What Is a Physician Advisor?
Your health needs a general manager like your business
When a company faces a complex challenge, they don’t throw five consultants at it independently and hope for the best. They make it someone’s actual job to fix it, with accountability and the right to bring in subject matter experts under their direction to get it done.
A CEO, a general manager—someone who understands the big picture, coordinates the specialists, translates between departments, and drives toward a unified solution.
When you face a complex medical challenge, the system does exactly what that company would never do: sends you to five specialists who rarely communicate, gives you contradictory recommendations, and expects you—while sick, in pain, and far from operating at your best—to be the coordinator, translator, researcher, diplomat, and decision-maker.
The gap between the best outcome and the outcome most patients get
In the last 9 years of practicing medicine in the traditional system, I’ve seen too many smart, proactive patients who were doing everything “right”– researching specialists and treatments, getting second opinions, becoming experts in their own condition, following their treatment plans precisely–and still getting worse.
It wasn’t that these were patients whose decline was inevitable. There was often an enormous gap between the best case outcome for patients like them, with the conditions they had and the medical technology available, and the outcome they got.
And for the patients who did get the best outcome, overwhelmingly what made the difference wasn’t money or status or concierge medicine influence to get them to the front of the line.
What made the difference in whether they got the best outcome, a good outcome, or an adverse outcome altogether was mostly luck.
Whether they managed to find a spinal specialist who’d worked with spinal fusions in hypermobile patients and knew why they were different.
Whether they ran into a cardiologist who’d seen their specific combination of cardiac and non-cardiac conditions that interacted to produce the symptoms they were having.
Whether an ophthalmologist they saw for an unrelated condition happened to have done a fellowship in post-concussive syndrome and recognized the symptoms they’d long since given up on treating.
This is not precision medicine. It is roulette.
The end of healthcare roulette
By the time one patient, Misha, came to our physician advisor practice, she had spun the roulette wheel 19 times. She’s seen three orthopedic surgeons, three pain management specialists, a neurosurgeon, neurologist, endocrinologist, rheumatologist, geneticist, therapist, several physical therapists, and others. She’d been to the ER three times and admitted for an overnight hospital stay. She’d been incorrectly medicated. And she’d been told, repeatedly, that she “wasn’t disabled enough yet” for anyone to help her.
None of those 19 doctors found either of the core problems. They told her she didn’t have a hypermobility disorder. They told her that her previous spinal surgery had resolved her disc herniation. They prescribed standard physical therapy—which can actually harm patients with hypermobility–and caused further pain without improvement.
At each appointment, Misha explained her full medical history again as it got longer and longer. Each appointment started from scratch with no one looking at the whole picture. 19 specialists and no one questioned the underlying assumptions.
What changes with a physician advisor
When Misha’s physician advisor, Dr. Ashley Alwood, reviewed her case, she did a deep dive investigation. She reviewed Misha’s thousands of pages of medical records. She talked to each of Misha’s existing specialists to get the background on what they had seen and what they had tried, and she did medical journal research specific to Misha’s symptoms, conditions, and possible conditions.
Dr. Ashley recognized the clinical presentation of a hypermobility disorder—something crucial, because it changed which treatments were likely to be effective, the likelihood of recurrences, and the risks and considerations of surgeries.
Dr. Ashley arranged for Misha to be seen at a hypermobility clinic where she received a formal diagnosis that would inform her treatment thereafter. Incorporating these hypermobility specialists, Misha’s physician advisor put together a cohesive (smaller than 19!) care team and kept them talking to each other, sharing the information each needed for Misha’s care–not just dropping “encounter notes” into each other’s fax machines.
With her physician advisor’s direction, Misha’s care team acted as a coordinated group rather than a collection of fragmented viewpoints that Misha had to mediate between.
The new care team concluded that Misha’s spine should be re-imaged to look for a recurrence of the herniation and found that the disc herniation had in fact recurred—something rare for average patients but common in people with hypermobility.
The two diagnoses multiple physicians had previously ruled out turned out to be the primary drivers of her symptoms.
With the correct diagnoses and care coordinated by her physician advisor, Misha received new treatments: a spinal fusion with due consideration for the impact of her hypermobility, a rib resection, and a redesigned pain management program.
“Since I had this second surgery that fixed things, I was able to play with my little cat... I’ve been able to go to two different weddings. I was able to have fun. …”It had been so long since I’d been able to feel that okay.” - Misha
Your health needs a general manager
Executive patients in the traditional system had asked me why there isn’t anyone quarterbacking their care.
Instead, they have 5 specialists who don’t talk to each other giving contradicting advice, no one accountable for synthesis or direction, while the patient sits on hold, tells their story again, and acts as go-between.
One CEO facing complex cancer treatment said “At work, I have a general manager who does this. Why isn’t there anyone to be the general manager for my treatment?”
A Physician Advisor fills that gap.
They take responsibility for the whole case.
They start from first principles rather than inherited conclusions.
They determine which specialists are needed and in what order to give each the information they need to work with.
They separate “getting answers” from sitting in endless doctors’ appointments.
They integrate clinical evidence, literature research, your experience, and their clinical experience into a single cohesive strategy with one goal: to get you back to doing the things that are important to you quickly.
Follow this Substack if:
You have access to excellent doctors but still feel like no one is accountable for the outcome.
You’ve noticed that “standard of care” often means average, not right for you.
You want to learn how to think about your health decisions like doctors do–not just the recommendations, but how to think about risk, tradeoffs, and uncertainty.
You are managing a complex health situation—for yourself or someone you love—and don’t want to leave the result to chance.
Think someone in your life could use a physician advisor? Forward this to them—it might be exactly what they need to hear. And if that person is you, start here: cartemedical.com.