I know I have been neglectful of you, and even somewhat insensitive of your needs, but I have a great reason, I promise you will be so proud of me! I am nearly done with my second book, and my days and nights have been consumed with trying to put the final touches with editing and such, you know how it is…:)
Today, I would like to share a piece of the book with you!
So, first off, the book is called A Teen’s Life. It looks at the lives of 10 different teenagers from across the globe. They are sharing their stories and struggles with me in a Dear Dr. Lulu format. I respond to their letters as best I can, and then I discuss their situations. It is statistics-heavy, it is sad and deep, but it is real. The stories are all real, but fictitious at the same time. It is essentially about youth suicide in a sense, but it is also about life, teen life. I am hoping that it serves as an eye-opener to the struggles of these youth, and hoping its readers (teens, parents, caregivers, the government, everyone) will come away with a better sense of understanding of the plight of teens and some simple but not necessarily easy solutions to tackle them.
Here is an excerpt from it. This is the portion that deals with myths about suicide. I am really proud of this…enjoy!
Before we embark on what we can all do to prevent suicide in our teens and youth, I think it is only proper to discuss some of the myths about suicide that are floating around. Debunking them will help increase awareness of their falsehood and help fill in some critical knowledge gaps.
Suicide is not a real problem; As we all know, suicide is a real problem in our world today, it is now the second leading cause of death in our youth.
Asking or talking to your teen about suicide causes suicidal behavior; Talking about suicide not only increases awareness and puts an end to the shame and stigma, but it also helps teens explore other options and keeps open communication lines.
The person/family needs more prayers and more Jesus; while having a sense of belonging to a community or spiritual group is always encouraged and actually protective of suicide it does not in of itself prevent suicide. However many suicidal persons have been known to say that when they reached out for help, they were told they were being dramatic and selfish and needed to pray more.
Religious persons do not die by suicide; just this past summer we heard about the young American pastor who was active in the mental health arena, who actually lost his life to suicide, there have been many others including a Nigerian pastor as well.
Denial: It does not happen to our ethnicity or family (Blacks, Asians); this thought process as we know is erroneous, and Black kids were recently documented as attempting and dying by suicide at a higher rate than other races.
Only a professional can identify a child at risk for suicide; one of the reasons for this book and my work in the suicide arena is to increase awareness by educating everyone about the signs so we are all more empowered.
Once someone is suicidal, they will always be suicidal; for the most part, suicidal thoughts and behavior are situational and temporary. Most suicidal persons need to know that their feelings can and do pass once they are equipped with the right tools to deal with their thoughts, and have the necessary support they need.
Only people with mental illness are suicidal; When I was going through my suicidal stage, I had never been diagnosed with mental illness, I did, however, experience a lot of life challenges which shook my core and caused me to consider myself a failure and not worthy of life. During the financial crisis of 2008, there was a sharp rise in suicides as a result of the enormous financial losses these people had experienced.
Most suicides happen suddenly and without warning; we know that 4 out of 5 teens who attempt suicide leave a sign. The decision to suicide is hardly ever a one-off thing, it is usually a culmination of events over time leading to “overwhelmedness”, an inability to cope, and a perceived or real lack of support.
Someone who is suicidal wants to die; in all honesty, most suicidal people do not want to die. They simply want their pain, suffering and despair to end. They often feel like they have exhausted all their options and they also have the means to end their lives at that moment.
Someone who is threatening suicide is not going to carry it out; I like to say “do not underestimate the power of determination”. We can never be too sure that someone will not carry out their threat. We must, therefore, take every suicide threat seriously. Part of the reason suicide is on the rise is because these people don’t feel they have any support, they feel all alone.
People who die by suicide are selfish and taking the easy way out; because these people have been suffering for a while, majority of them actually feel like suicide not only puts an end to their suffering, it also frees them from being a burden. Many suicide attempt survivors say they feel their lives are a burden to those around them.
All in all, suicide is a complex issue, but suicide prevention must be front and center in everyone’s minds in today’s world. To find out more, you will have to wait a couple more weeks for the actual book!
I am sitting in my home office on a sunny Thursday afternoon, as I write this letter to you.
In the past year since I quit my full-time job as a pediatrician to start speaking on child, teen and young adult depression and suicide, (read about it here and here). I have discovered a different side of me. The side that loves to write, and speak. The side that is an activist for a cause. The side that was lying dormant until the passion to actively save the lives of children and teens through creating awareness was ignited when my then 7-year-old patient attempted to hang himself in May of 2018.
I have always known that medicine, pediatrics, in particular, is my life, and public speaking is second nature, so it was sort of a natural progression for me. I have never had any trouble speaking in public to air my opinion, so when this opportunity to practice medicine in the most preventative way picked me, I had no hesitation to say, a resounding…yes! As the good book says, “many are called, but only a few are chosen”.
Though I don’t know when it will get published, I couldn’t think of a better day to write this letter than today, the 12th day of September, two days after September 10, which is recognized as World Suicide Prevention Day. This week marks National Suicide Prevention Week 9/8 to 9/14. A week which eerily includes September 11, a day suicide bombers set our country on a never to be forgotten path, a day that will forever go down in infamy, in the month of September, suicide awareness and prevention month.
This letter is, however, not about suicide days and suicide bombers. It is about a path that has led me, a Nigerian-born mother of three, a board-certified pediatrician, to become a speaker, bestselling author, and activist on youth suicide. It is about how finding a new way to practice medicine is allowing me further my cause. Every time I tell people what I speak about, it never fails, they look up, and suddenly get interested, no matter what they were doing before I started speaking. Some look at me with concern, some look at me with disbelief, and yet some look at me with sorrow, especially when I tell them my story, my why, which you can read here. Usually, by the time I am done, a majority of my audience wants to know where they can find me, where I practice.
For the past year, my response to that line of questioning has been a combination of the following…” nowhere in particular”, “I don’t have a practice”, or “I quit medicine to speak publicly”. To which even more eyes look at me with a mix of wonder, pride, gratitude and amazement… and then after a brief thought, pretty much everyone says a combination of “that’s such an important topic” or “that’s so needed” or “wow, thank you for the work you are doing”, etc.
As I have continued to speak locally, around the country and internationally, and as the questions have continued to come in, I have had to finally admit to myself that I have missed practicing medicine. I have missed clinical practice, but most of all, I have missed having physical contact with my patients. Those who know me, know my patients are my “anti-kryptonite” (if that is a word). That been said, I have known in my heart that I did not want to go back to traditional medicine (what I call “assembly line” medicine). The kind that is run by CEOs with little or no knowledge of what it’s like to have boots on the ground. The kind that has enslaved us doctors and caused burnout to now become a household phrase. The kind that puts profit and the bottom line before patients and providers. The kind that you, me, we, did not sign up for. The kind we did not dream about in our days in medical school. The kind that has unfortunately driven too many of us (400 per year at last check) to early deaths through suicide.
I knew that kind of medical practice was definitely no longer for me. So, I tried out Locums, but with my son still being in grade school, I am unable to travel out of town as much as most locum gigs would require, plus, I am only licensed in Texas so that limits me as well. I know the hospitalist route is not for me. So, while I was still pondering my next move, I happened upon a facebook group called DPC Docs. A two-thousand strong community of doctors practicing medicine on their own terms. I had actually heard of DPC about 2 years ago. Direct Primary Care. Three words that are turning out to be life-changing for those of us who care to look closer, look further and farther, think outside the box, and dare to be bold enough to say “enough already” to the big bosses and take back our lives.
I happily jumped in with two feet. You see, Direct Primary Care is exactly what Dr. Universe ordered for me. A spin-off of Concierge Medicine, DPC seeks to allow doctors to practice medicine the way it was meant to be. I had heard about it through a podcast that featured one of the true pioneers in DPC practice Dr. Josh Umbehr of Atlas MD in Wichita, Kansas. I remember excitedly running to find my spouse to tell her all about it that evening. I was so intrigued by the model, I was immediately hooked. And even though I knew the traditional medicine model I was in as an employee at that time was toxic for me, it still took me nearly 2 years to act on it. Not because the process is hard, but because I needed the right mindset and star alignment to get over the voice in my head telling me to stay put.
As soon as I decided to start back clinical practice, I knew it had to be on my own terms. My first order of business was to call the Texas Medical Board and enquire about my idea to only attend to at-risk youth aged 8 years to 18 years who are the exact population that I speak and write about. When the lady on the telephone told me I could, that was one of the happiest days of my life! Her words were something like “ma’am, as long as you are licensed to practice in this state, you can see only those born on the 5th of May if you like”. That essentially spun off my dream to open my own youth health center that would cater to the children that had picked me those many moons ago!
Do you know that it took me less than 6 weeks and cost me less than $10,000 to set up? I have a micro DPC practice model, that means I have no front or back office, no fancy equipment, no staff, and an expected patient panel of less than 300, compared to nearly 2000 which I had at my last place of employment. The way my practice is set up, I shall see only 6-8 patients a day for up to 1hour or more per visit, three days a week, compared to 35-45 patients at my last multigroup practice employment. My monthly overhead is far less than I had when I owned a traditional practice, my EHR is user-friendly and convenient, my stress level is low, my patients are happy, and so am I 🙂
While this might not work for many, it works for me and others with a small niche. My friend, Dr. Amber Price of Willow Pediatrics up in Chicago, Illinois’s niche is only newborns. She incorporates home visits as part of her practice. Yet another friend, Dr. Sara Sultz of the DOC group up in College Station, Texas does home visits as well as telemedicine as part of her pediatric DPC practice. She even gives vaccines and IVF right there in the patient’s home! Such is the new way to practice medicine, and I am proud to be a part of it, and to announce that I am the first and only pediatrician in Texas and the US with my specific niche in this particular model.
So, what exactly is DPC? And why is #yourstruly so elated about it? Ironically, many of the doctors that I speak with have never heard about it. A few have heard about concierge medicine, but not many, much like I was a few short years ago.
In the Direct Primary Care practice model, the emphasis is on affordable care. In its purest form, no insurance or third-party payer is accepted. That right there puts the first nail in the burnout coffin! I was like “whaaat?” No insurance means; I. Get. To. See. My. Patients. For. As. Long. As. I. Want. To! Yassss!! We do encourage patients to keep their health insurance, and some practices will even generate invoices that might be reimbursed by the patient’s insurance after each visit. The model is based on a flat monthly fee in exchange for services, longer times spent with the patient, more intimate doctor-patient relationship, overall lower healthcare costs, direct access to patients both virtually and in person, improved work-life balance for physicians; thus drastically reducing burnout, reduced patient load, and reduced administrative costs and overhead burdens. The increased intimacy with patients is a huge win for me, especially with the niche I see. Like any business, the fees vary depending on location and market competition.
The key here is; it is a membership model, much like Netflix or your gym membership. My patients have access to my cell phone number to call, text, email or facetime me whenever they need to, and they can be seen, as many times as they like to, each month! My question to you is; when was the last time you had that kind of access to your doctor? Let’s take for instance a 14 year old who is experiencing a depressive crisis at 2pm in the afternoon while at school, they would have the ability to call or text me right away, and not have to wait until they get home, inform their parent, who calls the next day only to get an appointment for the next week, take time off from work and school to arrive at the appointment, only to wait for one hour in the waiting room, and the doctor spends all of 10 minutes seeing them. Then wait another 2-3 months to get an appointment with the psychiatrist who may or may not accept their insurance, or is very likely to charge them 2 or 3 times my monthly fee for only one visit! Get it? #aintnobodygottimefordat!
Some DPC doctors are set up like traditional practices with office staff, laboratories, X-ray equipment, EKGs, and whatever else they need. Depending on state laws some also dispense medication in their practices, (Texas aint one of them…:) all for the same flat monthly fee. It’s just like a gym membership or Netflix for your doctor! In my case, for less than a cup of coffee at #Starbuxx my patients can see me everyday. Oh, and they don’t need to live in San Antonio Texas, I also have telemedicine included in the practice, so I can consult with patients virtually. Other services I am so proud we offer are a teen-2-teen support group (because teens speak teen, they don’t speak adult) and parent coaching, both of which I facilitate.
For now, I am loving DPC. It affords me time in my week to “mother” my children the way I want, be an awesome spouse to my Beloved, make time in the week to blog, work on my speaking gigs, record and edit my podcast; Suicide Pages with Dr. Lulu, The Podcast, you can subscribe, download and listen to it here and everywhere you listen to podcasts. I am finishing up my second book, a chronicle about Teen Life (my first book; a Parenting Guide, can be bought here). I have many more tricks up my sleeves in the coming weeks, so #staytuned.
In conclusion, I believe I have found my happy place in medicine again. While DPC might not be for everyone, it is for me, and it might be for you too, think about it. You never know. Here’s what you do, first start by conquering, silencing or banishing that voice telling you you can’t do it, the rest will fall in place. Ultimately, Happy Patient: Happy Doctor is what we all seek, right? Keeping it simple is what our mom’s taught us, yes?
So, I ask this time, dear doctor, will you DPC?
“We can’t be afraid of change. You may feel very secure in the pond that you are in, but if you never venture out of it, you will never know that there is such a thing as the sea, or an ocean. Holding onto something that is good for you now, may be the very reason why you don’t have something that is better.”
― C. JoyBell C.
Words by Black Butterfly 