Why I’m Starting a Radically Different Kind of Medical Practice

Why I’m Starting a Radically Different Kind of Medical Practice

52
SHARE

Screen Shot 2014-12-29 at 11.03.12 AMWe hear a lot about how US medicine is broken, from how much we spend annually ($4 trillion) for unimpressive outcomes, to the growing epidemic of obesity and diabetes, to problematic financial models, to the growing malaise amongst doctors.

Across US health care, a lot of smart people are crafting solutions to these problems, but in my view the reality is that many of them are generating efficiencies on top of a broken product.

The real problem is that conventional primary care as it’s practiced today no longer serves the needs of most people, be they wealthy or under-served, be they patient or provider.

I am starting Parsley Health, a new kind of medical practice that directly addresses these problems, first by providing something called Functional Medicine rather than traditional primary care, and second by providing functional medicine in a tech driven, modern and affordable way.

What is Functional Medicine?

I became a functional medicine doctor because early on I recognized two major limitations of the conventional medicine.

First conventional medicine does not effectively address the fact that most individuals’ health is determined by three things: day-to-day behavior; access to health-defining resources like unprocessed food and regular exercise; and how lifestyle choices affect the body, about which education levels are  shockingly low amongst all socioeconomic demographics.

Second, conventional medicine is overly reliant on drugs that suppress symptoms but do not address the underlying cause of disease. Your insomnia, for example, isn’t due to an Ambien deficiency, but a conventional doctor doesn’t have the time, the resources or the training to educate you and support you in addressing the multifactorial reasons you can’t sleep, so you’re given a drug like Ambien, which is addictive and has multiple problematic side effects.

Functional medicine is an approach to the practice of medicine that better suits the needs and challenges of the 21st century individual because it addresses the root cause of disease, and seeks to understand the multiple upstream factors that determine a person’s health, including personal history, genetics, current lifestyle, environment, and mental and emotional factors.

Functional medicine’s toolkit is also much broader. It takes advantage of best practices from all over the world, including diet and lifestyle modification, stress management, detoxification, supplements and botanical medicines, and when necessary, prescription drugs.

Functional medicine works because its providers spend meaningful time with patients–often visits are 60+ minutes–which allows them to create authentic two-way therapeutic relationships and to provide the level of education and support that most patients today need in order to make meaningful lifestyle changes.

Functional medicine has earned greater acceptance across the medical establishment, most notably with this October’s opening of the Cleveland Clinic’s new Center for Functional Medicine. But today functional medicine is still not available to most Americans.

Parsley Health’s goals are to provide functional medicine to mainstream Americans, thereby lowering the chronic disease burden, lowering health care costs, improving the happiness of doctors, and improving the user experience in health care for more people.

Parsley achieves these goals in four specific ways. First, by providing its services through a direct-primary care based membership model, meaning patients pay a monthly subscription fee. Parsley Health is making functional medicine accessible to many more people than before, while still avoiding the limitations of accepting insurance, which stifles doctors’ ability to offer new models of care delivery.

Second,  Parsley offers unlimited health coaching services. Health coaches are critical members of the functional medicine team because of the importance of education and personal support to the success of patients who would otherwise struggle to make and maintain lifestyle change.

Third, by providing functional medicine through a digital technology-driven services platform, Parsley is able to make health care more efficient, modern and enjoyable for both patients and providers. From backend office services, to patient access to all labs, notes and health care data, to tracking outcomes in real time, technology is the backbone of Parsley’s practice.

Fourth, Parsley saves money in two ways. One, it largely reverses and prevents chronic diseases like obesity, diabetes, asthma, autoimmune disease and even dementia, which account for more than 75% of health care costs. Two, as an alternative to an employee wellness program, Parsley can save employers money through improved productivity and lower insurance premiums.

Parsley Health is ultimately a new hybrid model of health care that combines the functional medicine approach that makes more sense for patients of all walks of life, with new care delivery models that both increase access to better medicine for more people, and that let doctors practice the kind of medicine that makes them feel good too. Parsley opens in January in New York City, and I invite you to find out more at parsleyhealth.co.

Robin Berzin is the CEO of Parsley Health and also works with Health 2.0 on Health Interactive

Leave a Reply

52 Comments on "Why I’m Starting a Radically Different Kind of Medical Practice"


Guest
Aurthur
Jan 3, 2015

All I want to know is will my feng shui consultant be a PCP or Specialist copay?

Guest
SFBishop
Dec 30, 2014

While I think this is a great idea for the patients who will be compliant with lifestyle changes. I think anyone who has practiced for any length of time will agree, it is beyond difficult to get your patients to buy in to this. Heck, I’m lucky if I can get my patients to drink more water and give up soda! They look at me like I have 3 eyes when I tell them their chronic pain would get better with a little non-weight bearing exercise! Someone said they “want a pill to fix every ill” and that’s about right. I would love to practice in a society where the patients saw the importance of lifestyle changes and would be motivated to make them.

Guest
Heather Rae
Dec 30, 2014

Go, Dr. Robin, Go!
And dear Laura, my story is similar to yours, as are so many in this country.
Go, Dr. Robin, Go! I have benefited already from functional medicine. Give me a simple payment structure (with a superbill if needed), Patient First across the street for $50 low-level emergency visits, and a relatively inexpensive catastrophic SICK CARE insurance plan (should Ebola ever find me, or more likely, I be hit by the commuter bus).
Go, Dr. Robin, Go! You are sorely needed.

Guest
William Palmer MD
Dec 30, 2014

Laura, why is your ejection fraction so low?

Guest
Dec 30, 2014

Wow so many detractors.

Most patients spend 1 hour a year with a doctor and 52 hours a year looking up medical conditions and symptoms online.

There’s nothing wrong with a concierge practice that goes beyond clinical documentation (over consumed) and into personal health telemetry (under consumed). Provide some kind of window into the 52 hours and greater context that don’t make the 5 minute cut into an EHR’s 1985ish user interface during an exam visit.

It may not be perfect, in the clinical or scientific sense. But surely it’s good enough to tie to behavioral science and effect change.

Let them experiment and see what happens; there’s nothing wrong with DPC payment models. Nothing wrong with moving away from addressing symptoms to improving overall health as long as you’re pay for performance.

I say go for it.

Guest
Dec 29, 2014

The name “Parsley” is a perfect metaphor. Some frilly, green garnish that serves little purpose and is plucked off and discarded.

Guest
Laura
Dec 29, 2014

Zip your pants sugar-your parsley is showing!

Guest
TCope
Dec 29, 2014

How will your system deal with a healthy person that comes down with metastatic cancer? This situation really separates the feel good types from the hardcore MD’s.

Guest
Laura
Dec 29, 2014

Not at all. My clinic helps me correct imbalances, achieve and maintain excellent nutrition, avoid foods/substances that irritate me (cause any inflammation) and build a program for strength and conditioning I can manage without a gym. They have referred me to a specialist here and there to rule out a possible problem. They do not decry traditional MDs to address a problem but they do support building maximum health. Interesting that I have never had an MD suggest a nutritionist….also, the mainstream do not believe chemicals in our food are bad so…they are of limited help from the start. They do not believe traditional MDs work towards health but are forced to be reactionary. The result is essentially an attempt at symptom abatement. My clinic believes this is the result of the system and does not condemn MDs like I do-I believe they are taught to tests and standards like our kids in school and this dumbs them down. They cannot practice according to their critical thinking or ethics. This is why more and more are setting up concierge practices and others are practicing functional medicine. My BIL’s MD has fortunately become a willing participant and team member for him and we are grateful.

Guest
Laura
Dec 29, 2014

New recommendations decry the benefits of these yearly exams. Really, you should read your journals.

Guest
Retired MD
Dec 29, 2014

Who said the pap should be yearly. Certainly I didn’t. Before you go off on your rants read what it is you are responding to. By the way, the antibiotics for strep throat are mostly for children. I suspect you have heard of rheumatic fever and how it is an immunologic response in some individuals to certain strep that can affect joints, the heart, and the brain, and that it can be prevented by treated with penicillin. I was not defending Dr. Oz, just commenting that the potions from Dr. Berzin put her in a similar category of giving questionable recommendations. I do believe that we can improve health quite a bit by non medical means, such as improving sanitation and hygiene, not smoking, not drinking, and not eating too much. In fact, in my practice I probably stopped as many pills as I started, and did not use antibiotics unless absolutely necessary. I did not see a drug rep for over the last 20+ years of my practice. Sometimes medication is useful, however, even though each one is a poison to some system in the body. Not all doctors are as pill happy as you think. In addition, I am still waiting for a study to show the proper diet for a human being, since many diets are based on theories that are later found to be incorrect.

Guest
Laura
Dec 29, 2014

How funny for you to speak of rants. I don’t need your approval because I have no respect for your opinion. I am doing quite well and with all that I have learned will work tirelessly to help others. I expect people like you to rain and I do t let it ruin my day-my day of knowing I am in better health without you. You have a lovely evening.

Guest
Dec 29, 2014

Did I say “yearly” anywhere? Don’t think so. Reading carefully is a good idea, journals, blogs or otherwise.

Guest
Laura
Dec 29, 2014

Sorry dear-responded to you and an MD. Didn’t realize you needed individual attention.

Guest
Dec 29, 2014

Just surfed the Parsley site. Yikes! You’re kidding? Right?

You’ve done a mashup of naturopathy, concierge practice, herbalism and wishful thinking. You’re going to flog folks almost 2000 bucks a year for this unholy brew and women STILL can’t get a pap smear? Because you don’t do enough of them?

At least with a “real” concierge practice, members get 24/7 access. You’re planning on banker’s hours. Fitting, somehow.

What a waste. Looks like you’ve had first class education and training in world-class institutions. And now you’ve opted to turn your back on the sick and frail…in a city teeming with those in dire need of your skills.

Oh well…

Guest
civisisus
Dec 29, 2014

Until your financial model incorporates a way for people to readily draw on formidable financial resources to protect them from the the costs of treatment they might incur in the remote chance that they or a loved one is struck by the proverbial bus – well, until then, you don’t have a financial model for your patients.

You may have one for your practice, but not for the people you intend to practice on.

Guest
Retired MD
Dec 29, 2014

This is the new medicine. No need to consider diseases such as diabetes mellitus type I and all those genetic disorders. How about little viral infections like ebola, or bacterial infections like strep throat. Oh well, they are just the fault of the person for not doing what you tell them and not eating properly, and especially not taking your prescribed supplements. Really, any one interested in this Marketing piece also see http://parsleyhealth.co/author/robinberzin/, and http://robinberzinmd.com/philosophy/. Too bad even the pelvic exam and pap test are not performed or included in the fee. I always thought they were an integral part of what we now call Primary Care. I’m sure you will get your 1500 worried well to pay for your exorbitant wares, but be careful, you saw what happened to Dr. Oz.

Guest
Laura
Dec 29, 2014

And thanks to your over abuse of antibiotics, they may not work for my next case do strep throat. The NEJM put up an article that claimed hospital and doctor mistakes kill over 400,000 in the US each year and properly prescribed scripts kill 140,000-not injure but KILL. This does not include improperly prescribed scripts. Those antibiotics you love and abused your entire practicing life do not help in most HAIs. I do not have a prescription pad sir-that is on you.

Guest
Laura
Dec 29, 2014

Dr Oz should be disbarred. I work with a functional medicine clinic in DFW. Depending on complaints there are referrals to allopathic docs to rule out a “crisis”. I was led to understand that there may be processes at work already such as colon cancer, etc that need to be ruled out. The goal is to help clean up all bad habits-including detox from your unnecessary prescriptions. I have a coaching team. I do not seek to down hands full of pills-yours or supplements. I was told I should take magnesium. In three years that is the ONLY supplement they have sold me. I take 3 at my own discretion and research. They have suggested I establish a relationship with a cardiologist but I have not-been there, done that. Their goal-which suits me just fine-is to eliminate as many “problems” as I can with the goal that I will be as healthy as I can be. If I do turn up with cancer from a process begun some time ago, I will be in the best shape to fight it both physically and mentally. And the fact that your ilk says this type of care is for “the wealthy” is testimony that our system is broken. To suggest removing toxins from daily food and increasing nutrition radically is “snake oil medicine” that should not be a mainstream goal shows me how messed up you and the system really have become.

Guest
Heather Rae
Dec 29, 2014

Go, Dr. Robin Berzin, Go!
Let the allopaths stick to their version of science, their pharmaceuticals (with its hideous side effects), and their insurance-based managed care, and let them continue to find quarter and community at QuackWatch and ScienceBasedMedicine.
The rest of us will be finding better living through improved diets and nutrition, exercise, saner lifestyles that include meditation and other healing modalities, and, heaven forbid, supplements if needed … all based on the basics of biology, metabolics, endocrinology, neurology, etc. and the new science. Perhaps this is a science which the naysayers missed in training of years ago … a science about which doctors and scientists like Gershon and Davidson and Davis and O’Bryan and Brogan (and on the list goes) write and research.
From the bottom of my heart, and the rest of my healing body, thank you to you, Robin Gerzin, and other physicians who understand the meaning of HEALTH care.

Guest
Dec 30, 2014

“Let the allopaths stick to their version of science”
__

There are no “versions” of “science.” There are only science and pseudoscience.

Guest
Dec 29, 2014

Heather, you are setting a false dichotomy between allopathic medicine and healthy living. There is an absolute role for healthy living within allopathic medicine, but sometimes horrific diseases happen, even to healthy people, and those “hideous” pharmaceuticals are necessary. I have seen the healthiest of people develop terrible diseases, and I get outraged when “alternative” medicine people blame them for something that is not their fault. In the meantime, many of us very health-oriented lifestyles and know that we are protecting ourselves from most, but not all, disease. My problem is not with those who advocate healthy living, but rather those who advocate treatments for which there is no scientific basis or efficacy,

Guest
Laura
Dec 29, 2014

To a degree you are correct but you are also a significant part of the problem. Our food supply is poisonous and corrupt-and those who make that claim are ridiculed. You will fight to maintain the status quo before you would embrace the idea that our food causes many of our chronic symptoms. And why are there so many varied reactions to medicines? Perhaps because of chemistry? We eat/drink/are poisoned by different chemicals so the additional pharma chemicals have radically different outcomes? You claim to stand on science but much of this is biased by pharma companies whose reps laughingly refer to you doctors as “drug whores”. The fact that you cannot reliably predict most reactions or outcomes belies your “science” and “fact”.

Guest
Dec 29, 2014

Laura, you are probably young and healthy, as I was a number of years ago. Some day you might find you might need those wonderful drugs that people sometimes need. Yes, drugs are overused, and often used when lifestyle changes would be a better alternative. But sometimes people get diseases that have nothing to do with lifestyle. Those awful drugs can be lifesaving in those situations. Everything is “chemicals”, from the foods we eat to the drugs we sometimes have to take. A little real-world exposure to healthcare and proper science education might be beneficial to you.

Guest
Laura
Dec 29, 2014

I can assure you I am more well-read on many topics than some people I have seen. I have seen medicine save a life and I have seen it take lives. I will not blindly follow anyone as long as I have the power to hold off and research. I advocate achieving balanced (to the best of our knowledge) chemistry, avoiding irritants and toxins in my life and my food. I practice part of the Wahl’s Protocol-I consume 2 cups/day of sulpherous veggies, 2 cups/day of greens, and 2 cups/day of bright colors. I don’t like many veggies so I do this via “shakes” to which I add ground flax, chia, pumpkin, and sesame seeds. I eat it cold like ice cream or drink it like a shake. All organic. I eat clean meat and uncured bacon. Perfect? I doubt it. Better than many? You bet! So I have seriously increased nutrition/fiber, reduced poison. I know this won’t erase some damage already done but it will prevent many of the chronic issues many face. It also says I am the best I can be should I need other interference. You cannot champion a patient, possible future patient taking responsibility to be in the best shape possible? My functional medicine clinic is my team and my coach. I did it on my own but it is better with a team. They do not tell me to quit on MDs and they refer out as I have said. I don’t understand how you can suggest this is not beneficial.

Guest
Laura
Dec 29, 2014

Neither I nor my functional medicine clinic suggest there is no need for traditional medicine. I have damaged myself for years, I understand there may be processes in place that may require direct intervention. my BIL is alive because of direct intervention. They helped him survive a crisis but could not and did not ever figure out what caused it to start with. He has now lost weight, become much more mobile, been able to get off BP meds. He did this while still chasing diagnoses from MD and GI docs. He has now given up but has corrected so many of his complaints he is not upset. Also, because of his bad BP, we worked through his MD while he was titratimg off of them. I don’t see how you can suggest this is wrong. Whatever may come for him or me, we are both in MUCH BETTER condition physically and mentally to cope. I cannot fathom how anyone can disapprove of what we have done and, quite frankly, if they do I can happily live with it.

Guest
Laura
Dec 29, 2014

I am 54 and was diagnosed with CHF 16 years ago. Tried the meds prescribed and after a month KNEW it was wrong. Backed off of them slowly and carefully and never looked back. Had a crisis of energy in 2011. MD said see cardio, I’m not comfortable treating you. Cardio said 2 BP meds (my highest BP ever was 128/73) among other drugs and bi-ventricular defibrillator. EF was 17, downgraded to 14 after a Lexiscan. I refused the cath lab. Sent home with a Zoll cardiac life vest. I was quite upset, afraid to get the defibrillator, my family was freaked. I thought it was time to put on the brakes. I saw an accupumcturist and this helped me achieve a state of calm. I had worked a week a month flying across country, in Bakersfield ( I live in OK) and I hate flying. I decided to “recover” from my year of this schedule so I took time off work and turned food into a hobby. My results have been excellent and I am not in the care of a cardio much less CHF specialist. In 2011 I tried the meds-my BP dropped so low I was passing out. When I turned up with critically low BP and said I was going off meds he said he could not help me if I was non-compliant-I asked how I could live ON the meds. He said he could not help me if I didn’t take them. That was the only true statement of fact-I realized he was right-he could not help me. Last summer I rated class 4 whitewater out of Moab. This year I went horse trekking over 7000′ an drafted the Taos Box. I have health.

Guest
Peter1
Dec 29, 2014

“The rest of us will be finding better living through improved diets and nutrition, exercise, saner lifestyles that include meditation and other healing modalities”

You don’t need a monthly membership in ClubMed-icine to make that work for you Heather.

Guest
Laura
Dec 29, 2014

Peter it seems people DO benefit from the “buddy system”, collective knowledge, and coaching. I was on my own for 21/2 years of my efforts and was successful. I wanted backup and another “pair of eyes” helping me decide if/when I might need intervention. This is one reason why teams have coaches, alcohol and drug detox programs have teams and coaches and sponsors. My MD wants me to not ask questions and do what I am told or I am just a complication. Before you suggest doc shopping, I’m 54 and I give up. I also do t need “cascading events”. Brother-in-law saw GI to learn why he was cyclically nauseated by food/drink. Had endoscopy and upper GI-told him nothing about original complaint but said he had Barret’s esophagus, “very serious” and here is a script. As it turns out, the script was for acid reduction. He has never had acid reflux in his life. Barret’s is most often caused by severe reflux, smoking, severe bulimia. I told him not to take the script. He said doc told him it would fix Barret’s. This is only true if he had severe acid reflux. I told him he was a 30 year smoker who had quit 4 months prior and that was all he could do to fix his Barret’s. The pills, unnecessary as they were, would deplete his stomach acid thus causing problems digesting food and giving rise to a larger bad bacteria colony. Yet these fine purveyors of health are puzzled and wonder why C dificile is increasing as a community acquired ailment. Could it be all of the acid reducing scripts? Remember my BIL never had acid reflux to start with. He has followed my “clean living” program, lost 80 pounds (needs 20 more off), his blown knees are better and he is able to move more now, and he has been able to quit all BP meds. His BP was regularly 180/110. He regularly sees MD while coming down on BP meds. He also sees my functional med people. His MD was skeptical but is supportive and amazed. Some call that anecdotal evidence. I like it. I call it real. Also, whenever they do studies and get subjects to report on symptoms they are collecting anecdotal evidence. My BIL and I will keep on our path. We have better health.

Guest
Peter1
Dec 30, 2014

Laura, when in your journey did you consult a monthly membership Functional practitioner?

I’m all for “healthy” living but fail to see why you need a slick marketer to get there.

Guest
Saurabh Jha
Dec 29, 2014

Peter, free will and free choice.

I’ve always wondered why more people don’t move from Upper East Side New York to Bhutan.

Guest
Hoofaun
Dec 29, 2014

I agree there isn’t much evidence for the efficacy of some of those CAM treatments. But then there is no evidence for the efficacy of flu shots either.

Guest
O. Benedict, MD
Dec 29, 2014

The patient population that could be interested in this arangement are those in the Healthy & Wealthy category that generally need only occassional health care but still want to explore and pay for alternative modalities. The biggest risk for the patient and practitioner is missing serious pathology while recommendeing detox which has no evidence of being effective, aside from particular circumstances like addiction and poisoning. Insurances do not cover most of these detox treatments due to lack of need beneficial evidence. Tech driven, I take, refers to scans (available today on a cash on hand and without referral basis on parked vans and clinics on many major cities) and blood panels of trace elements that do not present a credible test result/pathology correlation. This means that the patient has to pay cash in most instances, again this is targeted to a healthier and wealthier group of patients. I do not see this as an innovation in healthcare as much as a way to capitalize on some (wealthy) people’s lack of confidence in traditional medicine.

Guest
Laura
Dec 29, 2014

First, what we call health insurance simply refers to our system of seriously over paying a middle man in which scenario the insurance company is your client, not the patient. Second, there is no room to reimburse time and quality in the present system; in fact the reverse is true and reward goes to procedures and pills. Third, it is so disheartening to see “medicine” resist all efforts at self help/improvement-but that does violate your system. Last, I’m so sick of reading/hearing that these ideas/treatments/supplements are not approved by the FDA. Vioxx, surgical mesh, hysterectomies with a roto-rooter, etc, etc, etc all having FDA approval makes the resulting injuries/deaths FDA approved in your eyes. Does this make it ok? How much time do you spend with a patient? Do you use your brain and common sense or simply practice plug and play medicine like so many? How many patients do you see in a day? I understand that in the food and supplement world I must do my due diligence as I must in your world. Advice/meds I was offered 15 years ago have changed and 3 docs agree that the old regimen would have been “detrimental” had I complied but all now seek to get me on the ” standard of care” in today’s terms. This tells me that what you present as “knowledge” is nothing more than a working hypothesis offered to a guinea pig-me. You cannot fix me but I will die from your efforts. No thank you.

Guest
Saurabh Jha
Dec 29, 2014

I was tempted to ridicule the concept but..

Perhaps well being is not in the provenance of science and involves interventions with deeper metaphysical and existential attributes.