Thursday, December 6, 2018

DPC: 20 Practices, 40 Doctors for the Miami Valley in 3 Years

Direct Primary Care, the movement, is energized, enthusiastic and expanding.  About 1000 practices currently exist in the United States.  There are two DPC practices in the 13 counties that constitute the Miami Valley around Dayton, Ohio.
I predict that we can have twenty practices including 40 physicians within three years.  Yes, by the end of 2021, we'll have twenty DPC practices.

There are hundreds of disaffected physicians in the area looking for an alternative to the grind that leads to burnout.  Many are already burned out.  Many intend to retire early or at the earliest realistic point in their life to escape and survive.  Many newer physicians and physicians in training are trying to avoid the misery that they notice in their faculty and mentors.
Medical students are avoiding primary care specialties and many are becoming hospitalists instead of pursuing a primary care career.  Less than ten percent of students actually enter into a primary care career.

Its time to reconstitute primary care into a career path that is fun again.  Direct Primary Care is one business model that seems to allow that.  Direct pay practices are here again.

Further definitions and information about Direct Primary Care can be found at and www.dpcfrontier.

More later.

Sunday, December 2, 2018

Nutrition and Health Interview: Healthy Brains and Bodies

Nutrition is a huge factor in our health.  Our genome and microbiome are other
huge factors. The environment and toxins are others.
The interview with Robert Lovegren on my 12/3/2018 Dr. Synonymous Blogtalk Radio Show
may address all of them. Bob is a retired physicist and electrical engineer.
He is a scholar in health and education.

Some questions that we may discuss include:
How did you get interested in nutrition, Bob?
What would an ideal state of health be?
What factors might lead to an ideal state of health?
What do you mean by “Bio-exhuberance?”
What role might be played by heat therapy?  Cold therapy? Red light therapy?
What are your thoughts about mitochondria in cells?
What toxic diet components are “poisoning” us?  What should we not eat?
What about fasting?
How about exercise strategies?
How do you get people to listen to your strategies for health, especially considering
our addictions to sugar, grains and high fructose corn syrup?

Are you finding like-minded people in the area of cellular and brain health?

Saturday, November 10, 2018

We Have Stories to Tell

As a holistic minded Family Physician, I notice a lot about the human condition in the context of health care, mostly in the office practice of Family Medicine.  The plight of humanity is still a fascinating work in progress.  We have an infinite array of response repertoires to our lives, many of which are unpredictable.  We have stories to tell.

I love to hear the stories and listen for the health related components that are misaligned with the dreams of the patients.  

I also enjoy reading blog posts and often have reviewed them on my Blog Talk Radio Show of the same name as this blog.  Medical Mojave, who used to call her blog Pissed Off Patient, is one I've followed for a few years.  She has been off line for a while and just reappeared with a couple blog posts and a comment on my last blog post.  Here is my response to her comment with more:

Thanks for your comment. Your blog, Medical Mojave is a Blog that I always read and used to comment about on my Blog Talk Radio Show. It points out the tensions between patient and physician from the patient side of a rare condition. A good book about thinking limitations in scientific and medical professionals that reaffirms the patient perspective that the physician could reflect a bit deeper on the patient story/ plight is The Limits of Scientific Reasoning by Faust 1984 U of Minnesota. From the preface: "human judgment is far more limited than we have typically believed and that all individuals, scientists included, have a surprisingly restricted capacity to manage or interpret complex information."
We have to work to process the complex information/situations better. The current Electronic Medical Record seems to have set back decision making considerably for physicians due to excessive administrivia and less time for patient care and clinical decision making.

I still believe that the patient's story is the most important part of the patient-physician encounter, in the context of an effective relationship between patient and physician.  It tells us us who the patient is and where they have been and where they are headed and more.  At the same time it resonates with who the physician is and where they have been and where they are headed.  The patient-physician dyad is powerful if allowed to be powerful.

Wednesday, October 3, 2018

Breakfast Chat with Dr. Pat: Talking with Doctors

Dr. Jonas, your host for the Dr. Synonymous Show will discuss strategies that may enable patients to be better heard by their physicians.  Physicians seem to have less and less time to engage patients.  This may be detrimental to quality in healthcare.  How might we get around this?  Dr. Jonas will engage those present about ways to get their story heard.  This will include some information about how doctors think and make decisions. 
We will talk about some common problems and at least one rare disease- Ehlers Danlos Syndrome.  The EDS patients get rejected a lot by physicians before they finally get a diagnosis.  How can we get beyond these rejections in this era of opiate abuse and dependency in which patients with pain struggle to get it treated adequately?  The EDS patients might be the poster children for this quandary between pain and opiates.
Click below to listen to the podcast on Blog Talk Radio.

Thursday, September 27, 2018

The Brain Nutrients and Depression: Presentation by A. Patrick Jonas, MD

The Brain, Nutrients and Depression.         A. Patrick Jonas, MD
Institute of Holistic Leadership September 27, 2018


The Brain. The last frontier?  Nutrient Power by William Walsh, PhD
Nutrients:  Food, supplements, vitamins, minerals, phytonutrients= nutraceuticals
Depression:  Definition(s)
           6 types: Undermethylation, Folate Deficiency, Copper Overload, Pyrrole Disorder, Toxic, Other
Neurons- cells that process signals at 200 mph.  100 B in the brain
           4-100 microns diameter.  Up to 4 inches in length. Act as tiny battery cells
           Long axon transmit electrochemical signal across synapse to other cell.
           1000 hair-like dendrites branching from the cell body, receiving chemical messages
           100 T receptors in average brain
Neurotransmitters: are made, packaged into vesicles, release into synapse, interact w/adjacent cell,      reuptake, death
Most psychiatric meds alter neurotransmitter activity at synapses.  e.g., SSRI’s disable transporters
           Top six biochemical imbalances in brain disorders
           Copper overload, Vitamin B-6 Deficiency, Zinc deficiency, Methyl/folate imbalances, Oxidative stress overload, Amino acid imbalances
Methylation Pathway Model by Amy Yasko, PhD - See Handout
Spectracell Depression Wheel --See Handout
Epigenetics:  DNA wraps around histones which have “tails”, where chemicals may adhere.   Methyl groups- tighten DNA wrap around histone and decrease expression of genes
           Delivered by SAMe to histones
Acetyl groups- loosen DNA wrap around histone and increase gene expression
           Delivered by acetyl coenzyme A to histones, delivers hi energy acetyl groups to mitochondria for processing in the citric acid cycle.
Neurotransmitter Transporter Proteins.  Methyl vs Acetyl for histone tails.  Gene expression of serotonin, dopamine and norepinephrine transporters dependent on M vs. A competition.  E.g.,histone methylation promoters are natural SSRI’s
Nutrient therapy and epigenetics:  Methionine and SAMe, Folic Acid, Niacin (B-3), other nutrients.
Epigenetic disorders:  Autism, Depression, Schizoaffective Disorder, Paranoid Schizophrenia, OCD, ASPD, Anorexia, OCP
Transgenerational Epigenetic Inheritance
The Clinical Process hx and pe, labs, diagnosis, treatment, aftercare
Nutrients and Neurotransmitters
                                 Increased Activity                                 Decreased Activity

Response times vary
           Pyrrole Disorder
           Zinc Deficiency
           Copper Overload
Toxic Metal Overload
Depression:  Undermethylation, folate deficiency, copper overload, pyrrole disorder, toxic, other
Schizophrenia:   overmethylated, undermethylated, pyrrole disorder
Autism:  Zinc deficiency, copper overload, B-6 Deficiency, Elevated toxic metals, oxidative stress, undermethylation
Behavioral Disorders and ADHD (94% with chemical imbalances):  Abnormal copper and zinc levels in violent persons, copper and zinc and Vitamin B-6

Tuesday, September 25, 2018

Crooked Trails: Interview and Discussion with Author Sandra Miller, MD

Sandra Miller, MD has created another medical adventure novel featuring Abigail Willmore, MD.  The second novel in this series (number 3 is almost complete) continues the story of Dr Willmore, who was successful at the Grand Canyon Clinic in Only Rock is Real, the inaugural book for Dr. Miller.  Read my post about the first novel by clicking here.  (including a link to the interview recording on the Dr. Synonymous Show).

Now we find Abby (Dr. Willmore) agreeing to practice in the expanding Yellowstone National Park Clinic for the summer.  Dr Miller's vocabulary is up to the task of writing about the breathtaking scenery, from the heavens to the glaciers and volcanoes to the sunrises and sunsets to the tattoo of a snake, which she calls "Bitey", on the arm of the clinic nurse.  As a retired Family Physician and educator, her medical vocabulary adds to the sizzle when she describes human relationships, illness, bleeding, nausea, infection, immunizations, medical office processes, delusion, stalking, sexuality, professionalism and sexual assault.

If you also are curious about Yellowstone National Park and dinosaurs in Montana, showcased in a medical thriller, get this book.  If you also want to hear the author discuss how she creates her work, listen to this and the previous interview on her first book.

We'll discuss many of these aspects of her book and her general writing style in the interview which will be broadcast on the internet on The Dr. Synonymous Show on Blogtalk Radio Monday October 1, 2018 at 9:30 PM Eastern.  At that time and for years thereafter you can:

Click here for interview on The Dr. Synonymous Show

Sunday, September 23, 2018


Malaise is defined as "a condition of general bodily weakness or discomfort, often marking the onset of a disease. a vague or unfocused feeling of mental uneasiness, lethargy, or discomfort."

I love the word.  I even appreciate experiencing it every year or two for 34 - 48 hours.  I have it now.
With myalgias - muscle pain.  Everywhere.  Similar to the first day of the flu.  But without the mucous in the head and lungs with the intense cough of the flu, fortunately.

The feelings of malaise and myalgias are caused by the white blood cells bursting and allowing interferon to float through the circulation.  Maybe it's part of the grand design to keep us away from other people when we're infected, to minimize the spread of contagious microbes.


Sunday, June 17, 2018

Direct Family Medicine: More Thinking and More Fun

What do doctors do when they no longer have contracts with any insurance companies?  They spend more time with patients, they think more and they have more fun being a physician.

We terminated all our commercial insurance contracts December 31,2017 and all remaining Medicare contracts on March 31, 2018.

Our patients could opt for our Direct Family Medicine subscription option or pay cash for their visits.  All new patients are only offered the subscription practice option.

We now have openings for 300 new patients who are interested in having a physician who will listen to their story and work with them to maintain or regain their health.

We get to think clinically with more of our time now and pay less attention to insurance or government initiated administrivia.  Medical Practice is more fun with this model.

Many physicians are getting burned out and frustrated.  They aren't having fun.

We're Neighborly Family Medicine now and we're still having fun- only more.
More later.

Wednesday, June 13, 2018

Decision Making in Medical Care: Interview of Dan Jonas, MD, MPH

How are decisions made in medical care?
Dr. Synonymous (A. Patrick Jonas, MD) will interview Associate Professor Dan Jonas, MD, MPH about this subject on the Dr. Synonymous show June 14, 2018.

Dan teaches courses at the University of North Carolina to medical students, physicians and public health graduate students about analyzing the medical and other scientific literature.

Full disclosure:  He is my middle son.  I'm very pleased with how he has used his gifts and talents.

Dan will review his background.

What are the courses he teaches?  What excites the students?  What surprises them?  What is changing with time and technology?

We'll talk about studies- how big do they have to be to count?

Evidence:  What is it?  What is "Evidence based" and what isn't?

Patients role in medical decision making:  What is it?  What could it be?

Basic Science versus Clinical Science:  How do medical learners process information early and later in their careers?

I'm a (holistic) family physician and Dan is a Med-Peds and public health trained academic physician, so we'll focus on primary care types of examples during the interview.

Chronic disease care (management) versus acute illness care:  What are similarities and differences?

Public Health versus Personal Health:  What are some differences and similarities?

Quality:  What is it and who decides?  How is it measured and reported?  What is patient role in defining quality?  Wheat Belly and Grain Brain.  The microbiome-Quality vs novelty.

Electronic Medical Records:  Benefits and Harms (Remember principles of medical ethics and physician burnout)?

Common versus rare diseases:  How are they found, followed and treated?  (We'll comment about Ehlers Danlos Syndrome among others)

Time management in clinical care versus clinical decision support (tools, etc.)?  Front lines versus ivory tower.

Direct Primary Care versus Usual Primary Care and other models:  How do we change?

How many studies are what level of quality?

Genomics:  Quality studies?  Consumer driven  genomic information as a source of quality and/or physician annoyance?

Click Here for the Interview

Saturday, February 3, 2018

Family Medicine: Is it All Medical?

The Coroner called.  Someone died.  Will I sign the death certificate?
The note was attached to the front of a thick chart.  I saw the name.  "Why would he die?"  I thought and a microsecond later I had the probable causes of death in mind.  It was not a real surprise.

They would come together for their visits.  One stayed in the truck with their dog while the other saw me, then they switched places.  The last two visits, the dog was in the exam room.  Six months ago, all three were in the exam room for her visit.  She was progressively sicker with recurrent hospital admissions which were getting closer and closer together.  He knew he had to be present that time. She didn't survive the next admission.  I had mentioned hospice as an option on three occasions and they opted to follow the full pathway with ICU's, ventilators, home BIPAP, etc.  The home BIPAP added five years to her life (five years of life after I initiated the first hospice conversation) and amazed several of us.

He brought the dog to his last visit, too.  He was lost without her.  Could the cause of death be a "broken heart"?

Family physicians are aware that sometimes the death of a spouse is followed by the death of the surviving spouse within a year.  In couples who are very close, a "broken heart" may be a significant factor in the second death.  It isn't a medical diagnosis, though- it can't be on the death certificate, which is restricted to medical diagnoses.  Too bad.  Things like "Old Age" aren't allowable, either. All deaths are "medical".  Too bad.

In Family Medicine, we develop insights about people that go beyond "medical" phenomena.  It's part of our essence-- knowing people, and their stories, and their meaning.

Thursday, February 1, 2018

Staying Alive

Now I lay me down to sleep
I pray the Lord my soul to keep
If I should die before I wake
I pray the Lord my soul to take

God bless Mommy and Daddy and Grandma and Grandpa Jonas and Grandma and Grandpa Clayton
and thank you for Jesus.  Amen

I flash back on that prayer taught by my mother and father to my brother and I, as my mother is in her last day or so of life (here in my home).

I held her hand and prayed The Lord's Prayer for her with son Patrick a couple hours ago.  She was smiling and looking to the heavens with such contentment, somehow ignoring her body and somewhat labored breathing.  She doesn't seem to need the body any more.

Oops!  She overcame the labored respirations and it's now 2/1/2018--I started this post in September, 2016.  I'm amazed at her resilience and whatever has sustained her life to be entering her 21st month in hospice care.

What is the secret ingredient that has some dying and others living?  She is bedfast and totally dependent on others for everything outside of her body.
More later

Wednesday, January 17, 2018

Only Rock is Real: Discussion and Interview with Author Sandra Miller, MD

Dr. Jonas, your host for The Dr. Synonymous Show interviews Sandra Miller on January 21, 2018 about her delightful novel, Only Rock is Real.  The novel deftly combines a geographically and medically accurate setting with astronomy and dynamic human relationships to deliver a message about the life of a woman physician.  Yes, gender matters - to all of us - and Dr. Miller knows it.  She develops her characters and connects them to other characters and situations then sprinkles in the Grand Canyon, The Grand Canyon Clinic on the South Rim and the heavens.  Wow!

I loved the book.  I do want to visit the Grand Canyon as a result of reading her perspective about life, love and medical practice on the South Rim.

Snakebites, gunshot wounds, brawls, dehydration, heart attacks, grief reactions, pneumonia, coccidiodomycosis and more medical conditions are daily fare for Dr. Abby Willmore and her clinical boss, Dr. Pepper.  Jake Peterson, park ranger, spices up her life, which is clouded with a history of panic attacks and alcohol abuse (maybe self-treating the panic?).
Tune in to the Dr. Synonymous Show on Blog Talk Radio to learn more about the book and the author.  We'll have geology, astronomy, Family Medicine, geography, clinical situations and even sex/intimacy/love to discuss.

Click here to tune in live at 9 PM eastern on Sunday January 21, 2018 or you can listen to it anytime on Blog Talk Radio by clicking for the next few years.

General author questions that I might ask include:

How did you decide to write novels?  Why this subject matter?

What is your geology background?  How did it change with your experience in the South Rim?

How about the same with your astronomy background and interests?

The tension among and between the characters in your book and the environment seems to work well, at least for me as a reader.  How do you decide on the tension levels and situations?

The amount of pain and suffering was OK for me as a physician reader, although I could feel one of the situations intensely.  What feedback do you have from other readers about the pain and suffering of characters, patients, etc?

How do you decide what limits to put on the development of Dr. Abby Willmore?

How do women in medicine respond to your writing about Abby?  How does the Abby Willmore, MD character seem to compare with relationships, dating, love, reproduction, etc. in women physicians you've known through the years?  How do you decide how far to go with writing about the intimate/sexual situations?  How many attributes can you toss into the life of such a character?

Thanks for integrating the medical student and resident physician roles into the clinic.  My first multidisciplinary experience in medical school at Ohio State was through the U of Az. in Marana, Arizona at a Community Health Center with nursing and pharmacy students.  A nurse practitioner named Pat was the boss.  We had a mobile clinic that we took to schools and a small village or two.  An internist from Johns Hopkins was serving his NHSC commitment there.  The pharmacy and community board of directors were other key elements.  There was a church next door and a mobile home for loan around the corner where I stayed with my wife and two very young children.  Cotton fields were vast and seemed to be everywhere.  It was a powerful experience.

How long does it take to write a novel?

How many do you have going at once?  Or are they sequential?

With your thousands of patient experiences, how do you decide which types will be included in the books?  What about one of a kind experiences- how do you mask them in your writing?

What else do you want the listeners to know about you or your work?

How can they buy your books? Books and Writings of Sandra Miller, MD

Sunday, January 7, 2018

Mission Chechnya, New Novel by Therese Zink, MD Interviewed on Internet Radio 1/8 at 9 PM

Link to interview with Therese Zink, MD about her new novel: Mission Chechnya  on 1/8/2018 at 9 PM live or anytime after that through the link above.

Dr Jonas, your host for the Dr. Synonymous Show, is delighted to get to interview Dr. Therese Zink again about her newest book, Mission Chechnya, a novel reflecting many of her insights about that area of the world and global health issues.  She will discuss the origin of the book, its background and her own, and her passion for writing and global health.
The book starts with a birth in the airport bathroom and moves from there to provide perspectives  on health needs and issues in Chechyna through well described characters. 
General questioning will include these type questions: 
How did you come to be a book author?
Are you a reader, too?
How often do you write?  What's your schedule?
Why this book?
Why these characters?
How do you decide on the depth of character development for these people?  I was impressed by the developmental detail of characters, situation, themes, etc.
How should global health be addressed?  By whom?
Once you're global, can you ever be local again?
How does Wright State BSOM introduce and promote global health and global health service?
How does a senior Family Medicine Scholar, Author, Leader operationalize global health interests/commitments?
How much fun are you having?
What's the process for promoting and selling books that you've authored?
How can listeners and readers get the book?