Further information


This practice involves the use of traditional medical treatment, however the importance of learning about and being open to treatments and approaches that have not yet reached mainstream practice is also recognized. In medicine it is wise to avoid extremes. Efforts should be made to scale back or stop medications that are causing adverse effects or are not providing a justifiable benefit to a patient. At the same time it is often necessary to use medications in cases where lifestyle changes (such as changes to diet, exercise, and sleep habits) may be insufficient to correct a problem.

A healthcare provider should never be satisfied that he or she knows everything about his or her field of expertise. I take time to look things up when it is felt that further information is needed. In this way clinical knowledge continues to expand and ability to help those with challenging problems continues to increase.

What to expect with an evaluation

Generally, the patients treated in this practice do not have routine problems that are easy to diagnose and/or treat by a primary care provider. At the first visit, the focus is performing a thorough, detailed evaluation and coming up with an initial plan. Typically a full morning or afternoon is set aside for a patient's first visit to be able to go through the several individual issues that may be present (eg, body pain, headaches, fatigue, cognitive issues, difficulty with standing, sleep problems). Doing a thorough assessment at the first visit is a more efficient approach for addressing complicated health problems than going through multiple visits and learning of different parts of a patient's illness in a piecemeal fashion. Typically several treatments that have been considered will be laid out, and then a smaller number of measures selected to start out with. At the second visit, further information is gathered and the treatment plan is further developed. This visit also usually extends beyond an hour although it is not as detailed as the first visit. During these initial visits, significant time is spent in helping patients learn about their condition and discussing treatments.

Responses to different treatments range from no effect (or adverse effects) to dramatic improvement. It is usually better to work on treatments in a stepwise fashion. The number of things done at each visit should balance the need for making progress with the need to know whether each individual aspect of the treatment is working or not. Sometimes, depending on the circumstances, I may plan a telephone follow-up, so that in case a treatment is not working, we can try a back-up treatment without having to wait for the next in-person visit. It is important to have realistic expectations regarding the progress of one's treatment, and to follow treatment recommendations to determine which ones are helpful.

What is not routinely treated

This is an internal medicine practice. Young children are not treated, although adolescents may be treated, particularly those with chronic fatigue or widespread pain issues. Generally, this practice does not involved routine obstetric (pregnancy), gynecologic, reproductive, or surgical care. Issues such as diabetes and hypertension could at times be treated, however for these you may want to consider a regular primary care provider.

One primary focus of this practice is to evaluate unexplained pain (particularly fibromyalgia and similar issues). However, this practice does not serve as a "pain clinic" and does not focus on prescribing opioid (narcotic) prescriptions or on managing issues such as routine cases of back pain as a standalone problem. Other clinics have specific expertise in managing these types of pain-related issues. However, if you are experiencing some form of pain and wish to have it evaluated, please feel free to call and discuss this.

Insurance coverage

At this point unfortunately I do not take Medicare due to the obstacle of dealing with regulations, etc. Rates are very reasonable so that in other cases where I am out of network on insurance, patients may hopefully still be able to afford to come in. Current charges are such that a 3-hour new patient visit at this office may not cost much more than what insurance is charged for a 1-hour new patient visit at a regular office. Rates can be explained in greater detail by telephone.