Gregory Petersburg, DO

Why does a cup of coffee cost more at a trendy café like Starbucks than it does at the corner diner or when brewed at home? It’s the value that the experience holds for the individual that determines the worth of the offering and the work of the business. Marketers understand this principle and the market value of experiences to consumers. Automobile ads don’t sell cars; they sell the driving experience. Restaurants advertise the ‘fine dining experience.’ Travel agents no longer book vacations; they book ‘adventures’. And let’s not forget the granddaddy of experience sellers: Disneyland. The product they sell is ‘experiences’. You may not have given it much thought, but the same principle applies to your medical practice.

Just delivering great service to your patients is no longer a winning strategy. Aging baby boomers already expect great service. And if you’re still competing on the basis of price, then you are offering little or no true differentiation from the competition. What would your patients really value? Better yet, for what would they pay a premium? Experiences!

It’s not that we don’t give our patients experiences. In fact, the medical profession already has a long history of creating patient experiences. It’s just that these experiences are not particularly positive, more often than not. How many patients can honestly say they enjoy and look forward to going to the doctor? Not many. That’s because, in large part, the experiences patients have are mostly unintended, the result of not understanding the principles of experience design and execution. Yet, the kinds of experiences we could create for patients hold the potential to significantly improve clinical outcomes, patient compliance, patient satisfaction and loyalty, provider satisfaction, and, yes, even profit margins. Ideal patient experiences can give them hope and inspiration, and are powerful catalysts for them to take action. In essence, experiences are what change lives. With a little planning you can create meaningful and memorable experiences that improve the quality of your practice and your patient’s life.

The following steps will guide you through the processes of creating unique experiences in your practice:

1. Make the Experience Intentional

What is the ultimate take-away experience you want your patient to have? Inspiration? Motivation? Transformation? Begin with the end in mind and engineer backwards, tweaking all of your practice processes in ways that contribute to the experience. Choosing a theme for your work is a helpful starting point for creating powerful experiences. How likely would you be to finish reading a novel if it had no theme? You would probably close the book before finishing the first chapter. A theme is essential, as it conveys the central idea of a story (or your work) and is necessary in order to fully and effectively engage an audience (i.e., your patients). Themes can be based on almost anything: people, places, events, times, ideas, messages, etc. Once you have your theme, build a story around it.

2. Make the Experience Individual

Give each patient the feeling that every interaction with him or her, and everything you do for him or her, is just for him or her. (-Or – Give your patients the feeling that every interaction with them, and everything you do for them, is just for them). You can personalize everything, such as phone calls, appointments, and patient handouts.

‘Mass customization’ is one way: Make small but personalized modifications and additions to standardized services, materials, or products that otherwise are the same for all patients. ‘Organizational memory’ is a way to give the patient the feeling that everyone in your organization knows and remembers the patient in a personal way. Your medical records already include the patient’s date of birth, so that information can help everyone in your organization to remember and celebrate the patient’s birthday. Similarly, you could collect personalized information in a new patient intake form that could be used in a variety of ways: favorite foods and music, who they admire and why, what kinds of things inspire them, where they go to ‘recharge their batteries’, what they list as personal strengths/weaknesses/fears, etc.?

3. Make the Experience Interactive

Expand the patient experience to include the time and space before, during, and after the visit. Examples might include pre- and post-visit phone calls, newsletters, interactive web tools, and ‘homework’ assignments.

4. Interpret the Experience

All work is theatre. Yes, even health care! Your office is the stage, the rooms in your office are different sets, stethoscopes and blood pressure cuffs are props, your white lab coat is your costume, you and your staff (nurse, receptionist, etc.) are the actors playing different roles, the things you say to patients (greetings, patient interview, advice for each medical condition, etc.) are the scripts. The reason for an appointment might be a ‘subplot’ in the patient’s life journey. Thinking of your theme and storyline (see above), imagine ways that your work processes can be applied or modified to fully and effectively engage your patient (the audience) in the story. How will you choreograph your ‘performance’, the sets, props, costumes, actors’ roles, scripts, etc.?

5. Make the Experience Inspiring

Become a storytelling organization. Medical practitioners have become so fixated on data as the focus of communication with patients that we have forgotten the most time-proven method in all of human history for passing along understanding and wisdom, for inspiring and motivating – storytelling. Data and information need stories to give them context. Stories add flesh and bone to the data and information. But the way stories are told is often as important as the story itself. Tell stories that are authentic to you and tell them with passion. Don’t be afraid to share your own story. Tap into timeless methods employed by every culture, religion, and organization to inspire: rituals, traditions, and ceremonies. Add them or incorporate them into your work and use them often.

6. Institute the Experiences

Incorporate these design principles and the delivery of patient experiences into all of the organization’s operational systems. Make it a permanent and ongoing part of the overall organizational culture, and commit it to words in an organizational ‘manifesto’ (A manifesto is a published/public declaration of your principles, intentions, and objectives). Tie measures (e.g., patient experience surveys rather, than service satisfaction surveys) of the effectiveness of your designed experiences to financial rewards, or give them teeth that bite (e.g., financially), if we fail to fulfill.

More about Dr. Petersburg

Kent Holtorf, MD

Learning Objectives:

• Determine the role of thyroid and cortisol in CFS and FM.
• Identify the first step of healing by stabilizing the patient.
• Reveal the causes of mitchondrial dysfunction and offending agents.
• Discuss the importance of hormone balance for optimal quality of life.
• Identify and treat underlying chronic infections.
• Review maintenance techniques for ongoing symptom prevention.

Sign Up for the Recorded Webinar

Kent Holtorf, M.D. is the medical director of the Holtorf Medical Group and the nation-wide Holtorf Medical Group Affiliate Centers, providing physicians a turn-key program for a successful cash-based anti-aging practice. Dr. Holtorf is also the medical director of the non-profit National Academy of Hypothyroidism; fellowship lecturer for ABAAM; The Endocrinology Expert for AOL Health and founding director of the non-profit Bioidentical Hormone Initiative.

• Get an overview of oxytocin’s role in the human body.
• Discuss the effect of the “Love Hormone” on libido and vitality.
• Identify the relationship oxytocin has on the aging brain.
• Evaluate common symptoms that require treatment.
• Learn key takeaways to implement into practice.

Click Here to access this recorded webinar.

Read Dr. Raffaele’s full article on the KEEPS Study

About Dr. Raffaele

Joseph Raffaele, M.D., the co-founder of PhysioAge Medical Group, a clinical practice in New York City that is at the leading edge of the emerging field of medicine focused on scientifically sound approaches to staying younger longer. He has been a featured speaker at numerous events sponsored by WorldLink Medical.

Brain lapses, memory loss, blank stares, confusion. Do you feel like you are losing your mind as you get older? What you may classify as old age and impaired brain function may truly be related to a decrease in estrogen.

Cognitive Decline as a Disease of Aging

Cognitive decline is a common concern for an aging population, in which the growing rate of Alzheimer’s disease and dementia has led researchers to look for ways to prevent cognitive degeneration. By the year 2050, it is estimated that 13 million Americans will have Alzheimer’s disease.¹ While hormone replacement therapy is not considered a treatment for cognitive degeneration, it has been considered a benefit for female patients to delay age-related cognitive decline and sustain healthy cognition.²

Estrogen and Cognition

A large concentration of estrogen receptors are found in the hippocampus – an area in the brain that regulates memory and learning.^4,5 Estrogen’s role in cognitive function is to support communication between neurons, aid the development of neuronal processes, and sustain the synthesis of neurotransmitters.^6,7

Overall, estrogen benefits cognition to:

• Support regulation of the neurotransmitters, acteylcholine and glutamate⁸

• Improve communication between neurons in the hippocampus²

• Protect nerve cells from free radical and excitotoxin damage^9,10

Summary of Estrogen Studies

Several studies have observed the effects of estrogen on cognitive function in older women. Researchers have found that among women who are over 65 years old, those that take estrogen replacement therapy (ERT) perform better on cognitive tests and show less cognitive deterioration over time.^11,12,13,14 One study recruited 288 postmenopausal women that were either taking or not taking estrogen replacement therapy.¹⁵ Researchers found that women taking ERT had better visual memory when compared to those not taking the treatment. A similar study followed 788 older women for over two years to find that those taking ERT had better cognition than those who were not taking ERT.¹⁶ A series of studies found that women had higher scores on verbal and fine motor skills tests when estrogen levels were at their peak in their menstrual cycle. Additionally, these women performed better on speed and accuracy tests.¹⁷

The Impact of a Healthy Lifestyle

Estrogen therapy may not be a main treatment for cognitive function, but it can help inhibit memory loss and cognitive impairment in women who already take HRT to treat their menopausal symptoms. It is important for the female patient to recognize that healthy cognitive function comes by living a healthy lifestyle. Along with balancing hormone levels, diet, nutrient supplementation, exercise, staying socially active, and a fascination to continue learning can help prevent age-related cognitive decline.¹⁸

Dear Colleagues,

I have been asked by many of my students what the difference is between the Part I and the Part II BHRT courses. So, I thought I would quickly highlight the difference for everyone.

Perhaps many of you have already started implementing the protocols we reviewed in Part I into your practice. And perhaps you are also experiencing different types of patients with unique treatment needs, and therefore you may have questions in your mind as how to treat these unique patient needs.

I have designed Part II to equip students with the knowledge it takes to effectively treat these types of patients, deepening their knowledge using advanced scientific review, important new therapies, tricks of the trade, advanced techniques and difficult case management sessions. In Part II, we will dive into more literature review of hormones, which will include the following topics: cancer and hormones, testosterone. estrogen and progesterone. Then I will cover the relationship that BHRT has with PCOS, Hirsutism, Osteoporosis, Estrogen Metabolites, NTX, Diabetes, Cardiology, Chronic Fatigue, and well… the list goes on.

In an nutshell- we are going from breadth-to-depth in order to improve the quality of life of your patients!

See you there,

Neal

“Superior to other courses I have taken. Your course is a better value, no question. I will be back.”

Dan Weathers, MD
Anti-Aging/Metabolic Specialist

“This course is 100% packed with useful information for my practice. This rates as the best experience and education to practice BHRT.”

Stephen Goldstein, MD
Plastic Surgery

“Best conference I have attended in 40 years! The printed syllabus was GREAT!”

James Pollard, DO
Anesthesiology

“I feel that I got much more for my money and time. Thank You! Thank You!”

Brenda J. Weathers

“This is by far the highest quality course I have attended! This is what I thought medicine would be like when I went to medical school. After this course I am more excited about medicine than I have been in a long time.”

George Rice, MD
Family Medicine

“Price and location was easy to access and affordable. Content was superior.”

Rachel Cook, RN
Aesthetic Medicine

“Greatly enhanced understanding of using BHRT in my practice with medical studies to substantiate my use of hormones to my skeptical colleagues. This is the best age managment course I have attended. I appreciate the evidence-based approach. Looking forward to Part II.”

Elizabeth Bowler, MD
Psychiatry & Neurology

“Neal is very direct, factual, science based and knowledgeable. Easy for the non-physicians to understand too. Six of my staff members have attended. More will follow. Thanks for allowing us to best serve our community.”

Cheryl Briggs, RN

“I continue to understand hormones better with every course, even Part 1, despite 10 years of practicing HRT. He always improves my understanding and updates me.”

James Goodnight, MD
Plastic Surgery

“This was truly the most oustanding CME course I have attended.”

Roger Olsson, MD
Family Medicine

“This is a far greater value, in regards to learning received and price, than any other venue I have ever attended.”

Thomas Briggs, DO
Neurological Surgery

“I can go back with a complete sense of confidence that I am doing what is in the literature.”

David Turner, MD
Emergency Medicine

“It is probably the most gratifying thing I’ve done in my entire career.”

Randy Birken, MD
Obstetrics and Gynecology

“When I became a regular attender of WorldLink Medical Seminars, my growth in this field exponentially increased.”

Genester Wilson-King, MD
Obstetrics and Gynecology

“I couldn’t have done it without his course”

Harry Collins, MD
Family Medicine

“It has been a tremendous gift for my practice”

Theresa Ramsay, NMD
Naturopathic Medicine

“This is the most actionable CME program I have ever attended”

Louis B. Cady MD
Psychiatric Medicine

• Describe what happens when women lose hormones
• Describe what happens when women replace hormones
• Identify which hormones women should use and which ones they should not use
• Discuss what happens when you don’t replace hormones to optimal

Access the recorded webinar

Presenter: Neal Rouzier, MD
Hormone Therapy Expert and Course Instructor
Worldlink Medical

This webinar will provide a general understanding for physicians, practitioners and patients regarding the use of hormone levels in women. A plethora of evidence demonstrates that loss of estrogen increases cardiovascular disease, Alzheimer’s Disease, osteoporotic fractures, urogenital atrophy, macular degeneration and depression. Furthermore, data demonstrates that synthetic progestins increase the risk of breast cancer, heart disease, strokes, bleeding, and depression. Recent studies sort out the confusion created by the WHI (Women’s Health Initiative) and conclude that certain types of hormones cause harm in some women, whereas different hormones avoid the harm and provide a significant protection. This webinar discussion will be based on the medical literature that Dr. Rouzier has uncovered throughout his experience as a provider of hormone replacement therapy and preventive medicine.

- Neal

Register I Objectives I Agenda

Dear John Doe,

I do not know why your tumor marker is elevated but you have had it elevated for some time. We do not use tumor markers here [in the U.S.] to diagnosis cancer. We only use them to monitor the progression of cancer once it is treated with chemo. Tumor markers can be elevated in normal people that don’t have tumors or cancer, so it is not a good diagnostic modality. If you are concerned, then do an upper and lower endoscopy. In addition, a PET CT scan will pick up any cancer that you may have. I doubt that you have cancer and I truly believe that the elevated tumor marker is not diagnostic of cancer. We see them elevated all the time and never indicate a cancer. Again we use them to monitor a cancer once it is diagnosed, but never to diagnosis them. The only marker that we use is the PSA and that is not diagnostic for cancer but makes us go further to R/O any cancer.

The Effect of Testosterone on Cancer Risk

With all due respect, the Japanese doctor that suggests that HRT causes cancer is perhaps unaware of the medical literature. Testosterone does not cause cancer. It may cause it to grow once prostate cancer is established, but no study shows that testosterone causes the cancer. On the contrary, our studies show that higher levels of testosterone are associated with a decreased risk of prostate cancer and less severe types of cancer if one develops a cancer. In fact low levels of testosterone are associated with a greater risk of prostate cancer and a more severe and aggressive type of prostate cancer. We used to think, and many of us were taught, that testosterone causes cancer whereas the overwhelming evidence shows the opposite. Several recent studies showed that testosterone treatment decreased morbidity and mortality from all causes, including heart disease and all cancer. The theory is that testosterone decreases insulin resistance and diabetes which greatly enhances the formation of many cancers. There are several recent studies where researchers (Morganthaler) are treating men with active prostate cancer and are seeing no increase in growth of these cancers. A meta-analysis study reviewed the world’s literature and the conclusion from a multidisciplinary team of specialists concluded that there is no evidence from all the studies that testosterone administration causes cancer. Articles from all specialty journals from endocrinology, urology, cancer, and epidemiology, all published that testosterone does not cause cancer, and in most circumstances, protects against cancer.

The fact that a famous Japanese doctor claims that testosterone causes cancer is very incorrect and not supported by any clinical or scientific evidence. What is more disconcerting is that this physician is misinforming, and perhaps scaring, many Japanese doctors into not prescribing or recommending testosterone which is doing just the opposite of what he has intended. It may increase the morbidity and mortality of many doctors who now resist taking testosterone. I never suggest, teach, lecture, or make any claim unless what I state can be very well supported by scientific evidence. May I make the same suggestion to your fellow physician before he makes reference to hormones causing cancer.

Fear Stemmed from the WHI Trials

It is very true that a synthetic female hormone (medroxyprogesterone acetate or Provera in this country) was demonstrated to cause breast cancer in women. We should not extrapolate this to include all hormones. Most physicians in this country also think that hormones cause cancer, so your famous physician is not too far off base from them. The medical and lay media in this country have scared all women into thinking that hormones cause cancer and this is very unfortunate. It is very true that our synthetic hormones have increased the risk of breast cancer and this has been demonstrated in many studies. As a result of this, there is an inherent fear that hormones cause cancer and there is a human tendency to extrapolate this to include all hormones. The medical literature supports that this is entirely not true. There are two Japanese Physicians that have recently attended Part II of the hormone courses that we offer here in the U.S. They both have the syllabus and 2 hour lecture material that I presented that demonstrates that the hormones in our body do not cause cancer in spite of the inherent fear instilled in us by the media and extrapolation from the WHI trial. Please contact them so that they may present to you all of the literature so that you may come to understand that the hormones in our body do not cause cancer, when in fact they are protective against cancer.

A Brief Summary of the WHI Studies

Without going into detail, I will summarize these studies. A meta-analysis of estrogen demonstrated that estrogen (alone and not with MPA mentioned above) administration decreases morbidity and mortality from all cause, both coronary artery disease, cancer, and osteoporosis. The WHI trial demonstrated that estrogen alone (that was the CEE arm that did not include MPA with the estrogen) was not associated with breast cancer. A most recent analysis just published demonstrated a statistically significant decrease (yes decrease) incidence of breast cancer in those that took estrogen alone in comparison with placebo. In addition, let us not forget that the estrogen only arm demonstrated a significant 27% decrease in colon cancer also. The theory is again the decrease in visceral fat and protection against diabetes that may play a major role in cancer protective effects of estrogen, similar to that of testosterone mentioned above.

The Protective Effects of Estrogen

Except in certain circumstances, which is beyond the scope of this letter, estrogen protects against heart disease, strokes, Alzheimer’s, dementia, osteoporotic fractures, and cancer as proved in the meta-analysis along with a decrease in morbidity and mortality from all cause including cancers. Based on this, would you like your wife, mother, sister to be on estrogen or not? It is very unfortunate that your doctors and the world misinterpret the hormones and cancer issue.

The Difference: Bioidentical vs. Synthetic

There is a plethora of data and studies that demonstrate increased longevity and decreased morbidity and mortality when levels of our hormones are maintained at optimal. This benefit applies to estrogen, testosterone, progesterone, DHEA, and growth hormone. As our hormone levels fall with age, so does the protection against cancer. Replacement of hormones reverses this harm. Replacement with chemically altered hormones (medroxyprogesterone and norethindrone) has always increased the risk of cancers. As per the medical literature, we must not equate them to be the same nor should your doctor. I certainly hope that this lengthy explanation reverses your misunderstanding and that you can pass this along to your fellow physicians.

Respectfully yours,

Neal Rouzier, M.D.