Primary Care Internal Medicine

Internal Medicine is the medical specialty that focuses on the prevention, diagnosis and treatment of conditions affecting the body's internal organs. Primary care internal medicine is the main point of contact for adults within the healthcare system. While specialists focus on specific organs, Internal Medicine maintains a broad and holistic view of your health, remaining vigilant for conflicting plans of care and keeping everyone on the path of your stated goals.

Signature Services

Providing comprehensive health assessments and personalized treatment planning while helping you to navigate the complex healthcare system.

Consultative Internal Medicine

Consultative internal medicine focuses on providing expert medical assessments, second opinions, and treatment recommendations to patients and their other doctors. People seek out consultative internal medicine in complex situations often involving unexplained symptoms or problems that cross the traditional boundaries of subspecialists.

Consultative Services

Schedule a Consultation for:

1) Appealing a Medical Insurance Denial (more details below)

2) Polypharmacy Evaluation

Stop unnecessary and redundant medications
Manage medication interactions
Adjust for adverse effects

3) Complex Pre-Operative Evaluations

Are you healthy enough for surgery?
What is your personalized risk of complications?
Can something be done to lower your risks?
Have all options and approaches been considered?

4) Medically Unexplained Symptoms (more details below)

5) Comprehensive Evaluation and Counseling (more details below)

6) Proactive Avoidance of Recurrent Hospitalizations

7) Expert Medical Witness Services (more details below)

Appealing Medical Insurance Denial

How I Can Help You Overturn a Denied Claim

Coding Error: doctors communicate with insurance companies using medical codes. Medical codes are extremely complex (like a different language). If the wrong code is submitted, it can result in a denial for lack of medical necessity. Only a doctor can look at the code submitted and determine if it accurately describes your medical situation. If a better code exists, resubmitting the claim using the more appropriate code can result in approval.
Appeal Letter: I can create your appeal letter to overturn the claim denial. Insurance companies do not approve medical claims based on the strength of an argument. They reference specific pre-determined clinical standards. If your letter does not fit those clinical standards, the appeal will be denied even if you make an excellent argument supporting your case using published medical research. Only a physician with knowledge of your specific case and knowledge of the clinical standards used by the insurance company can create your ideal appeal letter.
Peer-To-Peer: Insurance companies often have an option for your physician to speak with one of their physicians. The insurance company physician has the power to overturn a denied claim. To get the best outcome, the physician representing you needs to know your case extremely well, have the necessary information well organized and immediately available, and know what the insurance company physician needs to hear in order to overturn the denial. I can make that call to advocate on your behalf.

Medically Unexplained Symptoms

Guidance Finding Answers

Patients frequent have symptoms that negatively impact their quality of life for which they have seen multiple doctors and no one has found an explanation or been able to offer a management strategy. If this describes your situation, I offer the following services:

Comprehensive Case Review: I collect all the information generated by your other doctors (tests, imaging, labs, consultation notes, procedures) and organize it. This is best done by a generalist physician with experience managing complex cases who can understand, organize and analyze the evaluations done by multiple sub-subspecialists.
Comprehensive History: We will sit down and you will be provided with as much time as is necessary to tell me your story from the beginning. I will ask clarifying questions along the way as I generate a list of possible explanations.
Personalized Medical Testing: I will order any tests that may have been overlooked by your previous doctors as well as test for some less common conditions that may clarify the cause of your symptoms.
The Limits of Medical Knowledge: Our understanding of how the human body works is incomplete. Sometimes we conclude that our current understanding and technology is not advanced enough to explain the cause of some symptoms. However, even if this is the case, we can often take steps to manage those symptoms to minimize their negative impact on your ability to live a full and productive life. In these situations, you need a physician-partner to work with you on chipping away at the symptoms. If you enjoy working with me, I would be honored to partner with you.

Comprehensive Evaluation and Counseling

Confident Understanding of Your Health

Today's healthcare system often means shorter appointments and care from many different doctors. As a result, your medical information can become scattered across multiple organizations and electronic records. With so many people to care for, your other doctors may not have the time to understand your complete health history and treatment plans. This can leave you feeling uncertain about your own diagnoses, medications, test results, and treatment plans. Here is how I can help:

Organized Your Information: I will collect and organize all the information generated by your other doctors including office notes, prescriptions, labs, imaging, procedure and surgery notes.
Understand Your Medical Information: We will sit down and slowly work through your medical information until you are confident that you understand it.
Concise Health Summary: When your doctors "request records" they are often send stacks of a pages hiding the information they seek in a sea of everything. Rushed doctors don't have the time to search for the needle in the haystack. I take those stacks of records and create a concise health summary that you can easily share with your other doctors. Even a rushed doctor will be able to get a complete understanding of your health history and quickly find the specific pieces of information they need to best care for you.

Expert Medical Witness Services

Finding Your Best Expert

Effective Communication: The job of an expert medical witness is "to clarify complex medical facts for the judge and jury." A renown specialist may have impressive credentials, but if they lack the skill to explain the complexities of medicine in a way that the judge and jury can understand, they won't help your case. A core service I offer my patients is to help distill down the complex evaluations of multiple specialists into terms they can confidently understand. I can offer that same clarity as an expert medical witness in your defense.

Credentials: Juries expect physicians that testify to carry credentials that support their role as a "medical expert." Opposing lawyers seek to discredit medical experts by casting doubt upon their credentials. I am board certified in internal medicine. I started my career as a consultative internal medicine physician whose role was to assist primary care physicians manage their most complex patients. I then transitioned into hospital medicine caring for people with acute multi-organ failure on top of their 10 chronic conditions and 15 daily medications. To support my never-ending quest to innovate and improve the care delivered, I accepted positions as an Inpatient Quality Management Specialist and Assistant Medical Director of Hospital Medicine for Kaiser Permanente Washington. At the same time, I held an academic appointment as an Assistant Clinical Professor of Medicine at the University of Washington. I currently teach Kaiser Permanente Family Medicine residents and am contracted with the Medical Board of CA as an "Expert Consultant" to assist in the adjudication of complaints brought to the Board.

Lawyer Tactics: A cross-examining lawyer's goal is to discredit the opposing expert medical witness. They don't do this by arguing medical science; they do this by causing the jury to doubt the Expert's credentials and integrity. They look for prior statements by the Expert that contradict their current testimony and conclusions. They use hypotheticals and misdirection to lay language traps for the Expert that once sprung will make them look foolish, unprepared, inconsistent, and incompetent. You want your Expert to think like a cross-examining attorney and proactively prepare. Your case depends on it.