One of the frequent questions from patients I get in the office is why they can't lose weight. I ask the usual questions like what is their diet ("I don't eat that much...really".), how much exercise do they get ("I get exercise...I walk for 10 minutes a day") and perhaps what other medical problems they may have (Diabetes, hypothyroidism etc). But it may be surprising to some of you that I also ask if the snore.

Severe Snoring sometimes indicates possible sleep apnea. Sleep apnea in effect gives the patient a lousy sleep--the brain will prevents REM sleep because with deeper sleep they obstruct their airway even more. Some sleep apnea patients will refuse to believe they snore but they often report chronic fatigue, needs forlate afternoon naps and even sudden nighttime awakenings-- which is their brain in effect screaming at them "Breath ya' idiot!!".

So how does all this effect the ability to lose weight. Recent research has shown that chronic sleep deprivation lowers a person's metabolism. Not only that but sleep apnea patients are so chronically tired they don't have the energy or desire to exercise.

Now trying to convince someone that they may have sleep apnea and that if we improve their sleep this will help them lose weight is usually a hard sell. I tell them they just have to trust me. I've had patients have a sleep study, get treated with the CPAP mask at night and suddenly within a few weeks they start feeling better, exercising more and losing weight at a regular clip. And frequently they can come off the CPAP device if they lose a significant amount of weight.

So if you struggle with weight, you may want to ask your significant other is you snore. Or maybe you already get "The elbow" on a nightly basis. Another simple self-check to see if you are risk for snoring: look in the mirror and go Aaaah. If you can't see your entire uvula ( the little fleshy thing that hangs in the back of your throat) then you could be a snorer. If you cant see your uvula at all...you are most certainly a snorer and I am sure you struggle with your weight.

So to lose weight, follow a well balanced diet, exercise 30 minutes daily, and fix that snoring.

Let's face it. The current medical model isn't working for either the patients or the physicians. Patients complain of not being able to see their physycian in a timely fashion and when they do, they feel rushed. Us Primary Care Physicians, which is actually an insurance company created term--I am an Internist--it says so on my diploma, are over-worked, under paid and under appreciated for what we do. And it's going to get worse.

The Obama health plan, although created in the best of intentions (work with me), is going to put even more stress on this system and push it to the breaking point. A savy patient recently pointed out that the high emergency room volume is often not due to patients without physicians seeking care, but rather filled with patients who cannot be seen in a timely fashion by their physician's office. Our physician's offices are booked to the last available second. Now we are adding more patients to the system, all well and good, but we have no capacity for them to be seen. And medical residents are not choosing primary care as a career because they rightly see the specialty as over-worked and underpaid.

It's because of this unpleasant health care climate that I started Weston Primary Care in 2007 and why I now offer my Executive Health Service in 2008 (a direct pay concierge service). Strictly speaking, my practice is a hybrid-concierge practice, ie I offer both traditional and concierge medical services. My timing wasn't great.

With the economy tanking in 2008-2009, patients were reluctant to spend discretionary funds on health care when they were not sure if they would have a job in 6 months. But since late 2009, the concierge practice has steadily grown by several patients a month. People are now ready to address their health care again.

Now some of you may claim that this is a service only for the wealthy. But at $2500.00 a year, this is close to what people spend on combined cableTV/phone/internet service per year, or what they spend going out to eat on a yearly basis. My concierge patients often choose this service, not because it is a nice perk, but because they truly need access to me more frequently, often at odd hours or on weekends, or they need longer visits (recently I spent 2 1/2 hours with a new patient during a weekend physical) to address complex or confusing problems. I also do home visits for the elderly or disabled. Patients and families rapidly learn to love the convenience and attention they receive. I also love the ability to practice "old fashioned medicine", you know when doctors had time to listen to their patients and ask insightful questions and maybe even read (!!!) about their patients symptoms and problems.

A surprising benefit has been that I have also found that I can now spend more time with my traditional patients as well. By having a more solid business, I don't need to overload my schedule and I can spend a little more time with patients or take some extra time to call a patient at home to discuss lab or test results. And some of my traditional patients like the idea that I offer this enhanced concierge service in the event that they develop medical problems in the future that will require extra time and access. My patients now have a choice, and they like it.

I may not be able to solve the nations health care system woes, but in my little corner of health care delivery, I believe I have created a system which allows me, as a well trained and compassionate physician, to be compensated for my time and effort, but also gives my patients better care and more choices in how they receive their medical care. And its going to get better.

From time to time, I will be blogging about my experiences in my practice and hope you will enjoy my postings.

More later,

Timothy Murphy, MD

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