Hirschenbein and Doyle developed their first practice, Personal Physicians,
in East County, San Diego. "I enjoyed the primary care component of
medicine and soon realized that it was difficult to be a primary care
physician and offer other services, so I began to hire additional
physicians to work with me. Within one year we had five primary care
physicians (family and internal medicine) on board with me, as well as
an Osteopath, Acupuncturist, Cardiologist who integrated homeopathic
medicine, and two Doctors of Naturopathy. We also had a commercial
kitchen with a professional nutritional Chef. People came from all over
the county for our cooking classes. Personal Physicians was a
unique practice in San Diego at that time and became the largest
primary care practice in San Diego not run by a hospital."
A New Location for Furthering Their Dream
Realizing
how tired he had become dealing with issues of traditional medicine,
Hirschenbein began commuting between East County and La Jolla in order
to collaborate with "Vital Imaging," a center offering body scans and
electron beam tomography. "They wanted a physician who understood body
scans and the myriad of health issues their clients would be posing, so
I set-up my own office adjacent to their clinic. Initially I worked
three days at this new practice and two days in East County where Doyle
continued to manage full time."
Before too long Hirschenbein and Doyle decided to sell their practice in East County, including the selling of the name Personal Physicians,
and settled in La Jolla to focus anew on their passion and commitment
for educating and inspiring patients in the practice of Lifestyle
Medicine that he had been pursuing for the past fifteen years. "During
those first years of medical practice," Hirschenbein explained, "I had
pursued learning many additional modalities of treatment, becoming
certified in nutrition with a CNS and CCN, becoming a fellow in
Holistic Health, Board Certified in Anti-Aging Medicine and a member of
the National Lipid Association." Doyle also completed her CCN. She was
the only RN in her class with physicians and pharmacists and loved
delving into bio-chemistry so deeply. Thus, now was the right time and
the right place for Hirschenbein and Doyle to create The La Jolla Institute of Comprehensive Medicine.
This
new venture more fully represents the "doctor of the future" that the
Hirschenbeins believe in. As healthcare providers that partner with
their patients in caring for themselves, body and spirit, they are
bringing to life the truth that Thomas Edison predicted. MaryAnn noted:
"The Zen mode of our new office is a healing environment with soft
colors, a library and an area for relaxing to enjoy a cup of hot
organic tea brewed for each patient and visitor if they so desire. We
wanted to create a life-giving experience from the moment they arrive.
An 18' hand-painted wall mural of a man and woman by famed artists
Michelangelo and Botticelli, along with the Edison quote, reminds each
of us about our innate beauty and value."
Patient Population
"Our
patients tend to be adults, with our oldest at this moment being
ninety-nine years old," Hirschenbein explained. "Some are age three or
four, but the average age of our younger patients is ten and older.
Patients come for a wide variety of reasons but the majority are
pre-selected because 1) they believe in lifestyle medicine, and 2) are
extremely educated. They are ready and willing to have us 'partner with
them' for their health rather than the traditional model of expecting
the doctor to 'do it' for them. Our patients range from people who are
basically healthy and want to continue to be so, to people with
diabetes, high blood pressure, heart disease, lipid problems,
fibromyalgia, chronic fatigue, cancer and many other issues."
"Our
holistic approach asks, 'What are the underlying problems people have?'
Six patients may all have diabetes, but the treatment plan will be
different for each because each one got there in different ways. My
background in gastroenterology is invaluable. Paying attention to and
understanding the intestinal tract is crucial in evaluating, treating,
and making recommendations for someone's health. Even if people are
eating an ideal diet, but not absorbing nutrients as they need, then we
have to look at any possible underlying issues. It's like peeling an
onion." Traditional lab tests are utilized, as well as specialized
tests such as GI testing, nutrient and metabolic inflammation testing,
and others depending on the protocol required for each individual
patient.
Hirschenbein is the only physician at this time and
therefore sees every patient himself. Doyle works in even greater
detail with patients, as needed, with regard to their eating
habits-including eating out at restaurants, their stress level,
exercise routine and the like. She reviews their access to good food,
who does the cooking and how, gives them recipes, goes with them to
their personal trainer or to the grocery store. It's very hands-on
learning and people love it. For some, it's a one-time visit with
Doyle, for others it is on-going.
Doyle's passion for empowering
others for health is efficacious when she says: "If we could simply
educate more people! Food is so important, as is water. We have a lot
of people who think they eat well, but in fact do not. When patients
clean out their cupboard of unhealthy foods and learn to read labels,
even those two tasks make a significant difference to their health! The
myth in our society, that medicine is a powerful force for health but
lifestyle is not, must be undone. One's lifestyle makes all the
difference in the world."
She continued, "I am a certified
lifestyle educator and am working on completing my Life Coach
certification. Whether or not I see patients depends as much on each
one's particular needs as well as their interest in such personal
coaching and making lifestyle changes. And of course each patient's
financial means is relevant since not all of our services are covered
by health ininsurance. "
Finances
At this
point the practice is self-sustaining. "We run lean and mean," Doyle
proclaimed. "We both do management details, with two part-time staff
persons and one full time medical assistant. Each person brings
exceptional qualities and expertise to this work."
"We are a fee
for service practice and therefore do not handle insurance. However, we
do give patients a 'super bill' that has all the pertinent information
they need for potential reimbursement. In addition, one of our
part-time staff comes in specifically to assist patients with any
insurance billing questions or issues. We advocate for them, and find
that 70% of Hirschenbein's services are reimbursed at anywhere from
60-90%. Many patients tell us that they 'have us in their healthcare
budget' which to me is a testimony to their own commitment to health."
Success is Real
The La Jolla Institute of Comprehensive Medicine
partners with patients in addressing a wide array of health issues and
utilize a wide variety of complimentary modalities including nutrition,
exercise, stress control and more. Weight loss is a key issue for many
patients. Hirschenbein says that the average weight loss of their
patients is 40 lbs.
Hirschenbein recounted a senior management
patient at a large corporation with metabolic syndrome. His weight
dropped from 315 to 215 pounds, and blood pressure from 180/120 to
100/70, with blood sugar having decreased as well. As an added benefit,
the patient's wife has also lost 40 pounds.
"Another patient in
his late 40's, who is diabetic with elevated lipids, and takes three
medications for diabetes and three for cholesterol (all at high doses),
has done remarkably well in only three months. His sugar level
decreased from 300 to 150, total cholesterol went from 350 to 150 with
triglycerides dropping from 2200 to 150 and HDL cholesterol increasing
from 25 to 50. At present he is taking the same medicines with a goal
of being able to decrease the dosages if not eliminate some of the
medications altogether."
Hirschenbein shared about heart disease as one more example of the service they provide at The La
Jolla Institute of Comprehensive Medicine: "The cause of
atherosclerosis is not elevated LDL cholesterol. Heart disease is a
complicated, multifactorial problem and requires a multifactorial
treatment approach. Multiple statin studies have demonstrated a 30%
reduction in cardiac events. However in other studies, combining an LDL
lowering agent with a HDL raising agent, cardiac events have been
reduced between 80 and 90%. Therefore a comprehensive approach to
identify and treat multiple risk factors appears to be the best
approach. This approach has been used successfully for years at our
Institute."
"It is exciting to witness our patients' success
rate," Doyle commented, "It is very high. Even those who fall back on
their progress, tend to come back within twelve months because they
remember how good they felt."
Marketing
"Our
number one marketing comes from referrals," Doyle says. "We are booked
four weeks out; all referred by other patients. And we average two new
patients each day. The effect we have had locally, and that ACLM is
having nationally, is phenomenal in terms of offering patients
solutions for their health that are real, are possible, and are
cost-effective."
ACLM Disclaimer: Our Practice Spotlights are intended to
provide examples of Lifestyle Medicine in practice. We recognize that
Lifestyle Medicine practices vary widely, and inclusion in Practice
Spotlight is not intended to imply official endorsement of individuals
or practices.
