When people think of the “cutting edge” of medicine, most will think of cures to cancer, AIDS or Ebola involving state-of-the-art science done in labs associated with big medical schools.
By contrast, every doctor will tell you to lose weight, quit smoking, drink less and exercise more.
But to Mountain View TLC, an innovative Durango medical practice, that all-too-familiar range of doctor’s orders is where there’s room for groundbreaking.
Mountain View’s Dr. Kirsten “Kicki” Searfus said the demoralizing part of traditional doctoring – like a New Year’s resolution – is its seeming simplicity.
For the most part, there’s no great intellectual mystery to losing weight: Eat healthier, smaller portions.
Want to quit smoking? Don’t smoke anymore.
To cut down on your drinking, drink less.
Yet the odds on actually doing those things would seem harsh.
Searfus said, philosophically, her practice is committed to recognizing human complexity.
“We all face significant barriers to doing the right thing,” she said. “People are bombarded with information about what they should be doing. They think, ‘I know what I should be doing,’ then find it impossible to do it in the moment they’re in.”
At Mountain View, five professionals – Dr. Searfus, psychotherapist Judith Vanderryn, dietician Marissa Kleinsmith, exercise physiologist Kevin Dehlinger and unsinkable patient-care coordinator Josie McCoy – work as a team to help patients change.
The atmosphere is happy, sometimes chaotic, with patients coming in and out, and the professionals sometimes physically running into each other in the waiting room. But they are bound by a common ethos: Change is hard, and failure to lose weight or quit smoking isn’t a moral commentary on the patient. It’s thoroughly human, and humanity is more medically complicated than science.
The day-to-day
Humans’ desire for self-improvement is, by some measures, heartbreaking.
Studies show millions of Americans resolve to lose weight, quit smoking, drink less and exercise more every December. The overwhelming majority fail by January, leading the journal American Psychology to warn against “false hope syndrome,” a painful consequence of New Year’s resolutions “characterized by unrealistic expectations about the likely speed, amount, ease and consequences of self-change attempts.”
When Cindy Humiston came to Mountain View in 2012, she was, by her own account, desperate.
She’d been exercising and eating healthy for months.
“I’m an amateur triathlete, and I’d been training to go from a sprint, entry-level distance to Olympic distance,” she said. “I gained 20 pounds, my blood work in terms of sugar and cholesterol was disastrous. It was a situation where I was working on my own for three years, trying to eat right and exercise. I was doing everything I was supposed to do, but the results were going the wrong direction.”
Humiston said she saw Searfus, “and she referred me to Kevin and Marissa. To their credit, they saw I was really trying.”
As a team working together over the course of months, they figured out she had “a triple condition, a perfect storm. I was menopausal, I had a metabolic issue from 30 years of being a desk jockey and I had a genetic condition I didn’t know about,” she said.
Her father died of a heart attack when he was 56 after getting off a treadmill. She credits Mountain View with saving her life.
“That began an 18-month journey I’m still on,” she said. “Once we identified all that, then the weight came off. I lost 30 pounds and went from a cardio risk of 9 to 2.7 – a woman is supposed to be at 4.4. I did half the Ironhorse. It was transformative.
“You have no idea what it’s like to know how hard you’ve been trying to lose weight and exercise and see the scale climbing,” she said.
Focusing on ‘how’
Mountain View’s psychotherapist Vanderryn said patients’ demoralization is one of the trickiest aspects of behavioral change.
When you try to lose weight and fail, she said, it creates a “sense of self-defeat that often taps into really old feelings about one’s self – ‘I always knew I was a failure, that I would never be able to do that.’”
The power of Mountain View’s model is it can address those ancient feelings of worthlessness and prevent the “fat loser” tautology. After all, feeling like a fat loser isn’t conducive to taking on an ambitious new fitness program – so much as drowning one’s considerable sorrows in a tub of ice cream and never leaving the house.
Vanderryn said from making a new friend to stopping drinking, the practice’s relentless focus on “how” the patient can do something defuses patients’ ballooning anxieties about whether or not they can.
Dietician Kleinsmith likewise said the devil was in the details.
“It’s one of the things that’s unique to our practice,” she said. “Searfus recognizes it’s easy for a doctor to say, ‘OK, you need to lose weight,’ and I can tell a patient, ‘You need to eat more kale.’ But if that person doesn’t know what kale is or where to buy it or how to prepare it in the kitchen to make it taste good, they’re not going to eat it for dinner – and it’s not realistic to suggest someone make that change.”
Dehlinger said sharing patients promoted an office-wide sense of “being in this together.
“One of the things that our model really allows is much more support than patients have been offered before. They are seeing us more frequently – and their goal is in the forefront – and we just try to be constantly encouraging and supportive of them,” he said.
Searfus said the model of collaborative care has produced excellent results. She said appointments run from 45 minutes to an hour – much longer than in the typical doctor’s office. And while the practice doesn’t take insurance, it has an affordable two-tier price structure catering to patients who need to visit frequently.
“I used to tell people to quit smoking or take better care of themselves and give them numbers to call,” she said. “But there was no collaboration or accountability, no feedback loop to help people keep on track. Now, I am actually able to give people the help they need to change. And as a physician – god – that’s so much more fun than the traditional model.”
