Lindsey Mcilvena, M.D., has nothing against physicians, being one herself. However, she believes you should solve more of your own health problems before you have to make that trip to the waiting room.
As a freshly stamped doctor out of the University of Missouri-Kansas City Medical School, Mcilvena (pronounced “MAC-ill-vena”) learned fast. She was halfway through her residency in internal medicine-pediatrics when she realized she wanted to travel a different road.
She did not want to work for a large health provider and see each patient for 15 minutes, and then have a bell ring in her head that it was time to shuffle the patient out.
She did not prefer to treat patients after they got sick. She wanted to help them not get sick. So, she took the large step — some might say rash — of changing her specialty. As though 10 years studying medicine were not enough, she took a step backward and, in one sense, started fresh. But fresh felt good.
She chose “preventive medicine.” She first had to get a master’s degree in public health, a requisite for the specialty. She also knew with such a practice that she would never be chief of staff of a large hospital, would perhaps never be able to afford that new Mercedes. And if some prestigious surgeon were told of her specialty, the response might be, “What’s that?”
After finishing her residency at Loma Linda University Medical Center, Mcilvena, 31, decided to practice in North County because her husband, David, is employed as an engineer in Carlsbad. She started checking the “help wanted” ads for doctors. (Yes, there is such a thing.)
“I went into physician databases and did a search on what jobs were available,” she says. “There wasn’t even a listing box for preventive medicine. At some point, I realized that if I want to see patients, and if I want to do prevention full time, then I’m just going to have to open my own practice.”
Mcilvena chose Encinitas in July 2014. As she expected, when anyone new in town opens a practice or any new business, they spend a lot of time staring at the telephone. That’s the startup cost.
Being a fellow with an appraising eye, I ask: When someone comes to see you and notices that you’re young and attractive .... Am I the first to tell you that?
“I don’t think so. Maybe the second,” she says with a sly grin. “I got some of that in residency. I remember a patient who would not quit saying, ‘Are you sure that you’re old enough to be a doctor?’ I kept showing him my badge and saying, ‘See, I have an M.D. behind my name.’ ”
She has some skill at self-deprecating humor (a handy thing for a doctor, if uncommon). She says, “I’m looking forward to aging, just so I look a little more wise. I considered getting some fake glasses. I tried on a pair and my husband said, ‘I think you actually look younger with those glasses on.’”
Mcilvena had long thought that prevention was the most important protector of good health, but it was driven home in her first residency, when she was seeing patients under institutional clinical protocols.
“When patients came to see me, it was clear that many of their ailments were a consequence of daily choices: They had high blood pressure, they had diabetes, they were on multiple medications for multiple problems.
“I had to deal with their immediate concern, which was refilling prescriptions. That was the number one priority. That frustrated me, because what I wanted to do was prevent complications that were caused by their lifestyle.
“I would make sure the medications weren’t causing bad side effects, then refill the prescriptions. That took up most of the visit. At the end, they would pretty much be walking out the door, and I would want to say, ‘But wait, we need to talk about your diet and we need to talk about quitting smoking and your exercise habits.’ But there just wasn’t any time.”
She pauses, aware of the gravity of the words she is about to speak: “I think the medical establishment is misleading patients because so much of the primary care visit is focused on prescribing medicines, changing dosages and ordering lab tests. There’s not enough time left to really address the root of the problems.
“The vast majority of our health care dollars are going to the treatment of chronic diseases, which are actually created by what we ingest and our lifestyles.”
What she thinks of sugar will not shock you. “Refined sugar is one of the more addictive substances on the planet. Avoiding it means avoiding processed foods, because about 85 percent of processed foods on the market contain added sugar.”
She uses acupuncture and holistic treatments whenever she thinks they’re appropriate. Those in themselves would make some doctors turn up their noses.
I offer a hypothetical: Let’s say a 60-year-old woman walks in not feeling well. What’s typically bothering her?
“Most likely, she lacks energy. She’s tired during the day, but then can’t sleep well. She doesn’t exercise as much as she should.”
Which means not at all.
“Probably. She’s overweight, and she is the first to say it. Maybe she’s got some arthritis symptoms on her knees, or maybe her ankles, or even her hips. She’s got some high blood pressure. Maybe not something that’s been high enough to be treated, but it’s been there for a while. I check her labs, and she’s got high cholesterol, and her blood sugar is high.
“So this woman, I think, would be a classic case of what we call ‘metabolic syndrome,’ where people are just not feeling very well and have all the precursors to diabetes and heart disease. Her labs would show it. I mean, this is a very typical scenario.”
Will she listen to you?
“Maybe she will, maybe she won’t.”
It’s easier to take a pill.
“Yeah, it really is, but there’s no pill that can fix lifestyle. Our food and our activity are the pill. I’ll sit down with her, go over her labs, and then I think she’ll believe me if I tell her that the reason why she has this crummy feeling is because of all these things together. And then, she and I, we can go to work.”
What happens when their facial expression says: “I come to you for medical advice and you only tell me the same things my husband’s been telling me. And I have to pay you for this?”
“It can be a letdown for patients that it’s not just going to be a quick fix that a pill can take care of. I tell them, ‘If you really want to feel better and you implement what I recommend, you’re going to feel better.’ ”
Mcilvena says if her exam detects underlying causes that haven’t been addressed, she is quick to refer to the proper specialist. “I’m never going to just recommend lifestyle changes if I see signs of a life-threatening illness. As a doctor, I’m very mindful of that.”
She goes to her records and pulls out a patient file for a 58-year-old man from Cardiff who came to see her to improve his diet and lifestyle. She said he was a nonsmoker and overweight. She did a work-up on him with fasting blood tests at the start, and then follow-up tests after four months.
She said at the initial visit he had high blood pressure but was not on a medication for it. He had no exercise regimen, and he consumed the “standard American diet, or SAD.” She described his heart attack risk as “worrisome,” and his risk of developing diabetes as extremely high.
She put him on a plan for nutrition and exercise, which he followed. After four months, he lost 23 pounds, decreased his risk of heart attack substantially and was at minimal risk of diabetes.
The patient’s four-month follow-up labs showed a drop of 100 points in total cholesterol and dramatic improvement in good cholesterol, blood pressure, blood sugar and triglycerides.
If a prevention specialist such as Mcilvena is able to help you, don’t worry about the pharmaceutical companies that you’ve supported for so long. They won’t go out of business without your money.
Mcilvena believes that to a certain extent, you can be your own doctor — without the old magazines and creeping elevator.
Fred Dickey’s home page is freddickey.net
His email is firstname.lastname@example.org