Dr. Laird Medical Advocacy Services
Thank you for requesting further information on my services. This document describes my
services as your “medical advocate,” my office policies and your enrollment questionnaire.
In order to promptly and effectively correspond with you, here is what I propose:
1. Carefully read through the enclosed description about my services.
2. Make a decision as to whether you truly need my help. Although you may have felt in need of my help when you first called, having read the enclosed write up may stimulate you to consider new strategies that you can pursue now, on your own. For example, going to your doctor(s) and asking that they step up their work on your case (perhaps ask them to do some or all of what I describe in the write up). Or, you may decide you need to find a different doctor to treat you. And/or you may decide to begin doing your own research, making your own phone calls, seeking therapies and treatment ideas on your own.
3. Gauge when you feel help is needed. The average waiting time for a new patient appointment with me is about 2 to 4 weeks, sometimes longer, sometimes shorter. Depending on the circumstances, for instance if it is a more acute, emergent situation, I may refer a case to one of several other physicians who have been trained in doing this kind of research and advocacy work. They are not part of my office, but are in the Bay Area.
4. If you decide that you do want to consult with me and that it is realistic within the constraints of your situation, then complete and return the questionnaire to my office. I’ll review it – most often within a day or two – and will have my office call or email you promptly to let you know if yours is a case I feel I can help with and to set a date and time for the initial appointment.
The initial appointment will be scheduled to last about 90 minutes, though sometimes it may run longer or end a bit sooner. It will cost $400.00. We ask that you pay by credit card at the time your initial appointment is made. We will invoice you by email. You can pay the invoice online quickly and securely. Alternatively, you can pay with a check for $400 by attaching the check to the questionnaire below, made payable to "John L. Laird, MD.”
The $400.00 fee will cover the time/costs of my preparing for our phone consultation, reviewing and analyzing your case, the actual consultation, and (within the U.S.A.) phone expenses (we'll call you). For international consultations, we will probably use skype or another internet based phone system.
While I'm not happy having to use a set fee and asking you to put money up front, this seems to be the best way to serve you in a way that will use my time most effectively (in the past, I have found that without a retainer fee or deposit, people tend to cancel or reschedule their appointments too freely). Please know that if, for whatever reason, our consultation does not take place, we will refund you the full $400.00.
During our phone appointment, beyond going over what has already happened in your case, we will brainstorm together as to how to achieve what you are seeking: looking at ideas from you or from me, exploring additional treatments you may be curious about, considering other possible diagnoses, discussing further testing and research that may expand and deepen our understanding of your case, identifying and arranging to see other consultants, pursuing unusual therapies and exploring clinical trials.
If, however, through our phone discussion, it does indeed seem as if additional help from me is needed, then we will arrange a schedule to work on your case. My office and schedule is set up to facilitate immediate and intensive work, once I’ve taken on a case. For all of the follow-up work required by your situation, I charge according to the scale described below. This may include time spent reviewing records, conducting research, collaborating with other practitioners who can help our cause and doing our phone consults and sending you emails. Initial work after our first consult typically requires five to ten hours depending on the complexity of your situation. If necessary, we will work out a reduced fee-sliding scale to cover the consultation costs from then on.
I've appreciated it when people send along a photo of themselves. Any photo will do, perhaps from before the medical problem, on vacation, at home, with your family - whatever comes close to who you are.
May the steps that I am proposing above be small hurdles.
Looking forward to our work together,
John L. Laird, MD
John L. Laird, M.D.
11 Holly Street, Asheville, NC 28806
Phone (707) 363-5709
Fax (844) 326-8109
I provide help to people in medical situations who may not be getting the complete help, information, or treatments they need. I'm good at resolving such dilemmas; I seek to put you fully in charge of your case. I call this work “clinical advocacy.” I use an uncommon consultation method, one that is wholly patient-centered and patient-directed. It involves advocacy, personalized medical research based on your unique situation, and communicating with you (and family members, if you so designate) each step of the way.
(1) I will be happy to consider helping any person (or family), regardless of where they live, type of health problem, or ability to pay (I charge on a sliding scale).
(2) I will be a physician in your corner, your own personal consultant, researcher, and advocate, working to help you gain the information and authority you need to be in complete charge of your case. I will not be assuming your care, nor will I be treating you, but I will help you find and receive the best possible treatments.
(3) I practice what I call "optimistic medicine." No matter how desperate or hopeless a situation may appear, there are always new things to try. And I'm willing to put in whatever time and work it takes to find, evaluate, and help implement new approaches.
(4) I have special interests in helping patients (and their families) facing the challenges of cancer and heart disease. For nearly forty years I have practiced integrative, mind-body-spirit medicine as an expression of my commitment to facilitate complete and optimal healing of my patients. I believe in using the best of both “allopathic” therapies along with “alternative, complementary or traditional” therapies. The key to having an optimal outcome is found in the wise and informed selection of the most appropriate therapies each step of the way.
Why There Is a Need for This Kind Of Service
Ideally, every patient and family should be able to access all of the information and options necessary to receive the best treatments and to experience optimum healing. Unfortunately, not many lay people are fluent enough in medical language or know the ways of physicians and hospitals well enough to provide themselves, family, or friends with this kind of help. Even if they are, the medical system is not, at present, set up to accommodate their efforts (nor are nurses, social workers, or other non-physician health professionals serving as patient advocates or ombudsmen).
There are "locked doors" in the medical system, guarded by physicians, through which only physicians are allowed to enter. I work out with you which of those doors need to be unlocked and go through them for you. It's an unfortunate reality, but compared to what they'll do for patients or lay people, receptionists and secretaries will quickly put me - a physician - through to their physician bosses. Calls are promptly returned, records and papers are dutifully sent.
In general, a patient can't buy physicians' time beyond the usual minutes-in-duration "standard of care." But some patients' medical situations require far more time and attention than is customarily provided by physicians.
No physician, no matter how expert, is entirely knowledgeable about every aspect of each patient's case. And rare is the physician who will spend the extra hours needed to search the medical literature for new or better ways to treat you, and make calls around the country to super-specialists on your behalf. More doctors probably would be willing to do this if they were compensated for it, and they had the time. However, some third-party payers, in particular HMO's like Kaiser, do not customarily reimburse physicians for that kind of time-intensive service. And, seldom do physicians set up their practices to allow for such time expenditures for individual patients. (Only for their own family members will most physicians find themselves doing this kind of work.)
I've found that there are very few "bad" doctors. Most want to do everything possible for their patients and are frustrated by their lack of time to do so. In effect, when patients bring me in on their cases, I am doing the work that the physicians would have preferred to do themselves. I take special care not to put off or threaten any physician on your team, presenting myself as just a family physician that has been asked by you to look over your case to see if I have any additional ideas.
Although physicians are used to having such discussions with consultants, what at first takes them aback is the fact that they weren't the ones who asked me to consult on the case. (You did, and I answer to you, not them.) Sometimes, just hearing that you've asked another physician in on the case will cause them to step up their performance.
In a sense, I'm looking over their shoulders, making sure they're practicing sound medicine. It's at the heart of what is called "peer review," and is what all physicians are supposed to be doing with each other, but usually don't. Accordingly, hospital and state medical quality assurance boards have had to institute after-the-fact audits, which unfortunately will never help a given patient at the time when help is needed. I conduct at-the-time quality assurance audits.
If the physicians really have your best interests in mind, they will be willing to talk with me and be receptive to suggestions. They'll put aside turf issues or financial interests, and put your interests first. In cases where physicians seem unresponsive to you, but are responsive to me, I will work to improve your relationship with them. In cases where a physician is completely resistant to both you and me, I will usually recommend that you seek a better, more communicative doctor (and I'll assist you in finding such a person).
More Information About Me
Undergraduate degree from Dartmouth College (1969) and medical degree from Dartmouth Medical School (1976). Family practice internship in Asheville, NC (1977). Served as a primary care physician in a rural “underserved” Appalachian community from 1978 to 1980. In the early 1980’s I founded the Great Smokies Medical Center (one of the first and largest integrative medicine centers in the Southeast) and the Great Smokies Diagnostic Lab (currently Genova Diagnostics) which was one of our country’s first functional medicine labs that has been a leader in the field for over 35 years. In 1984, the Medical Board in North Carolina moved to revoke the medical licenses of all doctors practicing “alternative medicine” simply on the basis that such natural therapies are not the “usual and customary” treatments. After ten grueling years of standing up to the opposition of “organized medicine,” I successfully lobbied the state legislature (along with thousands of my patients) to change the medical practice act to allow for the safe and responsible practice of complementary medicine. In this case, the “good guys” won! I receive ongoing training in the specialized field of Medical Advocacy from the founder and internationally recognized leader in the field, Dr. Mark Renneker.
What To Expect From Working With Me
(And What I'll Expect From You)
Most of our work together will take place over the phone. In most cases we may never meet face-to-face, usually because you live at some distance from me. However odd that may seem at first, you'll find that in many ways it facilitates rather than hinders our working together, particularly in how much more flexible we can be in our scheduling (ie., evening or after-hours appointments, group phone meetings with family members from various parts of the country).
If conducting our work by phone doesn't set well with you, and if you live nearby, or want to travel to San Francisco to meet with me in person, it is possible to come to my office.
Many of my clients say that they're grateful not to have to meet in a medical office or hospital (some say that's where their problems began!). I seldom need to perform a physical examination, but there are appropriate facilities at my office for conducting such examinations.
I have a team of specially trained individuals (e.g., both traditional and alternative medical researchers, Internet/Online specialists, medical librarians) as well as unique consultants (oncologists, immunologists, laboratory testing specialists, nutritionists, pain specialists, etc.). I serve as the case manager. I answer directly to you; you're the boss.
All too often, in a medical situation, the family members sit helplessly on the sidelines, wanting to help, but not quite knowing how (and not being given a role by the physician). As a family physician, my orientation is strongly towards involving family members as much as possible. I encourage their direct participation each step of the way. Be sure to consider asking your spouse and/or key family members or friends to be part of the initial consultation. (In some cases, if you're too ill, I'll be working primarily with the family; in fact, it's often family members who first make contact with me.)
Obviously each case is different, but in general the format and sequence of a case is as follows:
Phase 1: Initial Phone Consultation
More than likely you will first make contact with my office by phone, and then be sent information (i.e., this write up and a brief questionnaire). Run it by people close to you, including your physicians, if you wish. Then, if you decide to pursue our working together, mail/fax back the completed questionnaire. I will review the information you have sent and my office will call you to set up an appointment or to let you know if your case is not one I feel I can accept.
I ask that you prepay for the first (approximately) 90 minute appointment (see "How I Charge" later in this write-up). Also, I really appreciate it when people send me a photo of themselves. In addition, let my office know if you’d like to include anyone else outside of your home on the call (we can conference in one other person).
There may be circumstances when we cannot start your case early enough, e.g., before a critical decision regarding treatment needs to be made. I apologize for that; the only way I am able to offer this kind of intense consultative help is to limit the number of cases I take on. The best I can promise is that when we do have our first appointment together, I will be ready to work with you fully, beginning with where your case is at that time.
Before our initial phone consultation, I will spend time going over what you've sent me, and be ready to pursue your case when we talk. During our phone consultation, I usually need to ask a number of questions to better understand the thinking that went into the various decisions that have brought you up to the present. Plus, I'll invite you to ask me questions, and to discuss the various options and concerns you have. I'll put forth my initial ideas and thoughts. It may be that I will say to you that it sounds as if everything is being done reasonably, that you're with good people and are going in the right direction (to which I may add some ideas). Or, if I think you will benefit from my help, I will begin discussing with you possible case strategies that we can pursue. If the general plan we work out feels right to you, we'll schedule the next appointment and work out what will need to be done before that appointment.
My decision to take your case will be purely on the basis of whether I think I can help; financial considerations (i.e., your ability to pay) will not enter into my decision.
Phase 2: Obtaining and Analyzing Medical Records; Case Planning
In many cases, you may need to arrange for various additional records to be sent to me. What can be uncovered by carefully and methodically going through your records usually leads to additional important areas for us to investigate. In reviewing your medical records, we will be reconstructing the course of events, trying to get at what your physician(s) thought was going on, looking for what may have been overlooked (a not uncommon finding), and considering what may still need to be done.
You or your family will need to contact physicians and hospitals where you were seen and request that the records be sent to my office. Release of medical information from any hospital, clinic, or doctor requires a written request signed by the patient. Sometimes they'll copy the records on the spot and give them to you, and you can mail them to me, but they will more often insist on sending them to me directly. [Tip: indicate a specific date on which you will be consulting me, i.e., "The records have to be there by next Friday, because that's when my appointment is." They can even fax or air express the records. Offer to cover the costs if need be.] I'll let you know if I need to see the actual scans, slides, or x-rays, but usually I don't, unless the written reports seem incomplete or inaccurate.
If Federal Express, or a similar courier is to be used, indicate that the package needn't be signed for at my end, and that it can just be put through my mail slot (it is secure). This will avoid unnecessary delay.
You should have a copy of your records for yourself. If possible, make a copy before mailing them to me, or else ask us to have them copied and mailed/given to you. In reading your medical records, don't be surprised to find major discrepancies between what you thought was going on (and what you were told) and what is actually in your records. Be sure to remember to ask me any questions you have about what you noticed (or were worried by) in your records.
The second phone appointment usually includes discussing your records (if they were needed), further brainstorming on your case and a determination of which specific research questions and case activities should be pursued. Our process will likely result in attainable objectives for our work together. Team members (you included) will take on assignments, and we will set a realistic time-frame for work on your case.
Please don't feel as if what you lack in the way of medical knowledge will limit your ability to participate. Your experience of your illness automatically places you in the position of being the leading expert on your case; my job is to try to understand you, not the other way around. I will do my best to speak in plain English (not doctor-talk). However, we may identify medical and technical areas you need to learn more about, and we'll try to come up with an easy way for you to acquire that knowledge, such as "homework" reading assignments from me, a trip to a patient-oriented medical library like Planetree, or Internet study. (If you're too ill, it may require you to assign a family member or friend to do some or all of that work.)
Phase 3: Research/Writing/Phoning
Some cases will require some form of computer search of medical literature, and then actually obtaining and analyzing the most relevant articles. I have team members expert at this, people who are particularly good at weeding out the wheat from the chaff, and pursuing parallel lines of knowledge (e.g., looking in separate but conceivably related fields of knowledge for clues, such as a cancer treatment that might apply to an arthritic condition). This medical literature search, article retrieval, and analysis usually takes one to two weeks. You may have already done, or had done for you, Internet/computer literature searches; rarely, though, are they of the breadth or specificity that complex cases require. However, we can use such initial searches as a springboard.
Occasionally, I will need to write a complete case history. It will be based on what you've told me about your case and what was in the medical records. Often, no prior physicians have done this, and if they have, it may be cursory, out-of-date, inaccurate, omit important facts, or not fit your recollection of events. I'll often use such a document, mailing or faxing it to specialists we consult with on your case.
As I analyze the medical literature relevant to your case, I'll annotate it in light of your specific case. A complete set of the research then will be sent to you (and to whomever you designate); I will keep an identical copy to facilitate our discussing it. It may seem daunting to receive such a research book, but I will do my best to make it as on-target, well-organized and "user-friendly" as possible.
When we next speak, our goal will be to decide if what we see in that research book sufficiently answers our questions or presents the solutions we are seeking. Often, some of the authors of the papers, or specialists mentioned in the articles or references, will need to be considered for direct consultation by me, usually by phone. We will agree upon which of these consultants I will pursue.
There is usually an enormous lag time (one to two years or longer) between when a medical study is completed and the results are published. My intent is to find studies-in-progress and pre-publication information. I go about this by tracking down persons who have recently published key articles and finding out their latest results, as well as inquiring about new studies they're engaged in, and additional research they're contemplating. Usually I will present your case to them for their ideas, and to gather leads on what or who else to pursue. Then I follow-up those leads, continuing that process until we're no longer uncovering new possibilities or we've had our questions answered. Although it may seem that just talking to the single most knowledgeable person will lead to all this information, I have never yet met or spoken to a specialist who knew about every bit of work being done in their field.
This kind of "medical detective" work is surprisingly time-consuming often because of the amount of "phone tag" involved. Since in most cases there is not the luxury of time, I will push hard to move things ahead quickly. We may be able to save time by applying information gained from recent work for a patient with a similar situation, but my general approach is to see each case anew and to make as few prior assumptions as possible. Even if the diagnosis is the same, every patient and every case is unique.
I will tell you at each appointment what I am discovering. If I need to talk with your physician(s), which may be a frightening prospect for you (because your physicians may be angry with you for going outside of them), you and I will discuss beforehand just how I will approach them and what questions would be good to ask, including adding your own questions and concerns to that list. I will report to you exactly what was discussed and what plans came from the conversation.
Phase 4: Analysis and Action
At this point, we'll analyze all the information we've obtained and move towards a plan of action. If we've done our work well, after we've weighed all the evidence your best options and next steps should be fairly obvious. Then we'll talk about how to accomplish taking those specific steps towards those best options. If it comes down to having to choose between options that seem equally good, I'll do my best to guide you in making a decision - but ultimately it will need to be your decision.
Issues that often need to be considered include: (1) completeness and accuracy of the medical record, (2) additional tests and consultations that may be needed, (3) the quality of your care to date, (4) traditional, alternative, and experimental treatment possibilities, (5) the quality of your life/pain control, (6) nutritional and physical considerations, (7) psychological, spiritual, and family considerations, and (8) primary, preventative, and wellness care.
There should be little resistance from your physician(s) to what you want to do; they will have to concede that your case has been well researched, and you can expect to receive the care you are looking for. However if there is resistance, we will work around it.
I will help you carry out the plan we've developed. Again, if we've done our work well, you should feel a new confidence and resolve as we proceed. For a period of time we may need to be in regular contact with each other to keep things on track. In the future, you'll probably want to check in with me periodically to report on how things are going and to use me as a sounding board for new ideas or problems. If new problems arise, however large or small, we can tackle them together. I will always be available to help you.
How I Charge After the Initial Consult
I'm well aware that your finances may be significantly challenged already due to your medical situation. Various strategies and schedules are possible for payment; I don't want what you owe me to become yet another problem for you.
I use a sliding scale ranging from $100 to $250 per hour, charging 3 times the thousand dollar value of your family's gross annual income. So, if your family (household) gross income (before taxes) is $35,000, that will be 3 times 35, or $105 per hour. The least I will accept on the sliding scale is $100 per hour. In my practice, the average rate paid by patients has been $180 per hour.
I charge an up front (prepaid), non-sliding-scale $400 fee for the initial 90 minute phone consultation. This also will cover the 60 or so minutes I spend reviewing your case before we speak, as well as the phone costs for that appointment. Once we've received your check or your request to pay by credit card (via secure online invoicing) we will schedule your appointment. The purpose of the (prepaid) fee is to lessen the chance of people canceling or rescheduling appointments at the last minute, or otherwise not making a firm commitment to work together (you should know from reading this write up whether consulting with me will be valuable to you). The sliding scale applies for the case work after our initial phone consultation.
Most cases initially require about 5 - 10 hours of my consultative time, but obviously it varies from case-to-case. Some can be done with the initial phone consultation or in one or two subsequent appointments; others can take longer and be ongoing. Cases will be significantly shorter where less research and writing is involved. Be sure to ask me at the start of the case for some idea of how much consultative time will be involved, and I'll do my best to give you a realistic estimate.
I will expect you to cover the expenses of working on your case: long-distance calls, xeroxing, couriers, faxes, computer literature searches, travel (if any), etc. Usually, this amounts to between $100 and $300.
Having team members to assist me will speed things up and bring costs down. You will be charged a rate commensurate with their level of training, ranging from about $75 to $150 per hour. Figure on the team members doing 4 - 8 hours of work (but, again, it can vary greatly, depending on the case).
I will expect a $500 retainer to begin the case (after we've had our initial phone consultation). I prefer you to make your payment by credit card that can be done securely and quickly via email. If you prefer to pay by check, make it out to John Laird, M.D. and mail it to my office. Let me know which option you prefer during our first consultation.
Payment of the retainer indicates that you have read and understood this write-up and agree to do your best to uphold the responsibilities it entails (i.e., gathering records, being willing to learn more about your situation, being as objective as possible in considering the information that comes from the consultation, and meeting the terms of payment).
At the time you pay your retainer you should indicate where on the sliding scale you fall, so it will be clear at what rate you'll be charged. (And don't worry, we won't be asking to see tax returns to verify the amount you've calculated; we will trust you.) If you don't let us know, we will assume you are to be billed at the $250/hour rate. You will be sent an itemized bill monthly.
I will be the one who will speak with you after the initial phone consultation to discuss the retainer, your billing rate, and the billing interval you prefer, as well as any other financial concerns you may have.
Please don't expect me to bill your health insurance company. Not having to spend time dealing with insurance companies is one of the ways I've freed myself to spend more time with patients. As a courtesy, we can provide you with a bill suitable for submission to your insurance company, if you have one. Please realize, however, that very few health insurance companies will reimburse for this kind of consultative help. Best to assume they won’t reimburse when making your financial decision about whether to consult with me.
Making Appointments, How Best To Reach Me
In general, the appointment hours I keep for this practice are Tuesday, Wednesday & Thursday, from 10am to 7p.m. (pacific time). However, I can be flexible depending on your needs. Some cases require working seven days a week. If that's what it takes, so be it. (Conversely, I sometimes need to reschedule appointments if I have to keep working with a given case.) Most follow-up appointments last about an hour.
If you have questions regarding appointments, please call me at 707 363-5709 or email me at: email@example.com . I will return your call as soon as possible.
Feel free to call, write, or fax us with any questions,
John L. Laird, M.D.
John L. Laird, M.D.
11 Holly Street, Asheville, NC 28806
Phone (707) 363-5709 Fax (844) 326-8109