Q: What drew you to focus your career on the prevention of heart attacks, strokes, and diabetes?
A: After the first 10 years in practice (circa 1994) I became dissatisfied with my outcomes. Having a few 40-somethings have heart attacks and strokes was distressing, so I started hunting and applying the literature on my own. Fast forward to 2010 and I met Brad and Amy at a 4-hour advanced lipid talk. Amy invited me to the preceptorship and I learned MANY more strategies for getting the great outcomes I was striving toward!
Q: You’ve been practicing preventative care for over 30 years. How have your methods and mindset evolved over that time?
A: I now firmly believe ALL root cause tests must be run on every patient in order to develop a comprehensive plan. That wasn’t possible in the insurance world, which is why I changed to concierge in 2014. I have never regretted it!
Q: What do you find most rewarding about helping patients make long-term changes that impact their health?
A: Hearing about how much more vitality, stamina, etc they now enjoy, along with the freedom from worry over being “a ticking time bomb”
Q: What do you wish more people understood about the connection between lifestyle and arterial disease?
A: “I can’t out-prescribe your lifestyle, ene though that’s what medical training taught me to do. YOU are the dominant force in your life!!”
Real-World Application of The BaleDoneen Method
Q: What was your first impression of the BaleDoneen Method when you began learning it?
A: Gob-smacked. Knowing that a systematic approach is possible was music to my ears. It was overwhelming, especially once I tried to apply it in my office.
Q: You now coach other providers on how to apply this method. What’s one challenge providers face in real-world settings, and how do you help them overcome it?
A: For the office staff:Having the standard procedures for testing in place–lots of vendors are needed, they get over-whelmed. Behavior change is the biggest provider barrier–both their own (learning new decision making) and for their patients. Mentoring is the only solution.
Q: How does science translate into everyday practice when you’re meeting with a patient?
A: I’ve learned to “tell the story” rather than the scientific data/research (I need to know that for those who ask, but most don’t once they understand what their issues are). The oxidative stress⇒damage to cells and arteries story makes them immediately ask “how do I know if I have that and what can I do about it”. This has greatly simplified getting them engaged for the long haul.
Q: How do you balance clinical precision with the need to connect and coach patients through difficult changes?
A: Since they are the dominant force in their lives, I ask questions to find out what they are ready/willing/able to do “now”. I remind them this is a life-long marathon, not a 3-month sprint. No one can do everything out of the gate, so I let them decide where to start (with my guidance if they are missing critical action steps).
Insight From Your Own Practice
Q: In your own concierge practice, what types of patients tend to benefit most from this prevention-focused model?
A: Because I’m a membership model, they have skin in the game and universally benefit. Their reasons for coming range from abnormal CACS, events, and family history.
Q: What does patient engagement look like when someone truly “buys in” to the method?
A: They start asking “what else should I be doing”
Q: What do you find most effective in helping someone make lasting health improvements?
A: Letting them help design their plan, then asking “on a scale of 1-10, how confident are you of being successful with the plan you just helped develop?” If they say 7 or higher, they are predictably successful. Below 7 means there is a barrier they haven’t admitted to….
Lab Testing and Early Detection
Q: Advanced testing plays a major role in the BaleDoneen Method. What labs do you find most impactful when assessing early risk?
A: LpPLA2 and MPO. All are important, but these are my near-term predictors.
Q: How do you explain inflammation or genetic markers to a patient in a way that’s easy to understand?
A: I have a couple of slides that work well.
Q: What do you say to patients who feel overwhelmed by lab results or diagnostic data?
A: I get this infrequently now that I ask them “where would you like to start” in designing their plan. Showing them the Root Cause tree with their problems highlighted gets their attention every time.
Education, Training, and Peer Support
Q: You present science updates to providers and serve as a clinical coach. What’s your approach to helping colleagues stay engaged with the latest research?
A: Tying it to patients I am seeing is the key. Front line providers want to know what to do with the problems they are likely to see in their office–and to hear what the science shows.
Q: What feedback do you often hear from providers after implementing the BaleDoneen Method in their practice?
A: Game changer for them and their patients.
Q: How do you help clinicians go from learning the science to actually using it with confidence?
A: Honestly, one-to-one mentoring is the only way I’ve been successful.
Q: What do you believe needs to change in how medical students and residents are taught about cardiovascular prevention?
A: I’m not optimistic that will change. I do believe there will be parallel systems–patients need disease care providers for all the diseases that aren’t preventable. AND they need providers that help create optimal health. Not every provider enjoys prevention. And that’s OK. Changing the national conversation so that patients demand better care is more likely to succeed. I had a recent patient who wasn’t sure he needed what we did. I always ask why they join. His answer “I read 50 pages of Beat The Heart Attack Gene and was convinced I needed to do this. True story.
Q: How can we better prepare the next generation of clinicians to recognize and treat early arterial disease?
A: By finding those who are interested. Having med students and residents in my office was eye opening–”I’ve never heard about this” etc.
Universal Questions
Q: Can you share a story about a patient transformation that still sticks with you today?
A: LT already had a CABG and stents by the time he was 50. He embraced this approach, has not had an issue in 10+ years, and is now my single biggest source of new patients.
Q: What do you wish more people understood about preventing heart attacks and strokes?
A: That they truly are preventable TODAY–the science is here!
Q: What motivated you to focus your career on prevention rather than treatment?
A: Having a 40 year old pass their stress test (this is in 1994) and then be in the ER 6 months later with a massive MI. I told him “I don’t know why this happened, but I’m going to read everything I can to figure it out”. He is still my patient (we are the same age).
Q: What’s one common misconception patients have about cardiovascular risk?
A: If their cholesterol is normal they are fine.
Q: What’s one simple change patients can make today to improve their heart health?
A: Get tested is the main action step. Short of that: move more every day.
Q: What do you love most about working with patients using the BaleDoneen Method?
A: Peace of mind that they are going to do great–especially if they had an event prior to seeing me. I also get joy from hearing them commit to, and following through, on behavior change.
Q: Anything else you want to add or share?
A: BDM transformed my life, my practice, and my patients–THANK YOU!
