Interview with Dr. Rick Abrams of Rose Center for Preventive Medicine

In my search for the best annual physical, I recently had an in depth discussion with Dr. Rick Abrams, founder and medical director of the Rose Center for Preventive Medicine. Dr. Abrams practiced internal medicine in the Denver area for over 30 years before making the transition to the Rose Center. “It’s still internal medicine,” Dr. Abrams’ explains, “but it’s a new style of practice for which most physicians and patients yearn. The emphasis is on prevention and thorough explanation.” The comprehensive evaluation begins with a detailed history and physical but incorporates many advanced imaging modalities performed at the adjacent radiology suite at the Rose Center. These include cardiac CT, virtual colonoscopy and carotid and abdominal ultrasound. Dr. Abrams also selectively uses comprehensive panels of biomarkers to gain further information on the metabolic and physiologic status of his patients.

Perhaps the greatest distinction of the Rose Center for Preventive Medicine is the manner in which Dr. Abrams and his colleagues present information to their patients. “This is the teachable moment” Dr. Abrams explains. He uses many PowerPoint slides and computer animations to graphically explain relevant anatomical and physiological issues to his patients. Imagine the connections that patients make when they view their own radiographic images side by side the physician’s teaching slides. Plenty of time is dedicated to this part of the experience. The patient leaves the center with a much clearer understanding of their health issues and thus becomes a true partner in their own care.

The entire interview is available as a pod cast.

Interview with Dr. Rick Abrams of Rose Center for Preventive Medicine - Podcast

Dr. R: I’m here with Dr. Rick Abrams who is the founder of the Rose Center for Preventive Medicine in Denver, Colorado. Rick has really been a pioneer in creating the optimal model for wellness evaluation and it is a pleasure to interview him today. Rick, if you could just tell us a little bit about what brought you to the point of founding the Rose Center for Preventive Medicine. Tell me a little bit about what lead up to that.

Dr. A: George, I practiced internal medicine for 30 years in a traditional small group practice. I always felt like we were doing the best we could with the time we were given and the tools we were given to deal with acute illnesses, but not to counsel people and do a careful yearly examination. Over the years it became increasingly evident to me that my time was so compromised by the volume of patients I needed to see and the size of the practice that I was spending less and less time with people particularly on the prevention side which is something that I’ve always been interested in. My passion was maintaining optimal health and preventing illness or identifying risk factors at an early stage when we could do something about it and I simply did not have enough time to meet those objectives. So, 8 years ago in conjunction with Dr. Jim Ehrlich founder of Colorado Heart Imaging, I began seeing patients in a setting where I could spend hours instead of minutes with people taking very detailed medical history, performing an unhurried, detailed physical examination and using more advanced laboratory testing and imaging with the goal of performing the most comprehensive exam possible. This was a toe in the water for me but very quickly I realized that I was able to identify risk factors at an early stage when we could actually do something about them. I also realized that patients were extremely satisfied with the quality of their exam and the time spent both in doing the exam and teaching people about their health and anatomy and physiology.

Dr. R: And then that lead to putting a Center together for this purpose?

Dr. A: Yes. Approximately 3 years ago I saw how productive this whole approach to health was and became increasingly interested in prevention. I partnered with Rose Medical Center in Denver to develop a full service facility specializing in preventive medicine using more advanced testing and imaging and spending ample time with every patient.

Dr. R: Right. Rick, Having gone through that experience which has been extensive, what would you say would be the elements or the components of the optimal wellness evaluation?

Dr. A: Well, the first element is perhaps a bit ironic given the fact that technology plays a big role in our program. The first element I would say is the basic detailed history and physical examination. I spend much more time talking with people about their health habits, their emotional concerns, nutrition, exercise, even personal safety. So it’s old fashion in the sense that the basic low-tech medical history and physical remains the foundation of our approach to prevention.
Dr. R: Yes. Please go on..

Dr. A: The second component of our program is laboratory testing. We use more advanced biomarkers, including a more detailed lipid profile, looking for people who have risks that can be addressed before advancing the process or atherosclerotic disease. A third component of our program is imaging. We’ve made extensive use of coronary artery calcium scoring. We currently use ultrasound to evaluate the neck and carotid arteries–intima media thickness, a full vascular flow study and thyroid ultrasound. The other component to the exam or at least the whole process is the time spent with people reviewing all of this information and teaching them about their health.

Dr. R: Right. And I think that is such a critical part of this whole thing of bringing in all of this information together into a package that you can give to the patient. I think some people refer to it as the moment of truth or the moment of awareness when it really all comes together for them. If you could just elaborate on that piece of this evaluation because I think that this is so critically important.

Dr. A: Sure. One of my observations over the years is that among our many failings in health care, one of them is that we don’t spend enough time educating people about human anatomy, physiology, and prevention. I have found that people are really hungry for that kind of knowledge. I find that most of my patients want to collaborate in their health care rather than be told what to do. I found very quickly when I started this program that the educational component was perhaps one of the most important things we do. It really speaks to the role of physician as teacher.

Dr. R: Absolutely.

Dr. A: It’s appreciated by people who go through the program and it’s also very satisfying on the physician side to be able to take the knowledge that we possess and teach people who are concerned about optimizing their health. With that goal in mind, we have developed an extraordinary number of visual teaching materials. I find that most people respond better to diagrams and animations, all kinds of teaching tools that we’ve developed in trying to understand their anatomy and process of disease and where in that process disease can be prevented. No matter how sophisticated the people we see in this program are, they still lack that knowledge and hunger for it. Among the best compliments I receive at the end of an exam with someone is when he or she say to me, “Gee, I wish you would have been my high school biology teacher”. That says to me that I’ve struck a cord that I’ve been able to get some information across in a way that’s going to be meaningful as people follow the recommendations that we provide for them and stay involved in their own health.

Dr. R: Yes. And I think that is such a wonderful program of doing that. When you compare how it goes now going through this evaluation and this teaching experience with your patients as compared to what it was back when you were in regular group private practice, do you find that the patient’s are now more knowledgeable, more motivated, better partners in taking care of their own health?

Dr. A: Absolutely. People understand that when we recommend a change in diet or prescribe a medication, why that recommendation is being made, it makes more sense to them. Compliance in our particular center is a non issue. People understand why if we’ve recommended a statin for them, why that recommendation has been made, what they can expect to see in response to taking that medication and if they have concerns about taking a medication or they have concerns about side effects we’ve discussed with them, instead of simply throwing the prescription away or stopping the medication without telling me. They call and we discuss other options if a change needs to be made. So practice is much more collaborative and it’s all based on knowledge, knowledge of their health and knowledge of disease processes.

Dr. R: Right. That must be such a gratifying experience for both parties. Both as the physician taking care of the patient but also for the patient themselves to have, as you said, a collaborative relationship with the physician.

Dr. A: Well, I certainly hope it is for patients and that’s the kind of feedback we get and I can tell you in 30 years of practice, I’ve never been happier. I come to work smiling and I go home smiling that I’ve really accomplished something for a smaller number of patients, no question about that. I’m not seeing the volume of people that I did in a traditional practice but for the people I see, I can feel satisfied as I can possibly be that I’ve done my best work and that they’ve understood everything that we’ve done and made a real difference in people’s lives.

Dr. R: Absolutely. Let me ask you about this in terms of prevention. You know there is a lot of press about the human genome and genetics and that sort of thing, what role do you see that playing in prevention at the present time?

Dr. A: At the present time I think we’ve just beginning to incorporate medical genomics into clinical practice; particularly in stratifying the risk of several cancers. But I think this area is about to explode. My prediction is that through contemporary medical genomics we will be able to truly offer more a personalized approach to health risk mangement.
Dr. R: Right. Now, I think that we’re entering into this more personalized medicine approach, which I think is really exciting. Now, if you could look into your crystal ball, could you give us your vision of what the future of health care and prevention wellness screening is going to be all about?

Dr. A: My hope is that the future will build upon what was excellent about the past. The patient-physician relationship which has been eroded by the pressures of modern health care can, and must be, restored through the effective use of technology. The future will incorporate advanced testing; safe, effective imaging; physiologic testing and counseling. Ultimately, health care should be collaborative among the patient, his or her primary care physician, and the various other members of the healthcare team. In order to achieve these goals adequate time is critical. The missing link remains the ability to pay for personalized medicine. By emphasizing prevention I’m confident we will save money and remain healthier and more productive as a nation. Furthermore, it is my vision that preventive medicine and information management will provide more satisfying and productive careers for those of us who have chosen to remain in primary care.
Dr. R: Right. I think that this is a great vision of the future and it sounds like that medicine is going in the direction of becoming more personalized, more collaborative where the physician and the patient are really working together to achieve the same goal of better health for that patient and where the patient is more knowledgeable, has the tools delivered I guess on the internet, their personalized health record and so they are really more empowered to partner with you in taking care of themselves.

Dr. A: It’s been interesting that the number of phone calls I receive in the evening or on weekends has diminished dramatically as I help people understand more about health. For example, they understand that viral illnesses doesn’t require. Health education is central to what I’m doing today and what I’d like to see get even better in the future.

Dr. R: Right. Well, that’s wonderful. I think that that is a great way to end this conversation, is that at the core of it, it is really increasing the personalized knowledge that the patient has and empowering the patient. I think that is a wonderful vision of the future and I’m confident that with leaders such as yourself, Rick, that this approach is going to come to fruition. Rick, I really appreciate your spending some time with us this morning to discuss these important issues and look forward to seeing you again soon.

Dr. A: Thank you very much. I enjoyed it.