When Dr. Chad Edwards served in the military, he saw a lot of things wrong with medicine.
"My two biggest issues that I saw in the military were continuity of care, meaning you get to see your doctor, and access to care," he said.
Due to the nature of the system involving how soldiers can schedule appointments with their doctors, continuity of care is an issue, especially with acute issues.
"When I was in residence at Ft. Bragg, our continuity rate was 18 percent," Edwards said. "So what happens is, the doctor is seeing a new patient. So if you have high blood pressure, maybe this guy this time doesn't agree with the management of that and wants to change that. And you may have come in for toe pain."
That same system also requires soldier-patients to schedule appointments eight weeks in advance.
"I saw these two things -- this access and continuity, and it was just, 'Move the meat. Get the patients in and get them out,'" he recalled. "I knew that there was a better way."
By October of last year, Edwards and his wife, Becky, had opened Revolution Health & Wellness at 2865 E. Skelly Dr. Offering what Dr. Edwards calls "functional medicine," the clinic is not only something of an off-the-beaten-path destination (medically speaking), but it's also often a last resort.
"We've got patients who don't feel good," he said. "They've gone to their doctor and had the routine labs, and they come back normal, and the patient is often told, 'Well, you're just getting older.'"
"'You need an anti-depressant' -- that's a good one," Becky Edwards interjected.
"'It's all in your head, there's nothing wrong with you,'" the doctor continued. "They just didn't ask the right questions -- as in the doctor didn't ask the right questions with the labs and other things."
Those questions, it turns out, are the root of the Edwards' functional medicine, the idea being the management and monitoring of the patient's physiology with any eye toward prevention -- not just prescribing something once the patient falls ill.
"Our primary function is optimizing health through basically any means possible," Edwards said. "We're trying to assess each patient's physiology on a functional level."
So rather than judge a patient's health relative to a textbook definition, he's looking at how well that patient is functioning in the real world.
"When you consider testosterone for men, normal ranges are between 300 and 1,000. If you're 301, you're normal. If you're 299, you're not. There's a huge disparity, so we're looking at optimal functions as opposed to set limits."
He then gave a pretty startling example of how the insurance industry works.
"If you take something like diabetes," he said. "There's a number of criteria for diabetes, and it starts with a hemoglobin A1C over 6.5. Those are some lab numbers. The problem is that the physiology is very different way earlier than that. Many insurance companies won't cover intervention and testing unless they're high risk or something like that until they meet certain criteria. Again, we know that the physiology changes. Our goal is to prevent the disease from coming to fruition by aggressively testing their physiology to make sure that it's functioning optimally."
That almost seems like common sense, doesn't it?
And then, the "i" word.
"Medicine is run by insurances. Right, wrong, or indifferent, that's how everything operates," Edwards said. "Insurance, then, dictates -- whether intentionally or not -- what tests can be run."
The problem is that insurance companies and even Medicaid approach medicine in a very different manner -- epidemiologically.
"Everything is evidence-based medicine," he explained of the insurance industry's procedures. "We're going to look at the populations and say that this population with this demographic profile puts them at a higher risk."
Once a test result points to a treatment recommendation, analysis goes to the cost-effectiveness of said treatment.
"If the cost of screening exceeds the cost of treatment, then it's too cost-prohibitive," he said. "It's making decisions about an individual based on populations' risks and money. I'm not trying to vilify them entirely. That's not my intent, but that's what those decisions come down to."
Edwards and Revolution are waiting. They can't plan for the future of medicine as it will unfold under the Affordable Care Act since congress keeps trying to repeal it and/or change/defund it. Without knowing what so-called Obamacare will look like, or how Medicaid will change, or what will become of Insure Oklahoma, Edwards and the medical community can't realistically plan for it.
When asked if Obamacare will make practicing medicine easier or more complicated, Edwards leads with a one-word answer.
"Yes," he said. "I don't think anyone really knows. Everything that I've looked at, we're speculating. That bill was thousands of pages and hadn't even been read in its entirely when it was passed. There are some good things coming out of it, but the bottom line is, going back to the number one priority in this clinic, is the DR patient relations. Anything that intervenes is not in the patient's best interest."
He is quick to admit that this is not a result of the Affordable Care Act.
"Insurance intervenes because it dictates what we can do," he said. "I think Obamacare will make that process worse. There's more bureaucracy, there's more criteria, there's more boxes to check. All of those things are going to weigh down the system."
What concerns him even more is a looming shortage of doctors. And to be honest, his numbers are somewhat terrifying.
"We're projecting that by the year 2020, we will be deficient 91,500 primary care physicians," he said. Physicians are retiring, some are retiring early (due to Obamacare, according to Edwards), and fewer students are choosing primary care medicine for their careers.
"Then you add in the 16 million additional patients that will now be covered under some form of insurance," he continued. "You increase the number of patients in the system by several million, and then decrease the number of physicians by almost 100,000. My concern is that access will become very difficult. When you put those two numbers together, that's not really any opinion. If someone wants to get in, I suspect it will become very difficult outside of clinics like ours."
Edwards and his wife, who serves as the clinic's chief operating officer, both feel good about that in terms of their business.
"It's definitely a little bit of a niche market," he said. But we also go about the practice of medicine differently because we do functional medicine. We're not the standard primary care office."
Not by a long shot.
"If you come in here, you're going to hang out with the doctor for at least 30 minutes," Becky Edwards said. "We like to tell them 30 minutes, but we're constantly yelling at him because he takes too long with the patients."
In addition to that face time that every patient gets, Dr. Edwards also offers prolotherapy, essentially his gateway into functional medicine.
"Prolotherapy is an injection technique where we're able to make a dramatic improvement in function and pain for musculo-skeletal conditions," he said. "We dealt a lot with musculo-skeletal issues in the army because people get bumped and bruised all over the place."
Becky Edwards interjected regarding one problem with the technique.
"Prolotherapy will never be covered by insurance," she said.
But for Edwards, it gets results, so he doesn't really care.
He told the story of a soldier who'd been through multiple training courses and several deployments.
"He'd done everything we had asked him to," Edwards recalled. "He came and said, 'My back hurts so bad, if you can't fix me, then send me home.'"
Everyone has heard stories of the patient that goes to the doctor for pain or issues that no physician can figure out.
"I remember vividly talking about him," Edwards related. "We were saying, 'There's nothing wrong with him. His MRI is normal. We can't find anything on xray.' The question was, 'Is he making it up?'" Once I saw prolotherapy, it gave me an answer for why that guy hurt, and it gave me a solution. Once I saw that, I said, 'Well, if I was wrong about this, and there really is something wrong with people like that, where else have I been wrong?'"
That self-examination opened what Edwards called a Pandora's box that pulled him into functional medicine.
"I would have patients coming in in their late 20s on sleeping medications and anti-depressants, and it's like, 'Why are these people falling apart?'" he said.
"It opened up to this whole new world of functional medicine and getting to the root cause of why someone doesn't feel well and why they're not performing optimally," he continued. "Once you find out, 'Oh, here's the answer,' then now we can work to find a solution."
That solution often involves simple lifestyle management, Becky Edwards -- also a personal trainer -- said.
"So many of our patients, it's simply education," she said. "What you fuel your body with. Fill it with sludge and crap, and that's how it's going to perform."
Dr. Edwards will continue doing what he's doing, no matter what does or doesn't happen with Congress and the Affordable Care Act, because what he's doing, as far as he's concerned, is working.
"I don't want to say we fix everybody, but we have pretty darn good success rate," he said.
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