Practice Summary

   As my summary outlines, I am not a participating provider with any insurance companies, so most people who see me have a pretty strong commitment to natural medicine or to some other aspect of my practice.  If after reading it you are still interested, we can communicate, or make appointments, by either phone or e-mail.
 
   My philosophy of practice is simple: The best way to help someone improve their health is to stimulate, support, and balance their own, natural healing system. This applies for all kinds of issues people face, from life-threatening problems to minor quality of life issues. It is also my main approach for people who are relatively healthy and want to maintain or optimize their health.
   The primary natural approaches that I use to help people’s natural healing system include holistic nutrition, classical homeopathy, and an emphasis on psychological, social, and spiritual health. I also refer out to local conventional and natural medicine practitioners. I can offer further reading or websites with more information in these areas if desired.
   Occasional use of conventional, allopathic, medical approaches is reasonable, but in many cases they are unnecessary or even counter-productive. By collaborating with the people who come and see me, we work together to find the safest strategy that will help most in both the short and long-term.

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Insurance

   Because this type of practice requires spending considerable time with each person or family, I do not participate with managed care insurers. This enables me to serve people directly, instead of working primarily for their insurance company. Although I am not a participating provider with any insurance companies, many of them will still cover at least some of the costs. It is best to call your provider to ask them about coverage, or just submit a claim after our visit.

Cost of Visits

   Currently I do not have any office staff, and am doing all ordering, scheduling, and billing. This allows me to charge somewhat less than the competitive rate of about $350 per hour charged by doctors similar to myself, although I have to keep phone calls and e-mails brief. My fees are $130 for follow-up visits, which last 30 minutes, and $260 for the first visit, which lasts 60 minutes. Some follow-up visits may need to be an hour long, with corresponding fees, if it has been a long time since our last visit or if there are challenges to address.  These rates will increase by about 4% every summer. In the initial visit there is extra time to hear the family story, which is not just a list of health challenges!
   I do not charge for e-mails or routine callbacks, but I do charge $20 for paperwork such as school forms or work related forms that need to be filled out, unless these are done during a regular office visit.  I also charge $20 for pages when urgent consults are needed by phone that cannot wait until I check my usual voice messages (see below).  I am happy to lower my prices for people in financial hardship, and will accept whatever is affordable for them.

Office Hours and Visits – Mondays Wednesdays and Fridays Only

   I check my phone messages twice a day on every weekday, once in the morning as early as 8am and once in the afternoon as early as 2pm.  However, I only see people in my office on Mondays, Wednesdays, and Fridays.  I do not check messages on weekends or holidays.  Although I do use email for non-urgent issues, it can take me one to two days to reply.  When scheduling visits by email please make sure I say "I have written you in."  Sometimes emails get lost in cyberspace, so we need clear confirmation that a visit is set.  I do all my well visits between 9:00 am and 12:00 noon, followed by urgent/sick visits. In the afternoon I often have meetings related to my being a member and former chairman of several committees at Inova Mount Vernon Hospital: the Family Medicine Committee, Palliative Care Committee, and Bioethics Committee.  I also use the afternoon for faxes, phone calls, and emails.  
  When I am returning phone messages I use a Verizon automatic callback system that comes in as "unknown caller" or "spam" on caller ID, and sometimes is sent straight to people's voicemail due to blocking such calls.  My return call comes in as the Verizon voicemail number 888-234-6786 and you can add that to your contacts to avoid the spam treatment :-).
  I try to limit each conversation to a few minutes because I often have a number of calls to make. If the problem is complicated and requires further time, we can schedule an office visit.
   On Tuesdays and Thursdays I do home visits for people in hospice care in my role as part time medical director for Capital Caring, a local non-profit hospice and palliative care provider.  I do check phone messages and make phone calls for my private office on those days, but I am not in the office.

Pager/On-Call service

   To reach me after hours and on weekends, I use a personal pager system. After our initial visit, if people need to reach me urgently, they can page me. However, there is a charge of $20 for each page. This limits the number of after-hours pages I receive, allowing quality time for myself and my family, but still allows people to reach me at any time, day or night, if they have an urgent need. To use my pager, call the number 703-422-0356, wait for the beep, then punch in your call-back number slowly, and then hang up. If you do not hear back from me within 15 minutes please page again and make sure to type slowly, as sometimes pages do not come through with all 10 digits.  Also, sometimes I am in an area with no cell reception, and if I do not respond to a second page please call my office to leave a message with your call back number. For non-urgent matters you can call the office number to leave a message or send an e-mail.

Urgent Visits and Phone Consults

   I can see people on the same day for urgent visits on a Monday, Wednesday, or Friday if you call in the morning before 8am and leave a message, or if you page me in the early morning. If you page me later than this, or leave a message after 8am, I will not be able to see you on the same day, but we can still discuss the issues by phone, just as we would on a Tuesday or Thursday. I can also help decide whether an urgent care or emergency room visit is reasonable.
I do not see people on weekends or holidays, but am available by pager for urgent telephone consults 24 hours a day, seven days per week (see above).

Initial Visits for People and Families New to My Practice

   For new patients I usually have at least a several week wait before I can get them in, which allows time for people to read my summary and consider whether my practice is a good fit. If someone is already ill, so that waiting several weeks for a visit is not wise, I always refer them back to their current provider or to a local Urgent Care practice designed to see people in this manner.
For families with children, we may have a separate well-visit for each child, or a joint visit. If the parents are also joining my practice I do not need separate well visits for them. However, if someone has health challenges to address I prefer to have a 60 minute initial visit for them.
After the initial visit, I like to have ongoing well visits as follows: At least every 3 months in the first year of life, every six months for ages 1 to 3, and every year for people older than that, including adults. If there are health challenges it is usually good to have more frequent visits.

Hospital and Home Visits

   Although I have been the chairman of the Family Medicine Department and also the chairman of the Bioethics Committee at Inova Mount Vernon Hospital, I do not follow patients when hospitalized except to talk with the hospital attending physician by phone to coordinate care, if desired.  I enjoy doing home visits for people, but I can only do this when their homes are very near my office or near my own home.  I have an extra charge for this service, adding 20 to 25% on to the visit cost.  Arranging home visits is discussed on a case by case basis.

Background and Medical Training

   Prior to entering medical school, I worked for a year as a counselor for adolescents with severe behavioral and emotional challenges, and then spent a number of years overseas teaching at international high schools. I have lived in Brazil, Portugal, El Salvador, and Taiwan, and am fluent in Spanish and Portuguese. After moving back to the United States in 1995 I began studying under a variety of teachers and practitioners of natural medicine, as well as practitioners of humanistic psychology and psychiatry. I also completed a Masters of Social Work while finishing medical school prerequisites, and spent one year in pediatric hematology and oncology as a social work intern.  I entered medical school at George Washington University School of Medicine in 1997.  I continued to study with natural medicine specialists throughout medical school and residency, including special training in pediatrics and natural medicine. 
   I am board certified in Family Medicine, and I see people of all ages, including newborns, toddlers, school-age children, adolescents, young adults, middle-aged adults, older adults, and people near the end of life. Even near the end of life, much can be done to help with quality of life, and to improve people’s emotional and spiritual health.