Detroit Medical Students Run a Free Medical Clinic

For the last 6 years I've been volunteering at a free medical clinic on Detroit's East Side called the Robert R. Frank Student Run Free Clinic or the SRFC. The SRFC services Detroit residents who are uninsured, and as their name implies, it is run by medical students.

Last night we had a stakeholders meeting and I am continually impressed by these medical students and their diligence, commitment, and compassion. 

If you'd like to help these students serve more uninsured Detroit citizens, you can donate here, participate in their upcoming 5K, or participate in their upcoming Golf Outing (date TBD). 

Heart Health in Detroit Video

Because it's February and it's heart health month, I shot a short video about high blood pressure, changes in blood pressure thresholds, and what you can do to keep your heart healthy!

Heart Health on SEEN Magazine

Today is Valentine's Day and it's a great time to talk about heart health aka cardiovascular health. We were invited to write a blog post for Detroit's SEEN Magazine and it is now live and currently on their front page! Head over to their website to read the full article, here.

Thanks for reading,

- Dr. Paul Thomas with Plum Health DPC

Morris S. Brent Lectureship at Wayne State Medical School

I'm excited to announce that I will be giving a lecture to my medical colleagues at Wayne State University School of Medicine's Sesquicentennial Celebration. A part of that Sesquicentennial Celebration is the Medical Alumni Reunion Weekend, which features the Dr. Morris S. Brent Lectureship. 

Image taken from Wayne State University's website, https://alumni.med.wayne.edu/mard

My topic is "WSU SOM - 150 Years of Medical Excellence & Innovation" and I'm proud of the rich history of Wayne State. A few notable facts: 

• What is now WSU SOM was originally founded as the Detroit Medical College by five US Civil War Veterans in 1868, thus 2018 is the year of the Sesquicentennial Celebration
• WSU SOM is the birthplace of the mechanical heart pump used in the world's first successful open heart surgery in 1952; it was a collaboration between General Motors and Forest Dodrill, MD
• In 2015, WSU SOM remains on the forefront of medical research as they opened the Integrative Biosciences Center, which aims to study and eliminate the health disparities affecting Detroit's residents.

After the break, there is a description of the Morris S. Brent Lectureship series in greater detail. Thanks for reading, and have a great day,

- Dr. Paul Thomas with Plum Health DPC

The Dr. Morris S. Brent Lectureship was established at the Wayne State University School of Medicine in 1989 by Brent General Hospital in honor of the late Morris S. Brent, M.D., to provide quality lecturers for continuing medical education during Medical Alumni Reunion Day. Dr. Brent, grew up in Detroit, attended Cass Technical High School and received two degrees from Wayne State University, a bachelor's degree in 1927 and a medical degree in 1931. He spent much of his career in general practice, specializing in surgery and obstetrics. In 1942, he founded Brent General Hospital, a non-profit corporation, and served as its administrator until his retirement. He married Anne, a dental hygienist, and they had two sons, Burton Brent, a graduate of Chicago Medical School, and Robert Brent, a graduate of the WSU School of Medicine (Class of 1960).

The Dr. Morris S. Brent Lectureship will take place in the Richard J. Mazurek, M.D., Medical Education Commons Margherio Family Conference Center. This year's program provides continuing medical education credits and feature presenters from our own Wayne State family of physicians who will speak on a variety of interesting topics.
 

Paul Thomas MD TEDxDetroit Video

THE DAY HAS FINALLY ARRIVED! Our talk at TEDxDetroit has been posted on YouTube! Check it out here: 

In case you missed the original blog post after the TEDxDetroit event, check out my thoughts on speaking during the event, here. 

Thanks for reading and have a wonderful day!

- Dr. Paul Thomas with Plum Health DPC

The Radically Accessible Doctor in Detroit

This week, we took on a new patient on a Sunday evening. They had developed a pretty serious abscess in their armpit over the Thanksgiving weekend. On their drive home, they realized that they should probably have it looked at. By searching Google, they found our clinic!

Our new patient searched "Doctor Open Today", that's when they found Plum Health DPC!

Because it was a Sunday evening, they knew that it would be difficult to find an available doctor in Detroit. They searched "Doctor Open Today" and fortunately found our Plum Health clinic. 

I believe that health care should be affordable and accessible. Because of that belief, I am radically accessible for the patients in my care. 

So, that patient called around 2:30 pm on Sunday, and I was able to see them at 4:20 pm. We drained the abscess and started the appropriate antibiotic, dispensed from our in-clinic/on-site pharmacy. They had a follow up appointment during regular business hours on Tuesday, and was feeling much better!

Thanks for reading, and have a great day!

- Dr. Paul Thomas with Plum Health DPC

Healthy Aging in Detroit

Let me tell you about one of my favorite things: educating people in the community about how they can be healthier. 

Today I was invited to the Earnest T Ford Recreation Center at 10 Pitkin Street in Highland Park to speak with a group of older men. They had questions and concerns about their health and their health care, and it was a pleasure speaking with them.

This group of senior citizens wanted to know how they could better their lives, and they peppered me with as many questions as they could think of, and I loved it. I love sharing my knowledge as a practicing family medicine doc with the people in my community. 

I especially enjoyed seeing the 'aha!' moments when things started to click with those men in my audience. We talked about high blood pressure, diabetes, erectile function and dysfunction, the aging brain, exercise, osteoporosis and bone health, and the connections between these conditions. Below are some pictures from the event!

Thanks for reading, and have a wonderful day,

- Dr. Paul Thomas with Plum Health in Detroit, MI

Health Fair with the Wayne State Physicians Assistants

Over the past 6 months I've been hosting and teaching Physician Assistant students from Wayne State University at the Plum Health office. I've also had a few residents rotate through and a few medical students visit the clinic, some from Wayne State and some from University of Michigan. 

As Plum Health is the only Direct Primary Care practice in Detroit and Wayne County, and only one of less than ten in the State of Michigan, I find that we attract PA students, medical students, residents, doctors and allied health professionals who are thinking differently about health care and it's delivery, especially in the context of health equity and health disparities. 

Anyways, I've loved having these students rotate through Plum Health! They bring a unique perspective, build genuine relationships with our members, and create an atmosphere of teaching and learning in the practice. This last point is important because I practice evidence-based medicine, and having a student helps to keep me up-to-date on the latest recommendations for evidence-based practice. 

So last weekend, we were able to host a health fair at the Plum Health office. "We" being myself and the Physician Assistant students at Wayne State. Their energy was boundless and they put a great deal of time and effort in creating fun health-focused stations that taught participants about being healthier.

All in all, it was a successful day! We reached out to new people in the community, and gave away free medical care. We caught a case of diabetes that was unknown prior to the fair and helped folks gauge their blood pressure, blood sugar, and cholesterol levels (HDL, LDL, Total Cholesterol and Lipid Panel). 

Below are photos from the event! Thanks for reading, and have a great day!

- Dr. Paul Thomas with Plum Health DPC in Detroit, Michigan

Don't Further Entrench an Already Broken System

Dear Congressional Representatives, Leaders in the AAFP, and all of those concerned with improving the health of Americans,

I’ve recently become aware of a part of the Alexander-Murray health reform bill that is concerning for the Direct Primary Care (DPC) movement, my practice and the patients that I care for in Southwest Detroit.

The bill includes a provision that mandates all High Deductible Health Plans cover an allotted primary care benefit. As written currently, the Alexander-Murray bill will cover “3 office visits per year” but many organizations, including the American Academy of Family Physicians (AAFP), are pushing to expand that.

While this may sound like a nice perk for patients, it only further traps patients and their primary care doctors in a broken system that undervalues primary care. It reinforces the notion that government and insurance companies must micromanage our dollars and decisions.

Forcing patients to pre-pay for a “primary care benefit” with no out-of-pocket costs will have a few detrimental effects. First, it will almost certainly increase the up-front costs of already skyrocketing health insurance plans. It will also dissuade patients from taking a proactive approach to managing their own health and health care, instead pushing them to be managed by an insurance plan or government programs. Finally, this pre-paid primary care benefit will discourage people from joining Direct Primary Care Practices, a promising practice model that is already achieving the quadruple aim: improving population health, increasing patient satisfaction, reducing per-capita health care spending, and improving physician and staff satisfaction while practicing medicine.

Furthermore, the Alexander-Murray bill fails to address the Health Savings Account (HSA) issue with regards to Direct Primary Care membership fees, something that my DPC doctor colleagues and I have been advocating for over the last few years.

My recommendation at this time would be to advocate for the Primary Care Enhancement Act (SB 1358), which would address the above HSA issue and not further entrench an already broken primary care delivery model.

In closing, Direct Primary Care is an innovative health care delivery model that has promise for achieving the quadruple aim on a nationwide basis. There are nearly 1,000 primary care doctors already practicing or on the cusp of engaging in this model. This is an opportunity to help us grow this DPC movement, to help us better serve our patients in this innovative way, and to potentially heal a broken primary care system in America. Help us reach our goal.

Thank you for your time and consideration,

- Dr. Paul Thomas, MD with Plum Health DPC in Detroit, Michigan

Direct Primary Care Conference 2017

Today I'm blogging from Orlando! The 2017 Direct Primary Care Nuts and Bolts 2.0 conference is ongoing! There are some heavy hitters in the room, and it's great to meet up with colleagues and learn best practices. Moreover, this is a call to action - it's inspiring being surrounded by 250 of the leaders in the Direct Primary Care movement!

These doctors have left a secure paycheck, given up on their employed gigs and pursued their dream of delivering the best care possible for their patients. I'm always inspired by their courage in the face of uncertainty and their dedication to lifting up the profession of primary care. 

One of the most inspiring talks of this conference was given by Dr. Doug Farrago. He received a standing ovation after sharing his truth about why he's a Direct Primary Care doctor. He detailed his trajectory from being a battered employed doctor, threatened with termination if he questioned his marching orders, to leaving the system and practicing in a DPC model with fulfillment. 

A big thanks to Dr. Lee Gross and the Docs 4 Patient Care team who have organized this conference. I'm looking forward to 'next time'!

- Dr. Paul with Plum Health in Detroit, Michigan

Family Doctor at the Open Streets Detroit Event

Last week I had the opportunity to be on the street level, talking with folks about health care at the Open Streets Detroit event! For those of you who don't know, Open Streets is a global movement. Cities across the country and across the world shut down their streets to cars and buses, and open them up to walkers, joggers, bikers, rollerbladers and community partners. 

This year, I again participated as the "Ask the Doctor!" community partner. Last year I participated as well, but I wanted to make my area more interactive this year. So, I brought out a hockey net, a few sticks and I had people take a few shots on me. I've never been a great goalie, but it was a fun way to interact with folks in Corktown. 

Our station was in front of the Michigan Central Station and I spoke with hundreds of people over the course of the day. There were thousands of participants, and the streets were filled with energy and vibrancy! I'm really looking forward to the 'next time,' but until then, enjoy some pictures of Open Streets Detroit 2017!

Mentoring Students at Wayne State University School of Medicine

Part of my mission, part of the "why" behind what I do, is to educate medical students and inspire them to choose a career in primary care specialties. Primary care doctors have the greatest impact on their communities, have the most tools at their disposal, and are most able to bend the cost curve in the health care ecosystem.

As a part of that mission, I spend a good amount of time interacting with medical students at Wayne State University School of Medicine (WSUSOM). This week, I took part in two different events at WSUSOM. The first was a mentoring session for first year students and the second was a mock interview session for the fourth year students. 

For the first year students, it's an opportunity to get to know each other, learn from each other, and to be a resource. For the fourth year students, it's an opportunity to help them polish their interviewing skills as they prepare for the next step in their careers - residency! 

This next generation of doctors will face significant changes and challenges in the health care system - from greater automation, to precision medicine, to even Artificial Intelligence. I hope that I can be a part of the foundation along with their formal education at WSUSOM that sets them on the right path to success in medicine. 

Thanks for reading, and have a beautiful day,

- Dr. Paul Thomas with Plum Health DPC

Drew and Mike on Health Care

I was listening to the Drew and Mike Podcast from September 26th, and Drew and his Crew were talking about how health insurance costs are outrageous! Early in the episode (time 1:16), one of the co-hosts admonished Drew Lane, "you can barely afford insurance for yourself!" This set off a conversation about the cost of health insurance, the little coverage that it affords and Drew Lane's displeasure with the overall system. 

Drew's first reaction (minute 1:28), "I don't know how people my age, in my position," not yet covered by Medicare, "and self-employed... ...that's a big chunk of money." He goes on to say that his insurance costs roughly $18,000 - 19,000/year and if you were to make $50,000/year, it would cost roughly 30% of your gross income. 

Because of this extremely high cost, Drew and his co-hosts speculate that some folks just choose to "roll the dice," i.e. go without insurance and hope for the best. They do mention that those folks earning less may be eligible for subsidies or tax breaks from the Federal Government. But, still - a huge chunk of our income is going directly to health insurance and health insurance companies. Even worse, the quality and service levels can be low because care is dictated by third party payers like insurance companies or the government. 

Because Drew's dog recently had eye surgery, Drew was talking about how veterinarians discuss charges before providing care, and how that concept should be applied to the human medical field. "Wouldn't that be something?" Drew asks rhetorically. 

Well, it doesn't have to be a rhetorical question. It doesn't have to be a pipe dream. I'm here to tell you that Direct Primary Care doctors make their prices clear and transparent, and it may revolutionize primary care!

Here's how it works: Direct Primary Care (DPC) is a membership model for health care. Prices vary between different DPC practices, but our prices at Plum Health are $10/month for kids, $49/month for young adults 18 - 40, $69/month for adults 40 - 65, and $89/month for older adults 65 and up. 

With that membership, patients or members can come in and see the doctor any time! They can also call, text or email the doctor anytime. 

Further, patients or members can have access to wholesale medications, at-cost labs, and at-cost imaging services. So far we've saved our members tens of thousands of dollars on these ancillary services. 

I shot a video explaining these concepts in more detail, here:

Thanks so much for reading and watching. I hope that I've opened your eyes to the possibility of better health care services with a transparent pricing structure.  Finally, have a wonderful day!

- Dr. Paul Thomas with Plum Health in Detroit, MI

Motivation to Quit Smoking

We are all on a journey, and at Plum Health we like to guide people to better lifestyle choices. For example, if you're trying to quit smoking, we can help you by reminding you of your commitment. 

How do we do this? It's really simple, actually. We just send you a text message! Here's a real life example, sent to one of our members last week: 

These are real text messages, and this is a real patient. Their name has been removed for patient privacy sake, but you get the idea. When you're a part of Plum Health, you are someone who I think about and that I care about and that I want to help. Sincerely, whenever I think about this person, I send them a text and ask - "how's it going?"

And, there is a great deal of evidence to support these types of interventions. There is a systemic review/meta analysis on Text Messaging-Based Interventions for Smoking Cessation in the Journal of Medical Internet Research that came to this conclusion: "The current meta-analytic review provides unequivocal support for the efficacy of text messaging interventions for smoking abstinence."

That's why I send messages like this:

Further, texting patients about their health can have different applications. For example, a text message to a patient regarding their exercise patterns or medication adherence can help them to achieve their goals.

So, what's your goal? How do you want to become healthier? Can I help you get there?

Thanks for reading, and have a great day!

- Dr. Paul with Plum Health 

A Golden Apple in My Office

This week, I was taking care of a family of 6 in my office! There was a lot of joyful movement and one of the toddlers grabbed an item from its resting place- it's an Apple, a Golden Apple, that I keep on my shelf and it's a reminder of my mission, vision, and values. 

When I was in medical school at Wayne State University, I was awarded with the Golden Apple Student Award for having an understanding of the Art of Medicine as displayed by the care and understanding of patients. It was a tremendous honor, and it's something that I carry with me, as well as something that I want to give to my patients and reflect in my practice.

Often, my patients will ask me about the best course of action going forward, and sometimes the answer isn't always clear. You see, there's the science of medicine, the reproducible, empiric evidence with its best practices and treatment recommendations. These guidelines are important to know and important to follow in most cases. But, on the other side, is the Art of Medicine, and because every one is unique, an individual, with unique medical concerns, treatment choices aren't always clearly defined. 

When difficult choices need to be made, I often ask my patients which course of action they'd like to pursue. This may be a unique aspect to my practice, but I know that it's important to engage in shared decision-making with the people that I care for. When decisions are made together, we can be on the same page about treatment, compliance to the plan is higher, and people feel like they have more control over the condition and situation. 

Thanks so much for reading and have a wonderful day,

- Dr. Paul with Plum Health

Why It's Important to Have a Family Medicine Doctor in Detroit

Today I had the pleasure of speaking with Keith White of the Cancer Awareness Resource Network. We talked over the phone about his organization, the work we're doing with Plum Health, and the potential that we have to serve folks with cancer in Detroit and beyond. 

Keith has had an amazing and inspiring journey. To read about him, check out what he wrote on his "about us"page. One thing Keith realized, though, is that even if folks have great health insurance, they may still have really high co-pays for doctor's visits and medications. He reached out to see what Plum Health could offer those with cancer and those in remission in his network. 

Simply put, we can offer the best primary care experience in Detroit. What that means is that you have a Family Medicine Doctor or a Primary Care Doctor who is truly your advocate. I take my role seriously, and I will advocate for your health and wellbeing, your family and your finances while you confront cancer. How do we do this? 

First, I focus on you and take a wholistic approach to your care. I have more time to spend with you, to get to know you and understand where you're coming from, what you're dealing with, and where you want to go with your life and your health. As your family doc, I will make sure that you're taking the right medications, that you are getting the right screening tests, and keeping up with treatment.

Second, I take care of folks in the context of their families and their communities. If there are emotional or familial stressors, we can talk about those and look for solutions together.

Third, I watch out for the financial wellbeing of my patients. This means that I make my prices clear and understandable, I don't charge co-pays for visits, and I give my members medications at wholesale prices. 

Cancer and its treatment are hard enough, so when facing these difficulties, you want a primary care doctor who knows you well and who can advocate on your behalf. 

Thanks for reading, and have a wonderful day,

Dr. Paul Thomas with Plum Health

The current look of our Plum Health Direct Primary Care office in Detroit, Michigan

Hatch Detroit 2017 Application

Today, we submitted our application for Hatch Detroit 2017. Our company is called Plum Health DPC and we deliver affordable, accessible healthcare services in Detroit. We offer street level, neighborhood-based medicine in a city with very few primary care medical resources. There are roughly 50 - 100 primary care doctors in a city of 683,000 people, or roughly 1 doctor for every 6,000 - 12,000 Detroit residents.

This lack of access to primary care has a net negative effect on the city. Medical problems go untreated, worsening the burden of disease in the city for all maladies from diabetes, to high blood pressure, and cancer. Residents who cannot get in to see Detroit-based doctors must drive to the suburbs for services, causing inconvenience and costing the city in terms of tax revenue.

The Hatch Detroit 2017 grant is an opportunity for $50,000 in cash, along with support services ranging from legal to accounting, and beyond. With this $50,000, we would be able to hire a second doctor as soon as possible. This has an immediate benefit for the community in that we can get another doctor in Detroit to provide holistic and comprehensive primary care services. 

We believe that primary care services are invaluable for a community, especially in a City like Detroit. The type and amount of value that we give to the community will exceed the initial investment from this grant competition, should we be so fortunate as to be considered for the prize.

In effect, this $50,000 yields immediate impact. First, the Detroit community gets a desperately-needed primary care doctor in a street-level, community-facing medical practice. More screening tests are ordered, more colon, lung, prostate and breast cancer cases are caught early. More diabetic and hypertensive patients have their blood sugar and blood pressures controlled, resulting in lower heart attack and stroke rates in the years ahead.

I know it's not super sexy! But it is vital for a functioning city and truly revitalized neighborhoods. In keeping with the Mayor's vision of 20 minute neighborhoods, having a neighborhood family medicine doctor can only serve to strengthen Detroit's neighborhoods and the future of Detroit in general.

Thank you for reading and for watching,

Dr. Paul Thomas with Plum Health in Detroit, Michigan 

Plum Health July Update

The last 3 weeks have been a whirlwind! About 3 weeks ago, we were featured on Channel 4 news in Detroit, aka WDIV. Within the week, we had roughly 2,000 unique page views, 100 phone calls, 200 emails, and 30 - 35 new sign ups for our service. It was an overwhelmingly positive response.

Our focus has been to take really good care of the new folks who signed up while maintaining our excellent standard of care for the people already signed up for our service. Our focus is on quality, not quantity.

Also, I attended the AAFP's Direct Primary Care Summit in Washington DC and met with some legislators and legislative assistants to discuss DPC and what we do at Plum Health in Detroit. This was a great trip and a great chance to talk with legislators about what we do at Plum Health and in the Direct Primary Care model, but also talk with our DPC colleagues. 

Furthermore, we continue to save our members significant amounts of money on their medications, labs and imaging. We had a person sign up who was charged $100 for 10 tablets of valacyclovir (Valatrex). This medication is used to treat genital herpes. At our clinic, it costs about $2.35 for 10 tablets because it costs $0.23/pill. 

Thanks for reading and have a great day,

Dr. Paul Thomas with Plum Health DPC in Detroit, Michigan

Plum Health featured in Good Life Detroit

This week, Plum Health DPC was featured on the blog Good Life Detroit. Jennifer is the creative spirit behind Good Life Detroit, and she did a fantastic job writing about our clinic and Direct Primary Care in general.

I really appreciated her perspective as a mother - she notes in the article that she has 5 children! - and that she paid $125 for a 20 minute doctor's visit for one of her children. Contrast that with our clinic, her child could have been seen for a full year for $120, with as many visits as needed included in that price. 

This is how we make our primary care services valuable for the community that we serve. If you were not aware, Detroit is a large, low-income population. We recognize this as a fact, and have adjusted our pricing to be accommodating for the community that we serve. 

Another great point that she brought up in the article is the frustration that people can experience when trying to reach their doctor! Sometimes reaching the doctor can be like pulling teeth. She puts it more eloquently, here: 

"Another great benefit of Plum Health Direct Primary Care is patients have the opportunity to speak directly to Dr. Paul without the hassle of long wait times and call screenings. Instead of having to go through a series of steps just to talk to their doctor, patients can call, text, or email Dr. Paul directly. In some cases, some doctors require you to leave a message with the office staff for a callback.

"Most of the time the office staff member screen’s the doctor’s calls and you have to tell the staff member exactly what it is you need or what your question is. Then you wait for the doctor to call you back, which can be anywhere from the same day or one to two days later, all depending on the doctor’s schedule.

"Members of Plum Health have Dr. Paul’s cell phone number and email address. They can reach him anytime they need to ask a question in regards to their health."

There are several other great points that she makes throughout the article. I was really impressed at her depth and thoroughness. I also appreciate her helping to get the word out about affordable, accessible health care in #Detroit. We're trying to serve as many folks who need this type of care, and articles like these help us to reach communities outside of our circle of influence. 

Thanks for reading and have a wonderful day,

Dr. Paul Thomas with Plum Health Direct Primary Care 

Plum Health Direct Primary Care is in Detroit, Michigan. We practice old-fashioned family medicine, but we use technology to make ourselves more accessible to our patients when they need us! I love this graphic that Jennifer at Good Life Detroit created for us! 

I also really liked this graphic that Good Life Detroit made about our pricing tiers at Plum Health DPC - really easy to read and understand! 

Plum Health Advocating for Direct Primary Care in Washington DC

This week we're in Washington DC, advocating for affordable, accessible healthcare services on Capitol Hill. We're meeting with the offices of Senator Stabenow, Senator Peters, Congresswoman Lawrence, and Congressman Conyers. This is one of those moments where I feel like the mission that I'm on is bigger than the community that I live in and bigger than my city and my state. Access to affordable health care is a National concern and our representatives and their office personnel have given us open ears. 

On Thursday morning, I boarded a plane to DC. That day, I met up with several of my Direct Primary Care colleagues at the DPC Summit 2017. We took a bus from our hotel in Crystal City to the Dirksen Building on Capitol Hill. We received instructions from our advisors about how to talk to our legislators: be authentic and tell your story. 

Here's the video I shot in the Detroit Metro Airport prior to taking off:

After our briefing, I was able to meet up with legislative assistants from the offices of Senator Stabenow, Senator Peters, Congressman Conyers, and Congresswoman Lawrence. Here's a video I shot inside the atrium of the Hart Senate Office Building:

The Hart Senate Office Building houses the offices of Senator Peters and Senator Stabenow. I was bouncing between this building and the Rayburn House Office Building, where Congresswoman Lawrence and Congressman Conyers have their offices. Here's a video I shot just outside of the Rayburn House Office Building:

Thanks for reading and watching, and have a great day,

- Dr. Paul Thomas with Plum Health DPC in Detroit, Michigan