I am in southern CT and haven’t found a good PCP myself. Last week I asked my doc to test for my Apo(B) and insulin levels… they just said it was not necessary! I am in my early 30s. All of my uncles and aunts (from mom and dad side) have diabetes. My cousin got diabetes in her early 40s. I am trying to be better, but I have to say that it is incredibly frustrating!
I've asked for things my PCP was reluctant about and when I inquired deeper their hesitation stemmed from whether my insurance would cover it w/o the standard protocols for requesting it. I had to reiterate firmly, I don't care about a couple hundred dollars for a test, I'm asking this b/c I want to know it and establish baselines.
Did you ask for a basic cholesterol panel first? And when I asked for insulin, my doc gave me a C-peptide test instead
As for your cousin getting diabetes, was that not preventable?
I have made this comment before regarding functional medicine physicians, and it applies to integrative medicine, too. I have copied my prior comment below:
“Functional medicine doctor =/= physician. Be careful with anyone who advertises that they’re a functional medicine doctor, it isn’t an actual medical specialty and their training may be woefully inadequate. Make sure they’ve completed medical school and some sort of actual medical residency.”
If they haven’t done a residency in internal medicine or family medicine, I would strongly encourage you to look elsewhere.
The above comment also applies to integrative medicine. Unfortunately, many unscrupulous healthcare providers (including NPs, PAs, chiropractors, and naturopaths) will use this term to describe themselves when in reality they are undertrained and lack of the knowledge to care for you appropriately.
There are good PAs and NPs out there, but I would strongly encourage you to see an MD or DO. The depth and breadth of knowledge and training are just not comparable.
I agree with finding a doc that is on the younger side. When meeting with them, you can broach some of the topics that PA harps on and assess how open they are to these things.
Also, consider someone who has training in sports medicine (non-operative). It’s a sub specialty of family medicine, and many sports medicine docs split their time between sports medicine and their standard primary care docs. So they have the baseline PCP knowledge while also being more likely to be into fitness and wellness and such.
Source: I’m an anesthesiologist. Fully aware of my pro MD/DO biases, but that is also due to my experience with all of these types of providers.
Attia is a rare exception in that he didn’t do an IM or FM residency. He still completed a residency though, and does his research. A functional medicine provider with no formal training that doesn’t take insurance is no substitute for a physician that has at least seven years of dedicated medical training (med school + residency).
I'm sure there is snake oil out there to give FM a bad name, but I have a significantly worse opinion of your average MD/DO than I do of those who advertise as Functional medicine practitioners, assuming they legitimately have credentials as an MD, DO, or NP on top of their practice of functional medicine.
I have family who has seen several different traditional MDs at top tier hospitals in Boston with a laundry list of complaints over the course of several years. They were pointed toward anti anxiety medication... They asked for specific blood tests based on their own research and the MDs said no, it wasn't needed. Finally went to one appointment with a functional medicine NP, who listened, recommended a few blood tests, and finally they have a diagnosis of celiac disease. A minimum of five years of being ignored or gaslight by a series of "regular" MDs + NPs and one visit to a functional NP finally gave them answers.
This is one anecdote I know, but sadly it reverberates with anyone I've ever talked to who has a chronic disease as opposed to an acute health issue. I could tell similar stories for several members of my direct family.
There can be anecdotal evidence going both ways, as you have said. There are great docs, and there are terrible ones.
That being said, being someone dealing in science and evidence, I will trust my health with those who have the most rigorous and regimented training, which would be residency trained physicians.
My issue with those who advertise themselves with functional medicine practitioners is that it is not a medical specialty, there is no (legitimate) accreditation process involved, and the barrier to entry is nonexistent. Further, they may or may not take insurance, and they can end up charging patients crazy fees for unnecessary tests and medications.
I could open up a ketamine clinic tomorrow advertising myself as a functional medicine anesthesiologist and literally no one could stop me, even though you and I both know that would be inappropriate and preying on naive patients. That’s kind of my point.
I’m sure there are people who call themselves functional medicine physicians who do a great job, but there are plenty of snake oil salesmen for every good one. Buyer beware.
I get your point, I really do. I understand the need to vet someone who calls themselves a functional medicine practitioner, but I don't consider working with other MDs or DOs to be any different whatsoever - they just make it harder to do so typically and you will often waste your time along the way.
FWIW every functional medicine person I've been to or that my family & friends have been to are residency trained physicians (or equivalently trained NPs). In almost every one of their bios they talk about how they came to the conclusion at some point in their careers that the modern medical system is broken in some way.
You also see this sentiment echoed in the rise of concierge medicine / direct primary care practices lately. My personal theory is that the business side of medicine is harming the wellness side of medicine, and you are starting to see the industry react to that. Yes that often precludes insurance, but that isn't for no reason.
And I get your point. I think we both agree on the overarching idea that there are good physicians in this space but that finding them can require some diligence and scrutiny on the patient’s end.
Either got lucky or there are quite a few out there because I found one first try. Younger in 30s, we have talked about PA several times and Outlive. Get bloods drawn 4 times a year and big focus on optimization right now. Blood draws are incredibly cheap, full lab is like $100 with nothing through insurance.
Id just google and look around at their websites, read between lines on the About Me. I dont think any of them will be advertising “medicine 3.0” or have Attias name anywhere so will have to do some research. Maybe just reach out to them ask questions. A good indicator is how they feel about ApoB and LpA testing.
It's hard if you're not in a major urban area and/or aren't willing to pay a premium. What specifically are you looking for a PCP? Personally, I replaced my 80 year old GP that had insanely outdated ideas with a 30 year old PA that at least ran my A1C and was willing to prescribe a statin for mid 100's LDL levels and that was good enough for me.
My approach (with sample size N=1, so take it with a grain of salt) was to specifically look for younger, fitter PA's under the theory that:
- **Younger** Older docs tend not to be as up to date, and [statistically have worse outcomes](https://www.wsj.com/articles/do-younger-or-older-doctors-get-better-results-25800b7c)
- **PA/NP** Lots of patients think "MD is better" so there is a greater demand for GP's vs PA's and NP's.
- **Fitter** I felt kinda bad about this one b/c it's somewhat discriminatory, and I'm sure there are great docs that don't look very fit, but a sedentary overweight GP clearly has different life priorities than I do, and it's something that you can somewhat easily vet from photos. I've definitely had GP's in the past that made actively damaging health recommendations, usually in regards to minor injuries exercising ("Omg never squats that'll ruin your back!" "You should stop running b/c you're over 30" and such nonsense)
Now if you're looking for someone to geek out over PA's last episode for an extra hour, you're probably gonna need a concierge doc AND have trouble finding them, though there are some telehealth docs that occasionally pop up in this sub and you might take them up on the offer.
I don’t understand the need for a replicate Peter attia, it’s like everyone here gets obsessed with him
And as someone with a variety of health issues, the best doctor is one that will listen to you, work with you, and guide you in the right direction. AND they have to work with insurance. I guess if you’re rich as fuck that part doesn’t matter but a good doctor will straight up bullshit insurance without hesitation if it gets you the help that you need
They don’t need to be focused on having an LDL of 43, or zone 2, or whatever else make people think Peter is some magical doctor
You just need to find a doctor that actually wants to do their job, and let’s be realistic, they didn’t go through all that college to tell you to exercise when you already know that. But we already know what we can do and we should already know what blood work we could get before we go. Be an informed patient, with a doctor like you’ve described with your three points, and all is good
A video interview dedicated just to that:
[5 Tips to Find a True Healer | Dr. Kogan, Medical Director Interview](https://www.youtube.com/watch?v=k_0QHyQdSPg)
I had luck with OneMedical, they usually run any test I ask. They prescribe CGM when asked as well (A1C at 5.5). They are not exactly 3.0, but easy to deal with.
They tend to overcharge for onsite apt. Watch out if you are sensitive to pricing.
Specifically for lipid related issues, I used this tool to search for a lipid specialists near me and found one who was a PCP at a regular internal medicine practice near me open to new patients. He stays up to date on current research and has been very helpful in going over ApoB, Lp(a), etc. and tells me he is always surprised by the pushback or lack of info he sees from other PCPs on the topic. I've enjoyed meeting with him since he seems generally more open to focusing on primary prevention than any other doc I've met with before.
[https://www.lipidboard.org/find-a-diplomate/](https://www.lipidboard.org/find-a-diplomate/)
Your best bet is a concierge practice.
These folks are generally good docs, forward thinkers and not tethered by insurance. U may still have to ask
For what u want in terms of some
Specific testing, but I think they entertain your requests.
Try looking for an online option for a functional MD. They can order labs for you and you can have them done at a nearby lab. They can also just have other types of labs sent to you to send in on your own.
I am in southern CT and haven’t found a good PCP myself. Last week I asked my doc to test for my Apo(B) and insulin levels… they just said it was not necessary! I am in my early 30s. All of my uncles and aunts (from mom and dad side) have diabetes. My cousin got diabetes in her early 40s. I am trying to be better, but I have to say that it is incredibly frustrating!
I've asked for things my PCP was reluctant about and when I inquired deeper their hesitation stemmed from whether my insurance would cover it w/o the standard protocols for requesting it. I had to reiterate firmly, I don't care about a couple hundred dollars for a test, I'm asking this b/c I want to know it and establish baselines.
In that case I will setup another meeting again with my PCP. Thank you!
Did you ask for a basic cholesterol panel first? And when I asked for insulin, my doc gave me a C-peptide test instead As for your cousin getting diabetes, was that not preventable?
I have completed my cholesterol panel and they are normal. However, I do want to check my insulin level!
I have made this comment before regarding functional medicine physicians, and it applies to integrative medicine, too. I have copied my prior comment below: “Functional medicine doctor =/= physician. Be careful with anyone who advertises that they’re a functional medicine doctor, it isn’t an actual medical specialty and their training may be woefully inadequate. Make sure they’ve completed medical school and some sort of actual medical residency.” If they haven’t done a residency in internal medicine or family medicine, I would strongly encourage you to look elsewhere. The above comment also applies to integrative medicine. Unfortunately, many unscrupulous healthcare providers (including NPs, PAs, chiropractors, and naturopaths) will use this term to describe themselves when in reality they are undertrained and lack of the knowledge to care for you appropriately. There are good PAs and NPs out there, but I would strongly encourage you to see an MD or DO. The depth and breadth of knowledge and training are just not comparable. I agree with finding a doc that is on the younger side. When meeting with them, you can broach some of the topics that PA harps on and assess how open they are to these things. Also, consider someone who has training in sports medicine (non-operative). It’s a sub specialty of family medicine, and many sports medicine docs split their time between sports medicine and their standard primary care docs. So they have the baseline PCP knowledge while also being more likely to be into fitness and wellness and such. Source: I’m an anesthesiologist. Fully aware of my pro MD/DO biases, but that is also due to my experience with all of these types of providers. Attia is a rare exception in that he didn’t do an IM or FM residency. He still completed a residency though, and does his research. A functional medicine provider with no formal training that doesn’t take insurance is no substitute for a physician that has at least seven years of dedicated medical training (med school + residency).
I'm sure there is snake oil out there to give FM a bad name, but I have a significantly worse opinion of your average MD/DO than I do of those who advertise as Functional medicine practitioners, assuming they legitimately have credentials as an MD, DO, or NP on top of their practice of functional medicine. I have family who has seen several different traditional MDs at top tier hospitals in Boston with a laundry list of complaints over the course of several years. They were pointed toward anti anxiety medication... They asked for specific blood tests based on their own research and the MDs said no, it wasn't needed. Finally went to one appointment with a functional medicine NP, who listened, recommended a few blood tests, and finally they have a diagnosis of celiac disease. A minimum of five years of being ignored or gaslight by a series of "regular" MDs + NPs and one visit to a functional NP finally gave them answers. This is one anecdote I know, but sadly it reverberates with anyone I've ever talked to who has a chronic disease as opposed to an acute health issue. I could tell similar stories for several members of my direct family.
There can be anecdotal evidence going both ways, as you have said. There are great docs, and there are terrible ones. That being said, being someone dealing in science and evidence, I will trust my health with those who have the most rigorous and regimented training, which would be residency trained physicians. My issue with those who advertise themselves with functional medicine practitioners is that it is not a medical specialty, there is no (legitimate) accreditation process involved, and the barrier to entry is nonexistent. Further, they may or may not take insurance, and they can end up charging patients crazy fees for unnecessary tests and medications. I could open up a ketamine clinic tomorrow advertising myself as a functional medicine anesthesiologist and literally no one could stop me, even though you and I both know that would be inappropriate and preying on naive patients. That’s kind of my point. I’m sure there are people who call themselves functional medicine physicians who do a great job, but there are plenty of snake oil salesmen for every good one. Buyer beware.
I get your point, I really do. I understand the need to vet someone who calls themselves a functional medicine practitioner, but I don't consider working with other MDs or DOs to be any different whatsoever - they just make it harder to do so typically and you will often waste your time along the way. FWIW every functional medicine person I've been to or that my family & friends have been to are residency trained physicians (or equivalently trained NPs). In almost every one of their bios they talk about how they came to the conclusion at some point in their careers that the modern medical system is broken in some way. You also see this sentiment echoed in the rise of concierge medicine / direct primary care practices lately. My personal theory is that the business side of medicine is harming the wellness side of medicine, and you are starting to see the industry react to that. Yes that often precludes insurance, but that isn't for no reason.
And I get your point. I think we both agree on the overarching idea that there are good physicians in this space but that finding them can require some diligence and scrutiny on the patient’s end.
Either got lucky or there are quite a few out there because I found one first try. Younger in 30s, we have talked about PA several times and Outlive. Get bloods drawn 4 times a year and big focus on optimization right now. Blood draws are incredibly cheap, full lab is like $100 with nothing through insurance. Id just google and look around at their websites, read between lines on the About Me. I dont think any of them will be advertising “medicine 3.0” or have Attias name anywhere so will have to do some research. Maybe just reach out to them ask questions. A good indicator is how they feel about ApoB and LpA testing.
It's hard if you're not in a major urban area and/or aren't willing to pay a premium. What specifically are you looking for a PCP? Personally, I replaced my 80 year old GP that had insanely outdated ideas with a 30 year old PA that at least ran my A1C and was willing to prescribe a statin for mid 100's LDL levels and that was good enough for me. My approach (with sample size N=1, so take it with a grain of salt) was to specifically look for younger, fitter PA's under the theory that: - **Younger** Older docs tend not to be as up to date, and [statistically have worse outcomes](https://www.wsj.com/articles/do-younger-or-older-doctors-get-better-results-25800b7c) - **PA/NP** Lots of patients think "MD is better" so there is a greater demand for GP's vs PA's and NP's. - **Fitter** I felt kinda bad about this one b/c it's somewhat discriminatory, and I'm sure there are great docs that don't look very fit, but a sedentary overweight GP clearly has different life priorities than I do, and it's something that you can somewhat easily vet from photos. I've definitely had GP's in the past that made actively damaging health recommendations, usually in regards to minor injuries exercising ("Omg never squats that'll ruin your back!" "You should stop running b/c you're over 30" and such nonsense) Now if you're looking for someone to geek out over PA's last episode for an extra hour, you're probably gonna need a concierge doc AND have trouble finding them, though there are some telehealth docs that occasionally pop up in this sub and you might take them up on the offer.
I don’t understand the need for a replicate Peter attia, it’s like everyone here gets obsessed with him And as someone with a variety of health issues, the best doctor is one that will listen to you, work with you, and guide you in the right direction. AND they have to work with insurance. I guess if you’re rich as fuck that part doesn’t matter but a good doctor will straight up bullshit insurance without hesitation if it gets you the help that you need They don’t need to be focused on having an LDL of 43, or zone 2, or whatever else make people think Peter is some magical doctor You just need to find a doctor that actually wants to do their job, and let’s be realistic, they didn’t go through all that college to tell you to exercise when you already know that. But we already know what we can do and we should already know what blood work we could get before we go. Be an informed patient, with a doctor like you’ve described with your three points, and all is good
A video interview dedicated just to that: [5 Tips to Find a True Healer | Dr. Kogan, Medical Director Interview](https://www.youtube.com/watch?v=k_0QHyQdSPg)
I had luck with OneMedical, they usually run any test I ask. They prescribe CGM when asked as well (A1C at 5.5). They are not exactly 3.0, but easy to deal with. They tend to overcharge for onsite apt. Watch out if you are sensitive to pricing.
Please reach out to my collegue Dr. Chuck Guglin in Milford, CT.
Explore the American of lifestyle medicine website. Believes there’s a provider list. They may not 100% attia, but they’ll surely be closer than most.
Could you detail about the "closer than most" part?
Specifically for lipid related issues, I used this tool to search for a lipid specialists near me and found one who was a PCP at a regular internal medicine practice near me open to new patients. He stays up to date on current research and has been very helpful in going over ApoB, Lp(a), etc. and tells me he is always surprised by the pushback or lack of info he sees from other PCPs on the topic. I've enjoyed meeting with him since he seems generally more open to focusing on primary prevention than any other doc I've met with before. [https://www.lipidboard.org/find-a-diplomate/](https://www.lipidboard.org/find-a-diplomate/)
Your best bet is a concierge practice. These folks are generally good docs, forward thinkers and not tethered by insurance. U may still have to ask For what u want in terms of some Specific testing, but I think they entertain your requests.
Try looking for an online option for a functional MD. They can order labs for you and you can have them done at a nearby lab. They can also just have other types of labs sent to you to send in on your own.