Making health care work: Local practitioners’ quest for practical medicine

Dr. Brian Lewis sees the crumbling divide between traditional and so-called “alternative” therapies as simply medicine returning to its roots. Back in the day, he maintains, doctors really knew their patients and served their communities as sources of sound advice. (Pictured: Drs. Brian Lewis and Chad Krisel; photo by Max Cooper)

Lewis and Dr. Chad Krisel operate Integrative Family Medicine on Depot Street. “We aim to spend more time with patients, to look at their whole life, to look at their perceived obstacles to health as well as their actual obstacles,” Lewis explains.

And while the proliferation of acupuncture clinics and the incorporation of once-suspect practices into mainstream hospitals garner most of the attention, he believes that much of the practical integration of medicine is happening at clinics like his, where individual doctors simply make up their minds to try a new approach.

“I think everyone’s aware that our health care system doesn’t work,” Lewis declares, noting that according to the U.S. Centers for Disease Control and Prevention, 75 percent of health care spending is tied to often-preventable, chronic conditions. “If we know these things can be prevented or reversed, why aren’t we doing it?”

For a small-scale practitioner like Lewis, however, bureaucracy can constitute a massive barrier to innovation. Treatment protocols, local laws and insurance coverage may vary widely from one state or company to another. And many integrative therapies, in particular, aren’t covered by either Medicare or private insurance plans, leaving patients wondering whether even a simple visit to a chiropractor might cost far more than they expected.

To get around this predicament, Integrative Family Medicine sidesteps insurance entirely.

“We decided to pilot a clinic that demonstrates that if you kept the overhead low enough and ran a wide business, we could see people for the price of the average copay,” Lewis explains. “We see most people for $50.” And a $40-a-month Integrative Life Program covers lab work, an annual physical, unlimited $20 office visits and access to free classes in things like yoga and nutrition.

But Lewis and his partner are hardly alone in their attempts to push the treatment envelope. “People across the country,” he reports, “are experimenting with models like this, taking out the middleman role that takes away so much of a doctor’s profit.”

Getting back to basics

A graduate of the UNC School of Medicine, Lewis has studied Tibetan health practices in Asia and Chinese medicine at UCLA. He worked as an AmeriCorps volunteer and co-founded the integrative medicine student group at UNC-Chapel Hill before making his way to Asheville in 2006.

In his travels, he’s been impressed by the care that countries even less developed than the U.S. manage to offer.

“In the West, we’ve given that approach the name ‘integrative medicine.’ In other countries, it’s just good medicine,” says Lewis. “It’s kind of ironic that what’s just considered basic care in other countries gets a special name here,” he adds with a chuckle.

But improving the dysfunctional U.S. health care system, Lewis maintains, will require both better individual practices and communitywide support for healthier living. Meanwhile, like many integrative-health practitioners, Lewis dislikes the label “alternative.” “Implicit in that term is that Western medicine is at the top of the pecking order,” he points out. “This is an evidence-based integration of practices across many fields.”

Based on that approach, Lewis explains, “We devise individual plans for patients that incorporate exercise, nutrition, stress reduction.” And because the fees are affordable, he ends up seeing a diverse array of patients.

“Some of the people coming in our door have never heard of herbs or acupuncture,” he reports. “But it’s also Asheville, so you have people who come in with a lot of information they’ve researched on their own, because we have ‘integrative’ in the name.

In the last three years, says Lewis, many people have become more open to practices ranging from yoga to acupuncture to herbal remedies, and patients’ informed questions help keep him on his toes.

“It’s made it into the public vernacular,” he observes. “You have to stay up-to-date on everything that’s out there.”

And by eliminating the obstacles to that kind of communication and exchange, Lewis feels he’s better able to focus on individual patients and still make ends meet. In this way, he notes, integrative practitioners are innovating not just in what they prescribe but in how medical care is delivered.

“You have time to talk to folks, get to know their lives, really visit with them,” Lewis reveals. “I think Asheville’s a lot more open to this than you’d see even a few towns away.”