our COVID questionnaire and we'll take it from there
• GIVING TREE SCHOLARSHIPS:
  • Are you struggling financially as a result of this COVID-19 pandemic? We have received donations that allow us to reduce your membership to $35/month for the next three months. Please click here to apply
  • Would you like to make a one-time or on-going donation to our Giving Tree Scholarship fund? Email our office manager - If you have already donated, THANK YOU SO MUCH!

​You have probably already heard from Meghan. Maybe you got to meet her! Meghan is an RN, who will be a Nurse Practitioner in April, and is currently working with us under Dr Brie's direct supervision. She was with us Dec-Feb as a NP student and her talent far exceeded her student status. So we hired her. Why?

First, Meghan is smart!
Second, Meghan is experienced! She has been working as a nurse for 10 years, 8 years in emergency room (including currently). Meghan is seeing COVID-19 from all angles right now. 
 
We are happy to have her on our team!

You have not met Chris, but soon you will! Chris was hired just before COVID-19 to help us have even better customer service at DOPC. You might have noticed our front desk has also been our manager? And our medical assistant has also answered your messages? Chris is our new dedicated Communications Representative. Why? 

First, we know people like it when a human answers the phone.
Second, we hired Chris because she was Dr Brie's clinic manager for 4 years with HealthOne. Chris has decades of clinical and administrative experience.
Third, you could not get a friendlier, more capable person to manage phones and messages. 
 
We hope you love having her on our team as much as we do.

GOOD NEWS ON COVID: Treatment options on the horizon.  Right now, many of these are experimental and all are reserved for hospitalized patients or those with severe disease.  We wanted to pass along the good news that science is doing its best to catch this thing.  Want to read along?  Check it out: Actermra Rx; Hydroxychloroquine and Azithromycin; Perhaps-Don't take Ibuprofen, here's why

Other resources: 
This Doctor Gounder knows what she is talking about.  Here's her podcast. 
Warning: She is an infectious disease specialist.  
Need to go the relaxing route instead? Try getting some Headspace
Feel torn between anxiety and complacency? Read this
 ​

COVID -19 INFORMATION 
DR BRIE'S RECOMMENDATIONS TO KEEP YOU
AND YOUR WORK SPACE HEALTHY
​
AS YOU KNOW, WE ARE TAKING COVID-19 VERY SERIOUSLY AT DOPC.  HERE ARE SOME CONSERVATIVE GUIDELINES YOU ARE WELCOME TO SHARE.  WE STRONGLY ENCOURAGE OUR SMALL BUSINESS OWNERS TO READ, DISTRIBUTE AND ENACT THESE GUIDELINES. 

*Any employee with a FEVER over 100.4 (a true fever) should not be allowed to return to work until 14 days after the LAST day of fever. 
*Any employee with a sick contact with a FEVER or someone that has tested positive should be asked to work from home or remain with limited access to other employees until 10-14 days have passed with no symptoms.  
*Any employee who has traveled to areas with dense infection (certainly this list will change as things evolve but currently - international travel, California, Washington, New York, Colorado counties with high risk - ie Pitkin County) should work from home if possible until 10-14 days have passed with no symptoms.  
*Company travel should be restricted - you can not ask your employees to refrain from travel in their own time but you can ask them not to return to working among others after elective travel.  Consider a shared work space where all employees who have traveled work together instead of amongst their non traveling co workers upon their return if working from home is not an option.  
*If the employee has a public facing job try cross training for employees to transition out of the public facing role for the 10-14 day period above if there is any concern about exposure.  This way, your high risk employees do not risk spreading the virus if they are in a period of asymptomatic viral shedding.  
*If you have at risk employees - those that may be most impacted by infection - immunocompromised, those with chronic health concerns such as lung disease, asthma, diabetes, heart disease, or those over 60 - ask them to work from home if possible until the risk passes or create safe spaces within your office for these employees.  Spaces that have extra hand sanitizer and wipes.  Spaces where the door handles, desks and shared surfaces are wiped down several times day with sanitizing solution or wipes.  
*Get OCD about shared space cleanliness - water coolers, food areas, surfaces all should have a cleaning solution or wipes ready and used regularly to keep your work place clean.  Be sure soap is stocked in the bathrooms and doesn’t run out.  It's the little things. 

WHAT TO LOOK FOR and HOW TO GET HELP:
*IF you have an employee that is sick FIRST have them self quarantine at home (see CDC guidelines on this at home) 
*Understand that the most concerning symptoms are FEVER, shortness of breath, trouble breathing and  cough. If you are worried about your employee and feel they need medical care first have them CALL their doctor.  If they do not have a doctor, have them call our office and ask for our expedited intake track (phone call service) and we will see if we can connect your employee to evaluation, services and testing as indicated.  

PREVENTION (chemical details informed by my chemical engineer husband):
*Hand washing - soap is the best option with 20 seconds of washing.  Any soap will work, its the soap function (bubbles!) that work “antibacterial” not needed as this is a virus. Hand sanitizer is ok (if >70%), but it works best for killing bacteria but unfortunately, its antiviral effect is not as strong.  
*Hard surfaces - diluted bleach solutions or wipes are the best.  Bleach is highly effective and and cheap.  Other disinfectants like hydrogen peroxide can work.  
*Rest, fruits and veges, hydration, exercise
*Vitamin D & C, Zinc, N-Acetyl-Cysteine (an amino acid that improves your antioxidant glutathione) *don’t hold me to the FDA on these health claims.  Anything that builds your HEALTH should help! 

Resources: 
https://www.cdc.gov/coronavirus/2019-ncov/cases-in-us.html

https://www.colorado.gov/pacific/cdphe/2019-novel-coronavirus

I LOVE WINTER. 
THIS YEAR, I AM READY FOR SPRING!
HERE IS FIONA, MY DAUGHTER CELEBRATING SPRING SKIING. 
SADLY, THIS YEAR, THE END OF GERM SEASON ISN'T IN SIGHT, YET.

There is a lot of hype, a lot of fear, some misinformation and some complacency all mixed together around Coronavirus or COVID-19. 
We want you to know...
You are in the right place with your DOPC membership. 
Here is why:  
If you have concerns about your health, we can do a phone visit.  
We can even do virtual FaceTime like visits if you need it!
You have us here, in your corner, and you can call any time. 
Just remember: press option one to leave an urgent message.
We hired another helper, she'll be answering the phone during business hours! 
We will introduce you to Chris soon, she is lovely.
If you want to add a loved one or friend under our proactive healthcare umbrella, now is the time.
We have developed a new, expedited on-boarding process. 
To add someone, just call or text and we will get started.  

We are proactive about HEALTH.  
We are here to serve in times of need.

We will continue to provide good information, resources and updates as the COVID-19 situation evolves.  See below for our current guidelines. 

NEW: APPOINTMENT CONFIRMATION
Over the coming weeks, due to the current concerns of COVID-19, we are asking every patient on the schedule to answer questions prior to coming in for an appointment.  Be aware you will receive the following by text before your visit:

1. Have you had a fever of 100.4 or more in the last two weeks?
2. Have you traveled within the last two weeks? Where?
3. Have you had exposure to a person with a known case of COVID-19?

If the reason for your visit can be addressed in a phone visit and you'd prefer to convert to that, please let us know.
 
What you can do to prepare for Coronavirus - for individuals and families
(COVID-19) 

At this time, DOPC does not have the ability to test COVID -19.  However, we can arrange for YOU to be tested and send an order if you meet criteria for testing.  This criteria changes daily.

We have made an internal protocol to triage all patients by phone or virtual visit - please protect our staff and our families by NOT coming to the office during or within two weeks of a fever over 100.4. 

CONTACT US BEFORE YOU GO ANYWHERE FOR COVID TESTING, its best we are in touch first if you are concerned.  

**SYMPTOMS** What to look for 
Fever over 100.4 GET A THERMOMETER. 
Shortness of breath and cough GET A PULSE OXIMETER ON AMAZON IF YOU CAN, VITAL SIGNS ARE VITAL.  
Difficulty breathing - Not anxiety related, the "can't catch your breath" kind. 
Worsening of symptoms at day 5 or 11.  THIS ILLNESS GETS WORSE BEFORE IT GETS BETTER.  REACH OUT IF YOU ARE NOT IMPROVING.
No symptoms but exposure to a KNOWN case of COVID- 19 within 2 weeks
If you get sick 
HYDRATE.  HAVE VITAMIN C, PEDIALYTE, GATORAGE AT HOME.
Tylenol and Ibuprofen (alternate every 3-4 hours) to control symptoms and your inflammatory reaction. 
STAY HOME FIRST.  CALL SECOND.  
Monitor for worsening symptoms - pulse over 110, uncontrolled fever with medication (over 102), Shortness of breath and difficulty breathing. 
This virus can present in many ways.  The concerning symptoms for progression to severe disease is a lower respiratory tract infection (LUNGS) primarily.  It CAN start as upper respiratory symptoms (sinus) and <10% of people will have nausea/vomiting and diarrhea.  MOST have fever from the outset, unfortunately not always. 
REMEMBER THIS: The biggest reason people get really sick is from the difficulty breathing so that is the symptom to keep track of.  Monitor for worsening around a week into the illness.

How to avoid it
*Hand washing - soap is the best option with 20 seconds of washing.  Any soap will work, its the soap function (bubbles!) that work “antibacterial” not needed as this is a virus. Hand sanitizer is ok (if >70%), but it works best for killing bacteria but unfortunately, its antiviral effect is not as strong.  
*Hard surfaces - diluted bleach solutions or wipes are the best.  Bleach is highly effective and and cheap.  Other disinfectants like hydrogen peroxide can work.  

*Avoid health care facilities for any non urgent concerns 
*Avoid public spaces, crowds and airports when not necessary 
HAVE ON HAND: Pulse oximeter, Thermometer, Acetaminophen, Ibuprofen, hand sanitizer or rubbing alcohol or good old fashioned soap!
Boost your immunity 
Fruits and Veges (oranges and blueberry are in season, yum)
Sleep 
Hydrate 
Exercise 
We have stocked a large selection of vitamins - if you want to pick something up to boost your immunity let us know in the new portal and we'll review what is right for you.  Vitamins we like for immune boosting: vitamin D, N-Acetyl-Cysteine, Elderberry, Zinc, and Vitamin C.
Remember taking care of YOU is taking care of the most vulnerable people in our society - our elders and immunocompromised patients.  If you get the virus, chances are your symptoms will be mild and you will be ok. Be cautious not to spread it through your community by your actions.
Good reads: 
A friend of mine, a doctor in California, wrote this excellent summary.  
Read this if you still do not think COVID-19 is a big deal.  
Up to date Colorado Public Health Department information here.
CDC information here. 

Lately, we have been very very busy with the virus and bacterial party that is going on around town.  Did you hear?   The world is full of influenza B, strep, laryngitis, bronchitis, pink eye, and a wicked sore throat viral infection that has been coming with a nice 2-3 week cough.  Yuck!  You may be one of the sick ones.  You definitely need to wash your hands fervently right now because the bugs abound.  

So what is the role of your DPC doc this time of year (and all year for that matter)? 

We are here! 

We are busy, yes, but we are not so overloaded that you will be sent to urgent care when all you need is a phone call.  When I worked in corporately-owned medicine, our clinic had 5,000 patients. We typically had 25-30 on the schedule on a typical midwinter day so we had to start sending coughs and colds to the emergency room or urgent care by 10 AM because we were already up to our eyeballs in visits. The emergency room is no place for a sinus infection. This was not effective care for anyone.  

This is what we do differently:

1) We know you

We know if you are prone to lung infections or sinus infections, we know that you are a person to get sick quickly and dangerously or if you never get sick and this is really unusual for you to call. We know if you prefer early antibiotics or none at all.  

2) We listen 

If you don't have a fever over 101, shortness of breath, a history of asthma or other concerning symptoms we can call you first and see if a phone visit will help us gather the information needed treat you over the phone. You might get a text message with details about your symptoms so we can make the right decision about a visit or a phone call even easier.  

3) We are your advocates

If you are not getting better with the plan we discuss at your visit, you can talk with us right away and see what adjustments need to be made. In the traditional model, you would be paying for another copay,  another visit, or moving on to urgent care. This is not necessary when you have a doctor you can trust to be there when you need it.  If you have to go to the emergency room because we are really worried we call ahead, tell them who you are and give details they need to know.  We follow up after you are seen and make sure we can see you soon as you recover.  

We have some people that see direct primary care as a bridge to when they have "good" insurance again. This is a limited way to see DPC services. I personally have had "good" insurance for 4 years AND my DPC doctor. Why?  Not because I am rich, lucky, or entitled. I pursued adding a DPC doc to my insurance even when I was between jobs and building this practice. It was a stretch on the finances, but worth it.  

Why? 

Once my daughter got super sick with a stomach bug when she was really little. She had vomiting and diarrhea for five days, much beyond the usual 24 hour bug. She had pain near her appendix. I was worried. Like most doctor moms - I thought she was either "fine" or dying of something major, like appendicitis. I called my insurance-based doctor. The phone tree led to a message. The message led to an RN. The RN read off an algorithm and told me to go to the ER. It was not that the advice wasn't sound or that the steps were inefficient. What I wanted was to talk with another health professional that treated me like a person, like the worried doctor mom I was. I wanted someone to talk to me about my rational and irrational worries and gather actual data from me on if it was important for my daughter to be seen immediately or if we could try some other options first. I signed my kids up for a DPC doctor then and never looked back.  

So if you hit the insurance jackpot, good for you! This will help you should you ever have a collision with the healthcare industry that requires some big time care - surgery, hospitalization, fancy drugs. But don't leave DPC, that would silly! We are your gas, your oil changes, and your day to day maintenance. 

We are the practice that knows you in the good times and the hard. We can be there by your side through it all. We know you, we listen, we care. There is no insurance, good or bad, that pays for that.  

Stay healthy and well!

Dr Brie ​

​It is that time again.  Time to understand Direct Primary Care Math and healthcare options for 2019.  

​When it comes to those already knowing membership benefits, may this serve as your annual reminder of why you are so smart.  It might even provide ideas on how you can save further. If you are looking at open enrollment like a deer in headlights, may this shed light on approaching your health care dollars differently in 2020.  If you are worried about your addiction to health insurance, you can read more here.  It’s not that we think you shouldn’t have it (you should) it's just time to give up the 1990s notion that there is such a thing as “good insurance”.  Get what you need to cover yourself in a collision with the healthcare industry.  For everything else, let our membership help you save.  

Every year, I go on the exchange and shop for my family of four to compare premiums, deductibles and learn the new insurance players on the market.   Turns out, again, we can save you money.  Here’s how it shakes out:  

The caveat? For one, our family is not in the age bracket that gets the astronomical rates, the 55-64 group.  If that is you, we are sorry, your rates can get close to the family of four for one person alone to get a “low deductible” plan. Definitely come and talk with us.  
 
Secondly, looking at deductibles and premiums does not tell the whole story.  When it comes to cost savings check out our article from last year, the same per visit, lab and prescription savings continue to apply.  In fact, our lab costs went down this year and we now include our basic lab panel after 6 months of membership.  
 
This year, like every other, we hear more about astronomical health care costs.  Shockingly, a local hospital charged $46,000 to our patient when we had to send him for symptoms of a stroke.  During his stay he was charged $16,000 for one MRI.  With our membership discounts, the MRI would have been $485.80, if it had not been an emergency.  Most of the time we can prevent these high cost visits all together.  If we can prevent you needing the ER one time, you save your whole year of our membership (just $900 for one person).  Good preventative medicine, a proactive team and your motivation go a long way to prevent emergencies.  
 
I am a small business owner, health care savvy and cost conscious (as many of you are).  So here’s what we did this year.  We looked at a health share option for our employees and their families.  Nextera Healthcare has been partnering their DPC with Sedera for over a year and they have had good experiences.  I have been wary of health shares in the past, but Sedera seems to know what they are doing.  Read more about their approach to medical cost sharing here.  Having a direct primary care membership gets you an even lower rate for Sedera.  Sign up with us, or if you are already a member, ask for our link to get more information.  
 
Oh, and did you hear?  Sesame Health, a cash based healthcare marketplace, is coming to Denver.  Check out their Kansas City page and search to see what it will look like when they launch their network here in 2020.  

​If you change your mindset and realize that healthcare is cheaper with cash, then Direct Osteopathic Primary Care + Sesame + Sedera is for you.  
 
Direct Osteopathic Primary Care covers primary care and preventative health.  Visits, labs, prescriptions, imaging and our unique holistic approach.
 
Sesame helps you find ways to stretch your healthcare dollars outside of our office - specialty practices, eye and dental.  
 
Sedera covers you in an emergency.  Sharing your costs if there is an accident or hospitalization.  ​Get on the direct primary care bandwagon, it just makes sense.

Please share this article for anyone who might need us.

This week, Dr. Brie and our Physicians Assistnt Torey Ivanic PA-C talk about Direct Osteopathic Primary Care's philosophy of the doctor-patient relationship.