We all read so many books throughout our lives, but there are only a handful that we find ourselves re-reading. For me, I literally have only 3 books on my shelf that I read multiple times.

The Present was a book I bought back when I was studying for my Masters degree. I was on a internship where I was learning basic managerial skills: motivating employees, establishing a teamwork culture in an organization, and increasing productivity. It has been recommended to me and I have learned that it continues to be shared in the workplace even today.

​This is a book that can be finished in a few hours, literally. It is very simply written, but demands one to reflect and contemplate. The Present is exactly what you make of it. We all are aware of it, but its implementation is what is so challenging. Carpe diem, as the Romans would say, is an ancient reminder that is illustrated in this book. 

The message is simple, yet difficult to implement on a daily basis. 

1. Live life in the present
2. Learn from the past to make the present better
3. Focus on the present to make a desired future possible
4. Live with purpose and intention 

The Present addresses these 4 core lessons through a story that is shared between 2 characters. The reader is asked to reflect upon the story and think how they can implement these lessons into their own lives. 

Living with purpose is central to my existence. I was taught by wonderful mentors and leaders who always put purpose before "work." The idea that our work must fulfill some personal purpose is key for self-motivation and focus in life. Consider following one of my favorite leadership scholars, John Maxwell, on twitter #intentionalliving. 

If you like books that are very descriptive and tell you exactly what to think, then you  may not like this book. But, if you like books that facilitate reflection, discussion, and allow you to reflect from your own  perspective, then you will enjoy this book. 

I love it and hope you consider reading this book. Share it with your young adults, discuss its principles as a family, and share it with others. 

- Dr. Ahmed 

Many of you know I am very passionate about the practice of medicine and am quite vocal about how to improve our national health care system. There is one question that seems to be brought up consistently by my audience: How has the Affordable Care Act affected your practice? Furthermore, some people will ask, I have insurance so doesn't that mean I am covered?

So, to clear the air on what is truly happening since the enactment of the ACA, I will attempt to explain it in simple terms in this blog post.

Prior to the Affordable Care Act (ACA) being enacted on March 23rd 2010, physicians and economists have been yelling at closed ears about how expanding coverage is not the only solution to this mess. The 2 major problems in addition to coverage is ACCESS and COST of health care. Simply put, here is how the ACA impacted these key components of our health care crisis:

COVERAGE: Although we have now insured an estimated 10 million of the 43 million who were uninsured, 18% of the US population uninsured down to 11%, we have accepted narrow provider networks, higher premiums, higher deductibles. The complexity of insurance products have increased, causing even more confusion as to what consumers are actually buying. In addition, there is confusion as to who is in your network and many consumers realized they have to travel significant distances to get care.

The Commonwealth Fund found that the rise in premiums for employer-based plans had slowed in several states but they continue to rise faster than median income. Therefore, as wages stayed stagnant, premiums continued to rise.

Finally, many providers do not participate in certain networks or insurance plans given their poor reimbursement.

COST: Insurers can decrease or maintain a premium by shifting the out of pocket costs to the consumer, co-pays, and deductibles. Medications continue to rise in cost by double digits. Medicare premiums continue to rise and out of pocket expenses on average are $5,400 annually for the 65-70 year old, but increase substantially as we age given increased hospitalizations.

The cost of medical devices and hospital stay continue to rise. Why do we have to negotiate these costs each time we review our hospital bills, which are full of vague charges? I have done outcomes research studies in a hospital setting where we try to show cost savings with a medical treatment.  To estimate and create a line item cost of a single unit blood transfusion is impossible.

ACCESS: Lack of understanding of networks, physicians not being part of poorly paying insurers, and the simple fact of increased demand with a decreasing supply of physicians has led to delayed diagnoses and even death.

So, how has the ACA affected my direct primary care practice? Single answer: it has helped me from a business standpoint as our solution is even more significant and patients enjoy their freedom. The ACA has made it harder for those who are in the "donut hole" and their states have not expanded Medicaid to get any type of care other than our practice. In effect, our practice is saving the ER and the hospitals from ever increasing accounts receivables to writing off large amounts as charity care.

From the PATIENTS PERSPECTIVE:
Our practice provides accessible primary care services, urgent care visits, and affordable services whenever they need it. In addition, this relationship in the long term will prevent illnesses that cost Americans thousands of dollars. Finally, patients are empowered with resources to take care of themselves, they have transparent imaging, laboratory, and pathology pricing. They can CHOOSE to use their insurance for any ancillary service if they want and compare cash pricing to what the insurance companies will cover.

From the PHYSICIAN PERSPECTIVE:
The ACA has increased the red tape and regulations on medical practice. For example, on October 1, 2015 ICD-10 came into effect. The previous ICD-9 had 17,000 codes and this newer version has 141,000 codes! Think about the direct costs of software update, hiring more staff, and the indirect costs of training, lost revenue from inefficiency and slowed practice. Since we do not contract with insurance carriers, these nuances have no effect on us.

The ACA has caused more physicians to leave the practice of medicine. There is an estimated deficit of 124,000 primary care physicians by 2025. Our practice has become more attractive where physicians can be sole owners of their practice and join Health Suite to share its resources and all of its community resources.

Finally, the ACA motivated us to seek more partnerships to save our patients up to 95% on imaging, medications, and pathology for being our members. 

Bottom line: Practices like ours will soon be paired with high deductible plans, as they are in Washington state. This is low cost and high value for consumers. So, spend the time to look at our practice, talk with us, talk with our insurance brokers, save thousands of dollars for yourself or your company by pairing the right insurance product with our practice.

Some good resources:
NY Times article
2015 Milliman Medical Index
Essay by Patrick Ishmael
More employers shifting cost to employees

So a couple of adventurous guys and myself thought we would head out to West Virginia to battle the infamous Gauley River. It is a 105 mile river that merges with the New River to form the Kanawha River, which is a tributary of the Ohio River. The Gauley River is the most popular advanced whitewater site in the country. It was a 2 day trip that involved piercing through challenging rapids that ranged from class 3-5. According to the American Whitewater Association, each rapid is ranked by the character of the rapid in terms of how violent and harsh it is, distance, technical difficulty to maneuver, and finally the difficulty of swimming in it. In other words, the higher the class of rapid, the higher the chance of something bad happening to you.

Check out the reviews: http://www.tripadvisor.com/Attraction_Review-g59234-d3330369-Reviews-New_Gauley_River_Adventures-Lansing_West_Virginia.html

As you can see from the pictures, the river beat me up bad! I strongly recommend trying new sports and activities. Prior to this trip, my workouts were truly at its peak. Those of you who workout know what I am talking about. It is a point where lifts seem easier, body responds to the workouts, and each session is better than the previous. We all experience set backs and for me this really sucks! Quite honestly, my immediate thought was about how I cannot workout my upper body for several months. It really stinks.

So you are probably wondering what happened? Well, it was the second day of the trip, the last class 5 rapid, and a huge rapid pushed me off the raft. This was the second time I was knocked off the raft and for some random reason, I thought I could grab a hold of the rope that was lining the outside of the raft to propel myself back onto the raft. The river, with all of its tremendous might kept pushing me away from the raft. The bicep muscle could not withstand the force and "pop" went the distal tendon.

Ouch.

Down I went with the river. If you have not gone rafting, this is the point of the story where all I remember is waves crashing on my face and seeing rocks zoom by as I continued to go down the river. This is where the only thoughts that go through your head is "I hope I don't hit a rock head first!"

Luckily, I swam and navigated to the nearest raft and was lifted up onto safety by friendly strangers. I was surrounded by laughter and smiles as each patted me on the back. But, I could not smile. The pain was too intense.

Life must go on. Today, at the clinic, I saw a few patients, ate lunch where I bumped into people I know who asked the obvious question after seeing my left arm in a sling "what happened?" It certainly makes for a good story.

I must say though, my practice has spoiled me rotten. I cannot help but smirk when I have to fill out so many forms prior to seeing the doctor, go into the "second" waiting room only to get my vitals checked, then wait another 10 minutes before the doctor comes. The funny thing is, after all that, I was told I had to see another doctor since my muscle was so high up my arm after the tear. Ahh! Another visit, more forms, and more waiting!

Will keep you posted on my progress. Please feel free to share your injuries with extreme sports or any sports injury.

Injured, but always there for my patients,
- Dr. Ahmed