About three years ago, around the time healthcare was saying its last goodbyes to solo practitioners, I decided to plunge into the world of private practice and one morning announced to my family, “I am starting a new primary care solo practice.” I am an Internist of Asian Indian origin and I graduated from residency about twenty years ago. To say that my family was bewildered is an understatement as I saw a mix of confusion, astonishment and concern on the faces of my three children and husband. The fact that I was almost 50 years of age had a lot to do with it. But that was not all. We live in an affluent town in New Jersey and I am Medical Director at the local hospital, the best part of which is that I walk to work. My friends driving by will often chide, “Long commute Kavita!” Why would someone in my position make a foray into an area with a very capricious future, that of a solo private practitioner?
At a personal level, it was a long and difficult decision. I graduated from medical school in India and came to the US after marriage. Along the way I got my Masters in Public Health from Columbia University and I liked being on the other side of healthcare for a change. I worked as an administrator at the hospital and kept up my clinical skills by working at the community health center affiliated with the hospital, so I had the best of both worlds. But I was getting frustrated treating 30-year-olds for three chronic illnesses which could have been better addressed with nutrition and exercise, regrettably which third-party reimbursements would not allow me time to do. With almost a third of the national population overweight or obese I knew something had to be done. I finally decided to practice wellness medicine and integrate weight loss and nutrition into my primary care practice. I planned to roll it out in three phases: primary care followed by weight loss and lastly nutrition, over 2-3 years.
But first I had to learn about nutrition. Unfortunately the focus of medical school training in my time (and possibly even now) was on disease management and not wellness. So I went back to school at Columbia University’s Institute of Human Nutrition which has a work-study program for professionals such as myself. What I learned there changed my perspective on nutrition both personally and professionally. I learned that patients will follow recommendations so long as they are made simple. Most patients need to be educated on changes in their dietary patterns in order to achieve their health goals. So I started to ask them about what they ate during their annual physical and medical visits. I explained dietary guidelines and exercise recommendations. Last year I introduced a medical weight loss program. The program has four components: medical evaluation and follow-up visits as necessary, weekly group sessions, weekly meditation classes and monthly cooking classes. For those who are not able to lower their caloric intake with food, I offer meal replacements. The group sessions help with behavioral aspects of weight gain and eating patterns. In January 2018, I am introducing two nutrition programs: Nutrition in Diabetes and Heart-Healthy Nutrition. The components of the programs remain the same but the group sessions and cooking classes will focus on the specific topics.
I think it’s time to usher in a new model of primary care that focuses on the wellness of our patients. My professional journey with nutrition and weight loss has taught me many lessons: that it clearly works, that it takes time and that it needs to be reiterated, but most of all it has to be a partnership between the physician and patient. Gone are the days when physicians spoke more and listened less. Now with newer techniques of motivational interviewing and harm reduction, I speak less and allow my patients to talk more. Telling our patients to eat healthy is not sufficient; we need to show them how to cook and how much to eat. We need to explain that exercise is personal and that while others are climbing mountains and spinning, if they could focus on being less sedentary and just walk in the park, they would do themselves a world of good. Lastly while the body needs to be worked, the mind needs to be rested. Mindfulness meditation or any kind of meditation helps rest the mind and reduce stress. The premise of my practice is that you don’t have to see your doctor only when you are sick: you should see your doctor in sickness and in health.
Dr. Kavita Kewalramani started a wellness-based practice in New Providence, NJ in 2015. She has a teaching kitchen and meditation room in her office. You may call 908-206-4676 to schedule an appointment.
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