What are Functional Medicine and Integrative Medicine?
Functional Medicine addresses the underlying causes of disease and engages both patient and practitioner in a therapeutic partnership. By shifting the traditional disease-centered focus of medical practice to a more patient-centered approach, Functional Medicine addresses the whole person, not just an isolated set of symptoms. Functional Medicine practitioners spend time with their patients, listening to their histories and looking at the interactions among genetic, environmental and lifestyle factors that can influence long-term health and complex, chronic disease.
Integrative Medicine is healing-oriented medicine that takes account of the whole person (body-mind-spirit), including all aspects of lifestyle. It emphasizes the therapeutic relationship and makes use of all appropriate therapies, both conventional and alternative.
The principles of integrative medicine include:
- A partnership between patient and practitioner in the healing process
- Appropriate use of conventional and alternative methods to facilitate the body’s innate healing response
- Consideration of all factors that influence health, wellness and disease, including mind, spirit and community, as well as body
- A philosophy that neither rejects conventional medicine nor accepts alternative therapies uncritically
- Recognition that good medicine should be based in good science, be inquiry driven, and be open to new paradigms
- Use of natural, effective, less-invasive interventions whenever possible
- Use of the broader concepts of promotion of health and the prevention of illness as well as the treatment of disease
- Training of practitioners to be models of health and healing, committed to the process of self-exploration and self-development
What is a Nurse Practitioner?
A Nurse Practitioner (NP) is a registered nurse (RN) with advanced training in diagnosing and treating illness. Nurse Practitioners prescribe medications, treat illness and administer physical exams. In Alaska, their license allows them independent practice and they are primary care providers for many patients.
- NPs provide patients with the information they need to make decisions about their own health.
- NPs take the time to listen to patients’ concerns, health and otherwise.
- NPs concentrate on preventative health care.
- NPs provide individualized, holistic (all-encompassing) care.
What services do NPs provide?
- Obtain medical histories and perform physical exams
- Provide immunizations and other preventative child care
- Diagnose and treat illness
- Identify, treat, and manage chronic diseases such as diabetes and arthritis
- Order and interpret diagnostic tests such as X-rays, blood work, and EKGs
- Prescribe medications
- Prescribe physical therapy, massage therapy, and other rehabilitation therapy
- Provide education so that patients can make wise decisions about their own health
- Refer to other health care providers
What should I expect for my first appointment?
Our thorough, initial intake lasts up to 75 minutes. It is a chance to tell your story and be listened to. Our goal is to create a road map to address your concerns. Please sign up for our portal before coming in and fill out the necessary paperwork electronically. This saves valuable time so that we can focus our appointment on a solid plan. Please come early so we can maximize our time together.
How often should I come in for visits?
This is up to the individual, depending on the complexity and depth of your health concerns, and ultimately your motivation and goals to get better. When treating chronic health problems, our visits should generally be more frequent so that we can attack the root cause and get you feeling better faster.
The following is a general guide for frequency of visits…
Come in ONCE YEARLY if you are:
- Super healthy/Have no new health goals
- Take no medications
- Have no change in health over the last year
(Goals: Physical exam, yearly labs, preventative screening needs, check vitals)
Come in TWICE YEARLY if you are:
- On medications but stable
(Goals: Refill prescription(s), assess effectiveness, make sure there are not major changes in health)
If you are starting a new medication for a new problem, we suggest appointments every 1-2 weeks until stable, then monthly, every 3 months, and every 6 months for maintenance.
For women starting hormone therapy, you should notice changes in symptoms within 2-4 weeks. These therapies may require frequent adjustments and follow-ups initially, in order to help you get the full benefit of therapy.
For men starting testosterone replacement, the first year of therapy involves the most monitoring for safety and effectiveness. Labs are checked at baseline, 6-12 weeks, 6, 9 & 12 months. Once a therapeutic dose is established, we can lengthen our intervals after that.
How do I make an appointment?
In Vitae’s ideal model, we strive to utilize technology for everyone’s sanity! Phone tag, phone tree and messages are cumbersome for everyone. My time is spent being 100% present with my patients in office. This is where the best care happens. To keep the office a healing space, we asking you to please:
- Check in with the front desk before you leave, especially if we know you already need a follow-up appointment. (Plan ahead now and prevent that panicky feeling when you can’t get an appointment later.)
- Log on to the portal and schedule online
If I have to cancel, what do I do?
Please do this as early as possible. We respectfully ask for at least 24 hours to avoid fees.
I want an earlier appointment. Is there a wait list?
Yes. If you want to come in earlier, please ask to be added to the wait list. If there is a cancellation, we will call.
How do we review labs?
In person! Labs provide us crucial information about your health. I want my patients informed and to understand what it means and how it contributes to their chief complaint. I use the information to create a treatment plan and want to be able to discuss this in person so your questions are answered. Sometimes this involves new medications or supplements. I don’t want you confused or worried.
I live out of town, can I see you?
Of course! I’ve continued to manage patients who have moved out-of-state via phone consults. If you are coming to town, I prefer to see you in person. It is harder with less contact, so I recommend that you make an appointment if you know you’ll be in Anchorage. Please do not expect care through leaving questions on the portal.
What is a patient portal?
The Vitae patient portal is an online tool that helps streamline the process and provides a high rate of satisfaction for users. The whole idea is to have open access to some of your health data quicker. I review labs, imaging results and other medical reports and post them to your portal. These results are printable and are always available, in case you need to share the info with someone else.
In general, the portal is used for: scheduling, refill requests, quick yes-or-no questions, and bill view/pay.
All you need to create an account is a simple log-in/password combination.
Do you accept insurance?
Yes. I am preferred with Blue Cross/Blue Shield and Aetna. We bill primary and secondary insurance. I do not take Medicaid, TriCare or Medicare. Patients with UMR insurance are billed in full at the time of service and can submit directly to their carrier. I do not take workman’s compensation. It is your responsibility to understand your plan and what is allowable, including co-pays and deductibles. Patient balances will preclude you from making future appointments.
What if I have Medicare?
I am not a Medicare provider. I can still see you, but the visit is charged to you directly.
How do I get refills?
All prescriptions need monitoring for therapeutic effectiveness and potential side effects. This is part of treatment. If you don’t have refills, you most likely need your follow-up appointment. This is purposeful to prompt you to review our treatment goals. Please make an appointment before you run out. Refills require time, evaluation and management, so please respect the process. I will review my notes and deny scripts because of lack of follow up. I will not refill medications if you have not been seen in the past year.
What happens if I no-show?
I will be sad. I want to see you, but I understand that life happens. I forgive once. The second time, I charge $50 and expect chocolate. The third time, I feel disrespected and understand you are not vested in a professional relationship and we are not a good fit. I want to help but can’t if you don’t show up. It is a missed opportunity for other patients who want to be seen. Our system gives you reminders: text, email, phone. Sign up for them.
Do you do paps? Physicals? Sports & school physicals?
Yes! This is all part of being a board certified family nurse practitioner. We recommend a well women exam annually. It is a full head-to-toe exam. Questions on guidelines/recommendations, we can discuss individually.
I do not do DOT physicals at this time.
I need a referral. How do I obtain one?
Referrals require that I assess you and document why I think a certain therapy is necessary for your health condition. I need to evaluate you in person in order to send a proper referral. Referrals often expire, while PT and medical massage need to be reevaluated for necessity and documented. This is required by insurance. Please make an appointment.
My insurance wants prior authorization. What does this mean?
It’s a cumbersome paper trail, along with phone calls and denial letters. It’s a way to not pay for things. This is more frequently seen. Sometimes there is some algorithm they want used with drug therapy or a specific code to cover it. I fill out their forms, send notes and my rationale. I do not have magical powers over your insurance to convince them to pay for things. I encourage you to speak to them about denials and find out about appeals. You pay for your plan.
Do you do acute visits?
Yes. Please feel free to call and see if there are any openings in the schedule. Let the scheduler know it’s acute and they can always talk to me about accommodating. I try to leave time at the end of day for this. Sometimes people call and cancel same-day, leaving last-minute openings.
Typical acute cases that I see include: sore throat, cold symptoms, UTI, yeast, need letter due to missed work.
What is a preventative exam?
Many plans cover a yearly exam. The goal is to prevent disease by having visits with your health care provider – including a physical exam and usually labs – to ensure your body is healthy. These visits are not to review chronic health problems or write prescriptions. This stipulation is universal with insurances.
Monitoring controlled substances
Theses medications require more monitoring. The goal is to use this sparingly. If they expire you need to come in, I will not automatically refill.
Narcotics, ADD medications, testosterone for men and women, and certain sleep aids are controlled. They are classified by the DEA and there are rules to dispensing. Some are mandated to be hand carried. Testosterone always expires in 6 months. Narcotics and stimulants are only good for 30 days.
I have paper work I need you to fill out (i.e. FMLA, biometrics for my work)
Schedule an office visit. Paperwork is cumbersome and I need your help with the answers. Often it requires exams, labs, vitals etc. as well as my time.
I want you to be my health care provider but I love my other doctor- can I see you both?
Of course! I can send notes as you request and try and collaborate your care.
What is an e -patient?
A health consumer who participates fully in his/her medical care. E-patients see themselves as equal partners with their doctors in the healthcare process.
They are informed, empowered, and savvy with their health. With the change in information access patients have resources readily available. There are over 2000 published researched health articles a day (not including popular media. The medical databases house millions of research articles. We can’t all keep up. The goal is to collaborate as partners in your health journey. I’m open to listen to what you have read. I’m willing to read. I’m happy to direct you to good sources for information, I’m happy to recommend books. I do the best I can to stay abreast so we both benefit.