How to value your health care?

If you guessed that this post would be about concierge care you are correct. Not all concierge care is equal despite the various price points promoted.  Getting the best of everything delivered in New York City is not an unusual experience unless you are talking about health care services.  Imagine calling or texting your doctor and getting a response immediately.  The standard of care of care provided is evidence-based and conveniently delivered to your home, office or hotel. 

Why is this practice any different? 

There are many differences between this type of care and the traditional doctor’s office style of care you may have experienced. Rather than focusing solely on the treatment of disease, what sets this practice apart from a conventional doctor’s office/concierge medicine experience:

  • Since this practice was founded in 2009 there has been a robust focus on client participation.  
  • Further distinguishing this concierge medical practice is the therapeutic relationship focusing on:
    • Enhanced quality of life
    • Mutually finding purpose and reason for being
    • Pro-active health promotion, and disease prevention
    • Delivered discretely to your door

Using this health management approach, your primary care provider is not merely concerned with your cholesterol and blood pressure numbers.  He is concerned with your overall quality of life, and peak performance in the multiple roles (husband, father, executive, athlete, community member)  you play in your daily life as well as the trajectory you are on. 

Real luxury in health care can allow you to live a meaningful life in which you thrive rather than merely survive. Ordering the priorities of your life in such a way that unburdens you by habituating them can significantly reduce your daily stress and provide you with a sense of control and mastery.  Luxury healthcare offers you just the right amount of support you need and the amount of therapeutic pressure you need to grow into achieving your full potential. That level of care is what is delivered discretely to your door.

Compassionate, competent, confidential care is a big draw to those with means to pay the membership fee necessary to gain access to this level of service.  The membership allows for medical and psychiatric house calls, web-camera visits, email, text, and phone access to Dr. Zakhari which enables you to receive care even when you are traveling. 

This type of service is the highest level of health care delivered in the most private and intimate setting.  Merely the access to medical house calls and your doctor’s cell phone number is not worth the thousands of dollars of many concierge medical practices. The personal attention and focus on each person’s needs make this service unique. Whenever a member needs some impromptu counseling, a moment of encouragement, or a confidant to consult regarding issues of well-being, someone that knows you and won’t judge you. That level of care is only a text away.  

Dr. Raymond Zakhari is a triple board-certified nurse practitioner who can address most of your health needs ranging from the comprehensive physical exam,  care when you are sick, chronic disease management, and psychiatric care including talk therapy, psychopharmacology, and genomic testing. He was also trained in human sexuality at the NYU School of Medicine,  no subject is off limits all in the privacy of your own home. 

 

The Edge: Psychiatrist and performance coach

No doubt you have seen the Showtime series “Billions” in which Axe Capital has employed a full-time psychiatrist-performance coach to enhance profitability.  The role does exist at many financial and hedge fund firms, but confidentiality may be lacking. One never knows for sure what a corporately hired counselor can keep from the employer.  Some have gone on to retain this service privately to reap the benefits of confidentiality and full disclosure. 

Much of the role of a psychiatrist-performance coach is to cultivate and enhance a resilient mentality that allows you to make high-risk decisions during stressful and uncertain times.  Whether in finance or the rest of life problem behaviors persist, and patterns develop.  Once a habit forms, it can be tough to change. Ask yourself these questions:

·         Have I become an anxious trader who over trades despite low volatility?

·         Have I developed a revenge pattern emerge where I make hurried decisions to quickly recover losses?

·         Have I bought into the social pressure of feeling guilty regarding my success and wealth that I may have started sabotaging myself?

A Nurse Practitioner performance coach trained in psychiatry and physical health (family practice) can help you stay on the edge of profitability. By engaging you in a holistic process that examines the emotional roots of your poor performance, your physiological changes that occur as a result of age and heredity, your diet, sleep pattern, social life, sexuality, and even spirituality. 

Developing a resilient mindset allows you to analyze and interpret complex, ambiguous, stressful events by distinguishing fact from fantasy. Imagine rising above being a victim of your feelings.  Developing this mindset requires commitment, consistency, and clarity.  The method begins with comprehensive physical, psychiatric, sexual and spiritual evaluation. A comprehensive strategy is devised to tackle the problems with primal precision power. 

This sort of performance coaching is not for the faint of heart. It will get to the cause of your performance anxiety and inconsistency. The only reason not to engage is if you are okay with the status quo.  

Stay tuned for subsequent posts that will shed light on the power of emotions affecting decisions, and how your lack of purpose is creating ambiguity, and what your sexual thoughts may reveal about your fears and desires.

What is real luxury health care really?

Getting the best of everything delivered in New York City is not an unusual experience unless you are talking about health care services.  Imagine calling or texting your doctor and getting a response immediately. The membership fee allows clients access to an uncommon type of concierge medical practice in Manhattan.  The standard of care of care provided is evidence-based and conveniently delivered to your home, office or hotel. 

The triple board-certified nurse practitioner can address most of your general health needs ranging from the comprehensive physical exam,  care when you are sick, chronic disease management, and psychiatric care including talk therapy and psychopharmacology. Trained in human sexuality at the NYU school of medicine, the nurse practitioner provides sex therapy to help enhance your performance or overcome your difficulties all in the privacy of your own home. 

There are many differences between this type of care and the traditional doctor’s office style of care you may have experienced. Rather than focusing solely on the treatment of disease, what sets this practice apart from a conventional doctor’s office/ clinic experience since the founding in 2009 is the robust focus on client participation.  Further distinguishing this concierge medical practice is the therapeutic relationship focusing on enhanced quality of life, mutually finding purpose and reason for being,  pro-active health promotion, and disease prevention all delivered discretely to your door. Using this health management approach, your primary care provider is not merely concerned with your cholesterol and blood pressure numbers.  He is concerned with your overall quality of life, and peak performance in the multiple roles (husband, father, executive, athlete, community member)  you fill in your daily life and the trajectory you are on. 

Real luxury in health care can allow you to live a meaningful life in which you thrive rather than merely survive. Ordering the priorities of your life in such a way that unburdens you by habituating them can significantly reduce your daily stress and provide you a sense of control and mastery.  Luxury healthcare offers you just the right amount of support you need and the amount of therapeutic pressure you need to grow into achieving your full potential. That level of care is what is delivered discretely to your door.

To that end, membership is limited to 50 individuals who are selected to enter into a collaborative relationship with Dr. Raymond Zakhari.  During our initial sessions, we will examine your current state of health and desired outcome in multiple areas of your life including physical, mental, spiritual, sexual, and social health.  You will also be asked to assist in some data collection between visits to develop an intelligent guide to help create the circumstances of optimal function, realistic health outcomes, and a daily sense of purpose.

Compassionate, competent, confidential care is a big draw to those with means to pay the  annual membership fee—the panel is limited in size to allow all members the level of availability and individualized attention they expect with this service.  The membership allows for medical and psychiatric house calls, web-camera visits, email, text, and phone access to your primary care provider which enables you to receive care even when you are traveling. 

This type of service is the highest level of healthcare delivered in the most private and intimate setting.  Merely the access to medical house calls and your doctor’s cell phone number is not worth the thousands of dollars of many concierge medical practices. The personal attention and focus on each person’s needs make this service worth that price. Whenever a member needs some impromptu counseling, a moment of encouragement, or a confidant to consult regarding issues of well-being, someone that knows you and won’t judge you is only a text away.  This experience is a unique offering that is hard to replicate outside of New York City. 

Treating addiction with discretion

While it may seem obvious in order to stop an addiction one has to stop using the addictive substance.  Quitting a narcotics addiction, in particular, can be very uncomfortable, and the discomfort during the initial detoxification process often leads people to abandon their efforts.  A medically supervised detox may alleviate some of the suffering associated with narcotics detox.  There are several medications on the market that can be used to minimize your symptoms of withdrawal as you go through this process. 

For the longest time methadone has been the primary prescription medication of choice when switching from a narcotics or illicit substance addiction.  Methadone came with a burden of having to go to a specific location each day over the course of many years.  In this respect, the individual’s entire life began to revolve around addiction treatment.  For many years now a medication called buprenorphine has been on the market as a way to maintain sobriety and facilitate detox and withdrawal from narcotics. Buprenorphine comes in a variety of formulations including in combination with naloxone. When buprenorphine is combined with naloxone it is sold under the brand name Suboxone. 

When you have identified a treatment provider and therapist he will discuss the timing of beginning Suboxone treatment.  In order to reduce the effects of withdrawal, Suboxone must be used with support.  It is best to wait 18-24 hours after using a short-acting narcotic before beginning Suboxone.  If you’re on a long-acting narcotic its best to wait 48-72 hours before beginning Suboxone. 

When the time comes to begin using Suboxone film you should be in a state of mild to moderate withdrawal.  You should begin by having a full glass of water to make sure your mouth is sufficiently moistened. Then placed the film under your tongue or in the between your cheeks and teeth and let it slowly dissolve. This film should not be chewed, torn, swallowed, injected, or taken in any other way other than slowly dissolving in the mouth.  You should not eat or drink anything until the film is completely dissolved. Typically you will take a film every 2 hours until you are stable. 

While using Suboxone maintenance and detox it is important to begin to engage yourself in other life activities so that you can set yourself up for success. If you are well motivated to do the right thing there is a very good chance you can successfully overcome your narcotic addiction with the proper help and support.  During your use of Suboxone, it is important to avoid all other medications unless specifically advised by your healthcare provider who is managing your narcotics withdrawal.  Once you have reached a steady state of Suboxone medication usually after 90 days to 6 months you may consider a very slow taper (2mg/ month).  It is not uncommon for some people to just remain in the steady state and not taper.

If you withdraw from narcotics or Suboxone too quickly you will notice increasing signs and symptoms of a narcotic withdrawal which can include:  Insomnia, stomach cramps, diarrhea, hot and cold flashes, restless leg syndrome, nightmares, depression, aggression, fear, and anxiety.  There are other supportive medications that can be prescribed to reduce the symptoms and improve your comfort.  Withdrawal symptoms may come and go for as long as 5 or 6 days before they go away for good. 

Suboxone therapy can be done in a doctor’s office, the medication-assisted treatment center, or in the privacy of your own home should you require discretion.  Many people have successfully kicked their narcotics addiction with the use of Suboxone and supportive therapy.

 

Dr. Zakhari is board certified in family practice and psychiatry and provides medically supervised home detox services in Manhattan. The visit begins with a comprehensive history and physical exam, and necessary diagnostic tests to evaluate risk. This service is available to member patients. 

You have a wealth manager, but not a health manager?

A health manger more commonly known as a concierge physician can be one of your most valuable consultants.  If your personal physician is not providing you with the time and attention to detail you need and deserve perhaps it is time to switch or get a second opinion. 

Making time for individualized preventative care can be difficult. Perhaps an executive health physical may be the perfect solution to your time constrained life in New York City and abroad.

What is an executive health physical and do you have to be an executive to get one?

First, you do not have to be an executive to have an executive health physical exam.  It helps if you have the salary of an executive as these comprehensive exams are usually not covered by insurance.  An executive health physical is simply a comprehensive physical exam and health assessment that helps you and your primary care provider stratify risk for disease over time. 

An executive health physical begins with a one-on-one meeting with your primary care provider in which a detailed comprehensive health history is reviewed.  Special attention will be given to your family history and lifestyle to uncover modifiable risk factors.  As part of your comprehensive health history your primary care provider will review your current diet, exercise, sleep, and sexual practices. After your comprehensive health history is revealed a hands on head-to-toe examination will be done. For men this will include a urogenital prostate exam and for women you will be referred for a gynecologic exam.   

Following your comprehensive history and physical exam your primary care provider may consider ordering various blood tests for screening and diagnosis.  Additionally, non-radiation imaging studies, and sensory tests (Vision, and Hearing) may be prescribed to provide a more detailed look at your physiology.  The tests ordered should be judiciously considered so as to not increase the likelihood of false positive findings.  False positive test results compound stress and increase the risk of harm. For this reason total body scanning is generally not a prudent idea for screening purposes. There is a very high risk of incidental findings without clinical significance in general body scanning. 

In addition to the comprehensive history and physical exam you should also receive a comprehensive psychiatric evaluation (not for the purpose of necessarily identifying a mental illness), but for identifying coping mechanisms and risk factors for maladaptive coping in the future.  A comprehensive psychiatric evaluation can provide you the anticipatory guidance necessary to relieve your stress at the different ages and stages throughout your lifespan.  Mental illnesses such as depression and anxiety schizophrenia and bipolar would have likely been discovered prior to your executive health physical. Less known but more common conditions such as dysthymia, adjustment disorders, dysfunctional grief, addiction, PTSD, insecurities and phobias will also be screened.  The comprehensive medical history, complete physical exam and the psychiatric evaluation are the three components that comprise an executive health exam. 

After this comprehensive evaluation is completed you will now have established a foundation for a participatory care relationship with someone that knows you very well. Now you have a relationship with a medical trained consiglieri whom you can call on in your times of need.  A modifiable personal wellness plan can be implemented with your coach at your side.

What happens if you need a specialist?

Should you need consultation from a sub-specialist a facilitated referral will be arranged.  Specialists are selected from renowned institutions in the New York City area.              

How great would it be if you had guy that could conveniently and confidentially take care of you and your family?  

Do you have a headache in your pelvis?

If you have discomfort, pain, or other symptoms in the pelvic floor, perineum, pelvis, lower abdomen, low back, groin, or genitals, massage and myofascial release can be of great benefit. Pelvic floor muscles are the foundation of the core, and problems can stem from overuse, disuse, misuse, and abuse, as well as mental and emotional stress. Some evidence has shown that the pelvic floor muscles can cause pain and sexual dysfunction. In addition to some conventional medical treatment such as anti-inflammatories and muscle relaxers, pelvic floor and prostate massage with myofascial release massage  can be an effective therapeutic option for both treatment and prevention of pelvic floor pain times called Category III chronic prostatitis.  A strong pelvic floor can increase your power in your core.

Some risk factors for developing pelvic floor pain/ nonbacterial chronic prostatitis include Cycling.  Cycling has a much higher potential to adversely affect the pelvic floor (including the genitals) due to direct and significant compression of these tissues by the bicycle seat (regardless of protective equipment). If you must cycle then routine pelvic floor massage and core strengthening exercises i.e. kettle bell, pilates and yoga can help mitigate some of the injury.

Prostate massage or “Prostate Milking” and pelvic floor myofascial release increases circulation and reduces suffering in many cases. Improving circulation can also increase the effectiveness of medicines. Few things compare with the simplicity and effectiveness of strengthening your pelvic floor muscles and reflexes. Physicians have prescribed prostate massage for centuries, as it is one of the oldest therapies and when done by a trained professional for the right candidate it can have many beneficial effects.

Benefits of prostate and pelvic floor massage:

1.    This complimentary alternative treatment helps in draining the seminal fluids, which have been collected and creates pressure in a lot of cases leading to inflammation.

2.    Pelvic floor massage helps to relax the tension and stress many men carry in the muscles of the pelvis, causing discomfort along the nerve endings in the prostate area. Men could truly feel relaxed when the muscles of the pelvic floor and prostate gland are massaged.

3.    Pelvic floor massage increases the circulation to the prostate gland, providing nourishment and oxygen.

Complete this NIH Chronic Prostatitis Symptom Questionnaire and know that you can be helped in the privacy of your home.  As with anything in health care consistency is key to lasting results. 

The busy man's annual physical exam

Having a regular physical examination allows your doctor to assess your overall health on a regular basis, providing a basis with which to compare when you do become ill. Unfortunately, most men only head to the doctor’s office when they are feeling ill or need medication. While heading to the physician when you are ill can help you recover quickly, scheduling routine physical examinations typically referred to as a well-visit, can be a vital part of staying healthy. Just like any other wellness visit, a routine physical examination includes checking the health of all vital organs as well as ensuring the health of the male sexual organs.

The manly physical exam:

 The most important physical exam diagnostics for men based on age and some FAQs that concern most men?

 In Your 20s

  • Annual physical exam by your primary care provider, including blood pressure, and height/weight checks
  • Screening for testicular cancer, including monthly self-exams
  • Cholesterol testing every 5 years
  • Depending on your individual circumstances, your Nurse Practitioner may want to do an electrocardiogram to check for heart disease, and blood tests to screen for diabetes, thyroid disease, liver problems, and anemia
  • Depending on risk factors, your Nurse Practitioner may also recommend screening for skin cancer, sexually transmitted diseases, HIV infection, and alcohol abuse

In Your 30s

  • Annual physical exam by your primary care provider, including blood pressure, and height/weight checks
  • Screening for testicular cancer, including monthly self- exams
  • Cholesterol testing every 5 years
  • Depending on your individual circumstances, your Nurse Practitioner may want to do an electrocardiogram to check for heart disease, and blood tests to screen for diabetes, thyroid disease, liver problems, and anemia
  • Depending on risk factors, your Nurse Practitioner may also recommend screening for skin cancer, oral cancer, sexually transmitted diseases, HIV infection, and alcohol abuse
  • Vision examination
  • Screening for coronary heart disease in individuals with strong family history and/or risk factors

In Your 40s

  • Annual physical exam by your primary care provider, including blood pressure, and height/weight checks
  • Screening for testicular cancer, including monthly self exams
  • Cholesterol testing every 5 years
  • Depending on your individual circumstances, your Nurse Practitioner may want to do an electrocardiogram to check for heart disease, and blood tests to screen for thyroid disease, liver problems, and anemia
  • Screening for prostate cancer
  • Diabetes screening every 3 years over the age of 45
  • Depending on risk factors, your Nurse Practitioner may also recommend screening for skin cancer, oral cancer, sexually transmitted diseases, and alcohol abuse
  • Vision examination
  • Screening for coronary heart disease in individuals with strong family history and/or risk factors

In Your 50s

  • Annual physical exam by your primary care provider, including blood pressure, and height/weight checks
  • Screening for testicular cancer, including monthly self exams
  • Cholesterol testing every 5 years
  • Annual screening for Type II diabetes
  • Depending on risk factors, your Nurse Practitioner may recommend screening for skin cancer, oral cancer, lung cancer, sexually transmitted diseases, and alcohol abuse
  • Screening for lipid disorders
  • Annual electrocardiogram
  • Vision and hearing examinations
  • Screening for prostate cancer
  • Screening for colon cancer with fecal occult blood testing, sigmoidoscopy, or colonoscopy at age 50
  • Screening for coronary heart disease in individuals with strong family history and/or risk factors
  • Screening for depression

In Your 60s

  • Annual physical exam by your primary care provider, including blood pressure, and height/weight checks
  • Screening for testicular cancer, including monthly self exams
  • Screening for prostate cancer
  • Screening for lipid disorders
  • Annual electrocardiogram
  • Discuss with your physician screening for coronary heart disease, abdominal aortic aneurysm, and carotid artery ultrasound screening
  • Vision and hearing examinations
  • Screening for osteoporosis
  • Depending on risk factors, your Nurse Practitioner may recommend screening for skin cancer, oral cancer, lung cancer sexually transmitted diseases, and alcohol abuse
  • Continue colorectal screening based upon previous studies and results
  • Screening for depression
  • Screening for dementia and Alzheimer's disease

In Your 70s and Up

  • Annual physical exam by your primary care provider, including blood pressure, and height/weight checks
  • Screening for testicular cancer, including monthly self exams
  • Screening for prostate cancer
  • Screening for lipid disorders
  • Annual electrocardiogram
  • Discuss with your physician screening for coronary heart disease, abdominal aortic aneurysm, and carotid artery ultrasound screening
  • Vision and hearing examinations
  • Screening for osteoporosis
  • Continue colorectal screening based upon previous studies and results. General screening until age 75. Discuss with your physician screening if aged 76-85 years old. Screening is not recommended for those greater than 85 years of age.
  • Depending on risk factors, your Nurse Practitioner may recommend screening for skin cancer, oral cancer, lung cancer, sexually transmitted diseases, and alcohol abuse
  • Screening for depression
  • Screening for dementia and Alzheimer's disease

FREQUENTLY ASKED QUESTIONS BY MEN FOR MEN

What sorts of questions might I be asked?

In order to assess how genetics may be affecting you, the Nurse Practitioner will discuss your medical history, including all of your family’s medical history. Additionally, the Nurse Practitioner may ask you about your current living conditions, any diseases you may have had or currently have, sexual history, lifestyle, and diet. Be sure you are straightforward and honest with the Nurse Practitioner so he has all the information needed in the case a diagnosis is necessary. If you have any concerns, now is the time to express them.

What will be the general flow of the physical exam?

After discussing your medical history, the Nurse Practitioner will then assess your current medical condition. This is done by taking your height and weight measurements, and checking all of your vitals. The Nurse Practitioner may also asses your reflexes and lung function. All of this will help the Nurse Practitioner determine if you are the healthy individual as you thought, or if there is something going on that you have not yet noticed.

What should I expect with the Prostate and Genital Exam?

Once the general wellness exam has been completed, the visit will then proceed to the examination of the penis and testicles to check for any abnormalities. While the testicles are checked for any strange growths, the penis is checked for anything unusual, such as lesions or discoloration.

Now that the external is complete, you will then go through a prostate exam. This is one of the main reasons most men avoid having a wellness visit as it is very uncomfortable. Checking the prostrate requires the Nurse Practitioner to insert his gloved and lubricated finger in the rectum to feel for the prostate gland to look for signs of swelling. Even though it is uncomfortable, just remember that over ninety percent of all potentially fatal prostrate issues were caught because of this simple exam.

What sorts of tests will be done or ordered?

Regardless, if the Nurse Practitioner is concerned about any specific occurrence throughout the exam, he or she may order other tests to be completed. For some, this is to assess an area to see if something really is wrong, while for others it is done purely to get a baseline or see how well the baseline has been maintained. This may be done through ordering either urine or blood test, or both. Doing so will allow the Nurse Practitioner to check your body’s levels and may catch anything that the physical exam did not.

How Should You Prepare for Your Physical?

Before going to your wellness visit, you will want to make sure you have brushed up on all of your family’s medical history, as well as your own. Such things as cancer, stroke, heart disease, and diabetes are all diseases that typically run in the family and your Nurse Practitioner should know about. Additionally, be familiar with all medications you are taking on a regular basis, even if it’s over-the-counter. Lastly, if you have noticed something strange, take notes about the symptoms you are experiencing so you can thoroughly discuss the issue with your Nurse Practitioner. Finally, take a thorough shower, and put on clean underwear as it will enhance your confidence.

What are the most prominent medical concerns for me based on age?

Even though men will not necessarily want to have these done once a year, they are called annual physical exams for a reason. Men should schedule these to occur at approximately the same time every year. In general, the following are visits that you should have at the listed ages:

  • Age 20: have annual testicular and hernia exams
  • Age 35: pay close attention to the thyroid and testicular cancer
  • Age 40: Cholesterol Lab Tests, and erectile function
  • Age 50: first colonoscopy, to be repeated every ten years; blood test to screen for prostate cancer erectile function and prostate enlargement

Why Would the doctor Tell Me to “Turn and Cough?”

For those who lift heavy objects for a living, or simply enjoy lifting heavy weights for their workout, this part of the exam can help determine if you have a hernia. When you “turn and cough,” the Nurse Practitioner will gently squeeze your testicles. If this causes you severe pain, you have a hernia. If not, then you are in the clear.

What happens if I become aroused during my physical exam?

It is not uncommon for some men to get an erection during a physical exam. It is one of the most common reasons I have heard that men do not go to the doctor. I generally reassure my male patients that this is quite normal and a sign of good blood flow and sexual health. Some men even become so aroused that they even leak some fluid (also normal, and nothing to fear). These problems are far less embarrassing in the privacy of your own home. 

 

Physician Heal Thyself . . .

By Dr. Raymond Zakhari, NP

Counselor Advocate for Yourself, Pastor Forgive Yourself, Entrepreneur Reinvent yourself

Many people struggle with feelings of shame and guilt in regards to mental illness. The burden can be especially difficult for professionals. Professionals often have a hard time seeing themselves as human beings vulnerable to the same issues as everyone else. Doctors, lawyers, ministers, executives, entrepreneurs, as well as other high achievers are traditionally ambitious, driven, and accomplished individuals. They have very high standards for themselves, and people around them may have even higher expectations.  

People that are used to being successful in various endeavors and having a sense of mastery do not typically deal well with certain life events. Some life events such as a failed deal, a loss of a relationship, a challenge to competence or professional identity can easily overwhelm your capacity to cope. A feeling a failure may grow within you and your confidence can feel undermined. Fears of a marred reputation, perception of weakness may build. You may begin to worry about your status as someone who may be perceived intellectually inferior.   

Leaders, especially prominent leaders, are so demanding of themselves that they don’t allow for physical illness much less a psychiatric mental health illness. High achieving leaders have usually attained their status by having a resilient tenacity towards achieving a goal. Like all people professionals are human, and they too have limits to their abilities to cope with multiple stressors. Professionals however are at a slight disadvantage than the average person because it is very unfamiliar territory to have to rely on other people. Doctors, lawyers, ministers, executives are used to being the rocks of the community. The ones that seemingly have it all together, the ones whom others go to for help.  

Professionals who find themselves in leadership often lament “it is lonely at the top”. Professionals and leaders often find themselves without a social support network either by design or by default. In order to build a successful career and reach the highest levels of achievement certain aspects of daily life may have had to be sacrificed. In an effort to be the go to person in an industry certain relationships may have had to be kept at arm’s length in order to maintain objectivity. Professionals and leaders may derive their entire identity from the work they do. They may see their work as a calling rather than a livelihood. Consequently they may derive most of their self-worth from the results obtained. As a result this person is at the highest risk for ineffective coping during times of crisis. The combination of depression and despair can be fatal.

Professional’s therapy allows the development of a therapeutic relationship in a discrete manner that allows for the development of coping skills, medication management, and introspective reflection to create a life congruent with a personal values system.  Treatment is intensive for the first 3 weeks and tailored to goals to create habits of mental wellbeing. Some common skills include the expansion of resilience, and empathy to the self. Participants will learn to build an internal validation system to cultivate a sense of belonging which will develop feelings of understanding leading to the ability to reconnect with others.

Some common struggles for professionals in therapy include overcoming familial, cultural stigmas associated psychiatry and mental health issues. Ambivalence and resistance is normal and common in the early phases of seeking help of any kind, especially mental health help. In the confines of the confidential therapeutic relationship the professional will learn to become vulnerable which will learn to mastering the first developmental task of life, trust. As therapy progresses professionals may learn to reconnect with their primary relationships or develop them. Professionals will learn to use the relationships outside of work to gain a sense of security, love, belonging, confidence and wellbeing that is essential to sustain working relationships and personal sanity. As the professional learns to trust other people emotionally they become more self-reliant.

The process of reevaluating priorities related to one’s career can be a wrenching process. Finding safe people with whom to share struggles at work can aid in recovery for those who do return to their former vocations.  There is no expectation to be vulnerable with everyone at the workplace nor is it professional, however building a trust worthy social net can make the work more enjoyable. As therapy progresses allies, safe havens, and wisdom will be cultivated. The therapeutic process will capitalize on the professional’s calculated risk taking proclivity as well as enhance resilience by teaching how to deal with failures, trying again, and refining character. Healing will occur on the physical, psychological, spiritual, and relational levels.

If you are a professional who can relate to what was written then 2015 may be your year for wellness. Ambivalence is normal and common. I will meet you where you are emotionally and physically (home, office, or hotel in Manhattan, walk and talk) and work with your motivation for change to improve your life.

Who does what in health care?

By Dr. Raymond Zakhari, NP

The interface between medicine and psychiatry is the crack that many patients often fall through in terms of having their health care needs met. A small group of health care providers in the United States is uniquely qualified to care for patients with both mental health and primary care needs. This group of health care providers is double board certified in internal medicine or family practice and psychiatry. That means they were equally trained in the traditional aspects of primary care as well as trained in the field of psychiatry. This healthcare provider can either be a physician or a nurse practitioner. If the provider is a physician they may be known as the Internist-Psychiatrist, and if the provider is a nurse practitioner they will be known as a Family Practitioner- and Family Psychiatric Mental Health Nurse Practitioner.

These two professions address the needs of people with mental health problems that impact a medical condition, as well as care for people with general medical concerns who develop a mental illness. They also have a great deal of experience in dealing with the adverse effects of psychotropic medications including diabetes, kidney trouble, and anemia. 

On average a patient with a serious mental illness such as bipolar disorder or schizophrenia can have a 10-20 year reduced life expectancy because of the barriers in accessing routine and preventative care, and the reduced adherence to treatment. People with mental illness can also suffer from the same conditions that affect the general population including heart disease, diabetes, and high blood pressure. Similarly it is not uncommon for a patient who has suffered a heart attack or stroke to become depressed or anxious to the degree that it impairs daily life functions. 

This holistic type of care which integrates primary care and mental health is an approach to care which seeks to optimize mental and physical well being with the added convenience of a one stop shop.  

Meaningful Relationships vs Meaningful Use: Concierge Care

By Dr. Raymond Zakhari, NP

Concierge medicine is rapidly gaining traction among people who are looking to establish a meaningful relationship with their primary care provider. Patients are yearning to experience a different kind of medical care – one where their doctor spends quality time with them instead of rushing off to complete paperwork, or see the next person in a crowded waiting room of patients. A few years ago, doctors were always ready and able to drop everything and tend to the needs of their patients. “Family doctors” had a relationship-based model of care, and made house calls.

Unfortunately, insurance companies and mounting government mandates have reduced health care to a list of codes, and endless forms. Patients are known by a string of numbers. Both doctors and patients are made to conform to the new regulations of the day. The traditionally practicing health care provider has a second full time job as a data entry clerk. Patient-focused services have eroded over time. Suddenly, the doctor-patient relationship is a business arrangement consisting of fast in, fast out, drive by physical exams, impersonal and fragmented care, and increased ER and Urgent care visits.

Do you find that your current annual physical leaves something to be desired? Are you sure that you know as much as you can about your health? If you are like most busy people here in New York, your annual physical does not provide you with full information about your health. Have you ever felt that your doctor could not provide you with the care you needed and have been rushed along? Are you tired of competing for your doctor’s attention? Are you fed up with calling to book an appointment and waiting on hold for hours, only to learn that the next available date isn’t for six months, and speaking to impersonal curt front of the house staff? If you’re one of the thousands of patients who has felt this way, it is likely because your doctor is one of the many overbooked Primary Care Providers/ Data Entry Clerks.

A Concierge Nurse Practitioner eliminates the need to chase your doctor and to try and fit yourself into his or her already overbooked slot. A concierge Nurse Practitioner deliberately plans enough time to talk to you as the most important member of your health care team. A Concierge Nurse Practitioner is willing to spend as much time as needed to uncover any potential issues with your health.

If you are ready to take control of your health care with a board certified primary care provider that has the time to focus on you, then you would greatly benefit from the expert care of a nurse practitioner. Concierge care allows you to experience relationship-based primary care, and return to the good old days, of house calls, compassionate care, talk therapy, and a complete understanding of your diagnosis and treatment options. Join this movement to revitalize medical care, with a nurse practitioner that values your business and respects your time.