Practice Spotlight: Marissa Fernandez-Kiemele, MD

Lifestyle Medicine Center: Offering Healthcare that is Experiential, Practical, Viable
 
Born in the Philippines, Marissa Fernandez-Kiemele, MD grew up in Canada. She completed her medical training at University of Alberta and is a board-certified family practitioner specializing in lifestyle medicine. Dr. Fernandez Kiemele believes in providing personalized, evidence-based quality health care that aims for a patient's optimal physical, psychosocial and spiritual health. Educating and inspiring patients via experiential, practical and viable methods for achieving healthier, sustainable lifestyle changes is her passion and gift.

 

Dr. Fernandez-Kiemele is the founder of Lifestyle Medicine Center in Gig Harbor, Washington which opened recently in partnership with Franciscan Medical Group. She and an integrative staff utilize the enormous power of nutrient rich food, physical activity, stress management and spiritual exercises, as well as comprehensive, personal medical supervision to overcome disease, restore health and build lasting vitality. Dr. Fernandez-Kiemele is involved in various local and international community organizations, providing primary health care, health screenings and education. Her volunteer work has taken her to such locations as Africa, South America and Latin America. She is a member of the American Academy of Family Physicians and Christian Medical and Dental Societies.

Background

Initially having been interested in pursuing research, a three month experience volunteering in S. Africa at the end of her medical school studies enunciated how important the one-on-one patient relationship is to her and being able to make a difference, one patient at a time.Not long after completing her residency training, she married an American and moved to the Midwest-- Minnesota, then South Dakota during which time she says she "warmed up" to the American system, working in obstetrics, ICU, CCU, inpatient calls. "I was young and needed to know I could do it," she says. "Yet through it all I realized I was just fixing things, temporarily, not for the long term. I asked myself, 'Am I really making a difference?'"

Dr. Fernandez-Kiemele and her husband settled in Gig Harbor, Washington four years later after a trip exploring the Pacific Northwest. Upon discovering Gig Harbor, they quit their jobs in South Dakota and moved! Dr. Fernandez-Kiemele's fervent attention to her own professional as well as personal needs goes hand in hand with her ardent pursuit of helping others listen to, and achieve their dreams as well.

The Evolving of a Dream

Having worked in Family Practice---outpatient, chronic care mostly, Dr. Fernandez-Kiemele  realized that she kept seeing same health issues and giving the same medications yet nothing was working long term--their medical problems continued to worsen. "I therefore started spending more time with patients, educating them, especially focusing on lifestyle issues. Whatever I would recommend, I would try myself, so that I'd know what it is they are going through; or if not myself, then my husband or friends. But because I was working in a large 'managed care' medical group, it eventually became difficult to spend time with patients, always being pressured to see more. Even though financial gain was better in that setting, it wasn't worth it."

"I knew I had to try it on my own, so I started a private practice for the next 3-4 years to test everything I believe. When I say body, mind, soul...I mean it. So when appropriate, I would refer patients to a spiritual director, or cardiologist, dietician, or fitness trainer. Yet as important as those referrals were, patients weren't always getting a consistent message from one practitioner to another. I longed to be able to bring all of those components together within my practice."

Welcome to Lifestyle Medicine Center

Actualizing such a dream would have been financially overwhelming (if not impossible) on her own, but a collaboration arose that turned her dream into reality. The President of Franciscan Medical Group was open to having Dr. Fernandez Kiemele join them for the implementation of this new approach to chronic disease management. So much so, that they built a new facility for Lifestyle Medicine Center which opened January 2009.

"In April 2009, just as our center opened, I attended Harvard's Healthy Kitchen, Healthy Lives seminar in Napa, CA," Dr. Fernandez Kiemele exclaims. "David Eisenberg's presentation regarding the need to have teaching kitchens in healthcare facilities was so exciting; that's what we had just built!"

"Our teaching kitchen is designed to replicate the kitchen in a small home so that people realize they can easily create healthy meals in their own setting; they don't need a showcase kitchen or fancy equipment. The same for exercising at home. We demonstrate in a living room setting to show that exercise is practical, accessible and affordable.

Staffing

The integrative staff, along with Dr. Fernandez Kiemele includes a Behavioral Health Counselor, Registered Dietician, Fitness Trainer, Spiritual Director and Lifestyle Coordinator. "It's not uncommon," explains Dr. Fernandez Kiemele, "for people to first and foremost need to see the Spiritual Director more than the doctor. For example, a healthcare professional who has been diabetic for ten years, on an insulin pump, has high cholesterol, high blood pressure, just wasn't motivated to make changes. She only eats 'junk food' - cakes, candies, potato chips and fast food all day, no regular meals at all. She was considering hypnosis when we addressed the question 'Why isn't she motivated?' In seeing our Spiritual Counselor and Behavioral Health Counselor the focus is now on how she sees herself; what gives her purpose in life, what makes her value herself."  She is now eating breakfast, counting CHO and going outside to pause for ten minutes daily."

Experiential and Practical Prescriptions

Dr. Fernandez Kiemele enthusiasm for this work is contagious. "We empower our program participants by providing hands-on training and experiential knowledge, leading each of them through a life-changing experience to restore and maintain their health. We offer group education as well as the individual consultations and guidance. Sometimes we meet with the patient in their own setting in order to evaluate their current behavior patterns. One very obese patient of ours was convinced that she was already eating only healthy food. Our feedback was a real eye-opener for her after one of her visits with our RD at the grocery store followed by a cooking session in our kitchen. She has now lost 30 pounds in 6 months, decreased her blood pressure and improved her leg and multiple joint pains."

"IMPLEMENTATION is the prevailing difficulty for people, so we are diligent about making our prescriptions for health realistic and possible."

Classes/Events at LMC include First Steps to a Healthy Lifestyle, a free health talk series includes topics such as First Steps to Nutritious and Delicious Food, First Steps to an Active Lifestyle, and more; Inside the Healthy Kitchen, a cooking class series which does require payment, invites each participant inside LMC's Healthy Kitchen to explore preparation strategies and techniques for healthy foods and healthy cooking.

 

Patient Forms and the Measuring of Success

Initial Health History and Food & Exercise Diary are required intake processes, along with vitals, labs -cholesterol, fasting glucose, BMI, body composition for everyone as well as patient-specific data depending on personal and family history. (Both forms can be found on their website.)

Tracking is done via electronic medical records, utilizing Practice Partners software whereby charted clinical elements are tracked for ongoing analysis. The first six months of Lifestyle Medicine Center's tracking were completed last month. So far every patient participating in LMC's programs is improving steadily. Dr. Fernandez Kiemele also tracks those patients to whom lifestyle recommendations have been made, but they undertake them without the assistance of LMC. Positive changes for this group are present but minimal. Dr. Fernandez-Kiemele shared an example that is very typical: "One of our patient's who had been making lifestyle changes on her own for 2 years without success was needing to start medication for blood pressure and high cholesterol but was very resistant to this. She joined the LMC program and after just 3 months, her blood pressure is 110/70, her cholesterol improved by 30% and has been the lowest in 3 years.

The Challenge of Money
Lifestyle change IS effective AND cost effective yet reimbursement is still nebulous. At present Lifestyle Medicine Center offers one year contracts with patients, with monthly payments charged automatically to credit card. "One year participation is important," Dr. Fernandez Kiemele explains, "in order for us to go through the ups and downs, with the patient,  of making lifestyle changes and partner with them for lasting change. And yet so many people who need this extent of care and education are the ones who cannot afford it."

I asked Dr. Fernandez Kiemele if she has researched the DIGMA model. She said she has, and continues to, but at present feels that reimbursement is too inconsistent. Until her work at Lifestyle Medicine Center grows, Dr. Fernandez Kiemele continues to serve patients through her family practice. She refers patients to Lifestyle Medicine Center as a patient's needs dictate.

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.