Dr Thomas Bolte :: Medical Mystery Consultant :: Bolte Medical (212) 588-9314
This page introduces my background and training, areas of interest and expertise, and beliefs.
I trained conventionally as an Internist then worked in fast-paced emergency rooms and urgent care centers. I added a Spanish-speaking multispecialty group to my resume, as well as an HMO.
My interest in diet and nutrition began in my childhood. Both of my parents believed nutrition to be the best preventative way to avoid illness and the associated pharmaceutical solutions. I independently studied nutritional biochemistry in medical school, and worked in the medical practices of Dr Leo Galland and Dr Robert Atkins. Both are brilliant yet very different diagnosticians, and both took the time to make a better doctor out of me, and are the role-models I admire most, and aspire to be. I learned a lot from Dr Jeffrey Bland, Dr Gary Null and Dr Lewis Thomas, all three with unique abilities to untangle complicated medical information into something incredibly interesting and fascinating.
As a healer, I realize I cannot know all there is to know, but I can know more than I did yesterday. My journey in medicine was mapped by my realization of the importance of medical knowledge and expertise in optimizing each patient's resolution of medical problems. Making another person's quality of life better is the most satisfying feeilng I know of, and there's no better way of doing that, than by 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 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?
I'm often asked "what type of doctor are you?" It's hard to label myself as there are many different definitions associated with each name given to a doctor. Like Woody Allen, I don't like to join groups who'd have me as a member. My practice of medicine is neither conventional nor alternative. I attract patients considered "difficult-to-diagnose" and coined the term "Comprehensivist" to describe a medical practitioner who solves complicated medical mysteries. I once heard Dr Mark Hyman call himself "wholistic" because he treats patients with a "whole-list" of problems. My medical practice fits this particular definition as well. Dr Aaron Feder was a great Cornell Hospital physician who referred to himself as an "Internist," though actually, he was a master diagnostician. When asked, I introduce myself as "a physician" or "Internist." Then I pray the next question is not "what type?" Semantic profiling is often better than it sounds.
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 the ones with the most branches, 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.
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.
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.
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.