Urgent Care, Integrated Medicine & Physician Housecalls
A pharmaceutical rep once asked what I prescribe the most? I told her "hope." She said, "who makes that?" I told her "the same guy who made the earth and sky."
This page introduces my background and training, areas of interest and expertise, and my beliefs.
I trained conventionally as an Internist then expanded my knowledge in emergency and urgent care, then onto nutritional, herbal and other areas often referred to as alternative medicine.
My curiosity of systems translated into a broad comprehension of many areas of medicine as well as non-medical fields such as car mechanics, computer technology, house construction, and music.
Early in my practice of medicine I realized I was correcting medical problems in patients of mine who somehow "slipped through the cracks" or were given "waste-basket" diagnoses by other practitioners.
Many cases were simple to solve and obvious, so I attributed my medical solving abilities mostly to taking time to listen to my patients.
My success in solving difficult medical mysteries is sometimes a mystery in of itself. It seems the most significant difference between my practice and that of other practitioners is my emphasis on the spiritual bond of the physician-patient relationship, i.e., taking a keen and passionate interest in understanding the pain and suffering of another individual, in their own words. With very few exceptions, more is learned about an illness by listening to the description given by the patient, than any lab test or radiographic study.
There is no formal training for a master diagnostician or "comprehensivist" though I presume one day there will be. In America, physicians have traditionally mastered their clinical skills in hospital settings. For various reasons the procedure-oriented "subspecialist" became the key target problem-solver for the general practitioner who understood enough about medicine to refer a particular patient, but not enough to solve the problem alone. As a result, health-care costs have increased (2 chefs in the kitchen doubles the price of a meal). The next problem is society's orientation to focus on treating a symptom and not its cause. Such a treatment plan is less time-consuming and more instant-gratifying: The pharmaceutical solution is temporarily more rewarding for both patient and physician. Our biggest expense is the price we pay insurers to manage our healthcare. Thirty cents of every health-care dollar is paid to private insurance companies, an amount close to one trillion dollars. The confusing part of it all is if Medicare can run its healthcare system at 5 cents per healthcare-dollar, why wasn't it implemented by Congress as an option to private insurance=Obamacare?
The most cost-effective measure our government can take is to allow a patient to directly manage their own healthcare, i.e., allocating an expense account for each American which reveals how each healthcare dollar is spent. If we currently spend about four thousand dollars per American each year on health care, then why not allow Americans to directly decide on a more cost-effective health-care delivery system which gives them time to ask questions and comprehend their options? What better system would exist than that of an empowered patient who could be guided by a physician who knew everything there was to know about medicine, who could directly handle most problems presented, and who had the time and desire to investigate the cause of a symptom in addition to applying the pharmaceutical band-aid?
One day, hopefully soon, "master diagnostician" and "comprehensivist" will be the norm, and all physicians will have the following qualities:
1. A deep curiosity and love of medicine which drives the expansion of their medical knowledge base.
2. An open mind which allows patients to express their symptoms beyond the normal tolerance level of the average physician.
3. Comprehension of both conventional and alternative medicine without prejudice of ignorant presumptions.
4. No time constraints placed on "atypical" medical office visit, often achieved through the "prescriptus interuptus," which allows the doctor to end an office visit by either a test request or pharmaceutical solution to the symptom.
There is nothing more cost-effective in medicine than an extensively detailed medical history.
I consider my practice of medicine both conventional and alternative. I attract patients considered "difficult-to-diagnose" and coined the term "Comprehensivist" to describe a medical practitioner who solves complicated medical mysteries.
I'm intrigued with solving the mystery of any compromised system. The list created by identifying the possible causes is called the "differential diagnosis" tree. The size of the tree is proportional to the level of one's knowledge and wisdom. The more branches it has, the more comprehensive it is. I like to climb up the biggest trees, i.e., the "comprehensive" ones. And that's why I call myself a "comprehensivist ."
I specialize in solving medical mysteries, unlocking secrets to illness when other practitioners have been unable to do so. Some call it a "medical detective" or "zebra hunter." I call myself a "comprehensivist," or a diagnostician who focuses on the most difficult differential diagnoses. A comprehensivist is a medical detective who steps beyond mainstream medicine in order to solve an evasive health issue. It's a zebra hunter who is ready to take on the giraffe as well.
Allopathic Medicine + Integrative Medicine = Integrated Medicine
Integrated Medicine + Medical Detective = Comprehensivist
A comprehensivist is a subspecialist of everything, as everything interconnects anatomically, chemically. metaphorically, emotionally, socially, psychologically, religiously, spiritually, and so on. I explore spirituality in the Mind_Body_Soul section of this website. Spirituality takes the zebra hunter one step further. It sharpens the strategy in catching a zebra, and reduces the risk of over-simplifying a hunt. Spirituality is often considered mystical and magical when applied to medicine. I see intuition as the translation of one's knowledge and wisdom, and discuss it in an essay called Shoelace Wisdom . I witness synchronicity on a daily basis, which intuition laces itself into in mysterious ways. The realization of the presence of synchronicity doesn't appear to have anything to do with my diagnostic abilities. My feeling is it's a phenomenon which our conscious minds sometimes see, when enough pieces of the puzzle are realized (kind of like Vanna White flipping the letters one at a time on "Wheel of Fortune," until one of the contestants sees the missing letters in their mind, and hits the button and gives the answer to the mysterious phrase).
The Magic of Synchronicity
Synchronicity, so far, has been entertaining and evocative, and is the foundation of most of my "magic moments." I still wonder about its significance, as it might indicate mightier forces than ourselves, or that the "kingdom of heaven" is actually within each one of us. The only application of synchronicity in my life at the moment is to appreciate its beauty like a falling star on a deep blue sky, a sunset on a cool breezy beach, or a smile.
Solving the Mystery of a Mystery
When we drive a car, most of us worry only about turning a key to start the ignition, and never open up the hood, and see how the car actually works. My essays are all about looking under the hood, to assist other practitioners and patients in understanding the mystery of a mystery. Knowledge and wisdom usually lead to fewer mistakes and more happiness. A grinch in a lab coat named House reminds us that success in solving a mystery will not guarantee happiness or a world less miserable. It's a paradox at first glance, but easily explained by relativity
of perception, which also sits under the hood of one's car, and another topic for another time.
Exploring one's mind and soul are valuable tools in sorting through diagnostic possibilities and treatment options, and solving unusual and difficult cases, i.e., the "medical mysteries." Unfortunately, modern medicine gives most healers time to look at only the body. As we moved forward in technology, mind-body-soul, diet, nutrition, and
time spent for physician-patient "human" contact, were the babies we mistook for bathwater.
My Approach to Medicine as a Healer
I am an Internist practicing comprehensive Integrated Medicine, diagnosing as many of the "undiagnosable" as possible ("Comprehensivist"). I am a Medical Detective, or Unusual Symptoms Investigator, combining conventional, herbal and nutritional treatment methods to combat symptoms which compromise one's quality of life. I rely on medical knowledge, intuition, common sense and good judgment. I treat each patient as "captain of their own ship" and approach each case almost always as "navigator."
I place emphasis on a questionnaire, copies of previous tests, and a 2-week food diary to begin solving the mysteries of illness, which are often revealed through patient-discussions. After the "obvious" causes of one's symptoms have been ruled-out by other practitioners, I search for the "not-so-obvious" ones. A colleague of mine, mentor and good friend Dr Robert Scully once said "there's a saying in medicine that if you hear hooves, don't go hunting for zebras. Most of us look for horses. But Tom, he's a zebra hunter." The patients who see me for chronic undiagnosed illness have often seen innumerable numbers of health care practitioners, are at "wit's end," and on the edge of losing all hope (occasionally I see individuals
completely void of hope, reluctantly dragged into my office by a concerned family member or friend).
My consultations include history and physical, but I will often set extra time aside to discuss a personal topic with a patient after traditional history and physical is completed. For example, if a car mechanic comes to my office, I might ask his opinion on weber carburators, after listening to the story of his illness in full detail. A patient's response often provides insight into the illness itself. Understanding who I am and why I am listening to them instills hope, motivation and enthusiasm, and hopefully erases fears. It lets them know I'm human, and my goals as a navigator. Words heal: They are capable of turning mountains into mo-hills, and vice-versa. They can give hope or despair, aggravation or peace of mind. The ultimate goal is to achieve serenity. Silence is important as well as it is the fuel for introspection, and self-valuation.
Life often is so busy that we often forget to set time aside to take a good look at ourselves.
I space my patient-schedule loosely enough for my challenging cases to provide time for such conversations to take place, i.e., no time is sacrificed for the traditional one-hour initial office visit. My local midtown house call practice is focused on taking care of elderly unable to leave home, and travellers with time constraints. A house call is an evaluation of one's home, and thus a tangible expression of one's soul. It also can lead to a nice cup of coffee. I am privileged to be a doctor and take the job quite seriously.
Essays and Quotes
My essays include my formal (and informal) education, "magic moments," and opinions
on healthcare and politics. Magic Moments are the precursors of
enlightenment and wisdom. They are the spiritual learning experiences which re-shape
our souls, and change the way we perceive the world, ourselves, and others.
Such moments are often associated with a smile both at the time of occurrence and each
reflection thereafter, and hopefully, when they are shared with others.
My life, my friends
There are a lot of people in my life or whom I've met that make life interesting. I've never a dull moment.
My friends will attest to that, hands down. It tends to hover in the realm of adventure and chaos and serenity.
Quality of life is so much more important than quantity, though it's nice to have both.
The compromised quality of one's life also compromise's that of family and friends.
Solving a mystery will therefore have a positive cascading effect on patients and those who love them.
There's nothing more gratifying than that. It's a spirituality builder in a material world.
One can't put a price on kind words such as "thank you," or prescribing hope, or restoring faith.
Faith and hope are spiritual prescriptions for healing the body, and are expressed from the most important
part of a stethoscope, i.e., which fits between the ear pieces, and which we sometimes rest a hat on.
We also cannot put a price on the wisdom we acquire from life's adversities. We are blessed with "life" for such a short amount of time, as we are all
"only visiting this planet."
My favorite patient is a happy and healthy one, who sends a Christmas card, letting me know their life is still beautiful.
Dr Thomas Bolte is an internist-comprehensivist specializing in solving medical mysteries. His midtown practice is Bolte Medical, a comprehensive integrated medical clinic and urgent care center in midtown Manhattan nyc. Bolte Medical received the 2009 US Commerce Association award, given to outstanding businesses who enhance the positive image of small business through service to customers and community.
Doctor Bolte makes physician house call visits to local area midtown new york city residents and nyc hotel guests. He was named "Doc-N-Roll" (Fox & Friends) and "Dr Wheel-Good" (New York Post) due to making house calls on rollerblades.
Discover Magazine recently featured Doctor Bolte in an article entitled "The Real Dr. House." Maxim Detox - Russia similarly published an article about Dr Bolte entitled "Original House."