BLOG

This page is going to tackle subject material that is pertinent to my practice in a bit more detail and will be updated on a (hopefully) weekly basis.  Enjoy the reading!

Friday, August 30, 2024--Direct Primary Care is a membership-based medical practice that emphasizes the personal relationship between a doctor and patient. In our practice, when you need to contact Dr. Kilpatrick, you contact him directly without any intermediaries. No leaving messages, having another doctor call you back, or even missed messages. You may choose email, text, phone, FaceTime or other virtual platform.  This is a huge benefit to joining our practice.  Sign up today!

Friday, September 6, 2024--Dr. Kilpatrick practices Internal Medicine and Pediatrics.  Why 2 specialties?  Back in the 1960s, training in Internal Medicine and Pediatrics was the original way for doctors to do Primary Care.  Family Medicine, beginning in the 1970s, has become a more popular option for Primary Care though Internal Medicine/Pediatrics still turns out Primary Care doctors.  Dual certification does have its advantages:  one has the credentials to claim equivilence with any other Internal Medicine or Pediatrics doctor nationwide, and be able to combine these 2 disciplines in a seamless way for the benefit of all patients in all age groups.  Why not consider this practice as your new Primary Care home?

Friday, September 13, 2024--How much are you really paying in an insurance-based medical plan?  The Kaiser Family Foundation found in 2023 that the average family medical plan cost around $24,000/year and that a plan for singles cost around $8,500/year.  When you consider that a lot of this cost goes to paying the salaries of insurance company employees and not to claims, do you feel that this is the best use of your medical dollar?  The most expensive plan in Brian Kilpatrick, MD, Internal Medicine and Pediatrics is $1,428/year ($119/month).  Plan costs range from $29/month to $119/month.  For those of you who primarily concentrate on medical care affordability, this is the practice for you!

Friday, September 20, 2024--When you are ill, do you have enough energy to get dressed, get in the car, and drive to your doctor?  That might be okay if you did not have a signifiant wait time, but that often happens as well.  In Brian Kilpatrick, MD, Internal Medicine and Pediatrics, when you are sick, and you need to be seen in person, you are seen in the comfort of your home.  Yes, we do home visits!  With our Maxi-Plan, there is no additional charge.  With our Mini-Plan, there is a visit fee.  But even if you ultimately have to pay a fee, the good tradeoff may be letting Dr. Kilpatrick come to you, rather that the other way around.  See why this and other ideas like this make this practice one of the best places in Central Virginia to obtain Primary Medical Care.

Friday, September 27, 2024--Have you had a complete physical exam recently?  At this practice, we believe that going over your complete medical history and physical exam at the beginning of your care with us is very important.  We want to be able to use that information to care for you from that day forward.  We don't charge extra for it either.   We don't want there to be any barriers to obtaining this information.  The cost is included in your monthly membership fee.  Why not let this be just another reason to change your Primary Care practice to Brian Kilpatrick, MD, Internal Medicine and Pediatrics?  It makes total sense.

Friday, October 4, 2024--Do you ever get disheartened when you find that you pay for each and every lab test that is done by your doctor?  At this practice, we make it a point to include six point-of-care lab tests for your care at no cost.  These include rapid flu test, rapid strep test, fingerstick hemoglobin, fingerstick glucose, urine dipstick, and hemoccult of stool or other body secretions.  All of these tests are covered in your membership fees.  Just another reason to make Brian Kilpatrick, MD, Internal Medicine and Pediatrics your health care home.

Friday, October 11, 2024--Medical procedures can be expensive.   At this practice, we offer at least 16 different prodedures at no cost to you.  These procedures are covered in your monthly membership fee.  To see what procedures are offered through our practice, check out the Covered Labs and Procedures page on this website.   Why not peruse the rest of the website to find even more reasons to consider changing your primary care doctor to Brian Kilpatrick, MD,  Internal Medicine and Pediatrics.

Friday, October 18, 2024--Knowing how to get lab work done in a timely fashion can be critical to your health and well being.  While we don't pay for your labs (except for the six tests that are listed on our website under Covered Labs and Procedures), we can recommend where to go in Lynchburg and the Central Virginia region.  Often, you can order labs on your own and have them sent to you directly.  We even have a working relationship with a local blood drawing service that will come to your home for a fee.  Make sure that your concern over lab testing and how to do it is not a reason to put off signing up with our practice.  We believe you will be pleasantly surprised as to how easy it is for this to happen.

Friday, October 25, 2024--Knowing how to get xrays and other radiology procedures (including ultrasound, CT, and MRI) done in a timely fashion can also be critical to your health and well being.  While we don't pay for these things, we can recommend where to go in Lynchburg and the Central Virginia region.  We even have an agreement with another Direct Primary Care practice in Lynchburg to do ultrasound exams at a cash price that is much lower than you would pay in the local hospital system.  Just another example of how Direct Primary Care is coming up with innovative ways to take care of you and save you money in the process.  Sign up today!

Friday, November 1, 2024--Specialty medical and surgical care is often needed when the limitations of Primary Care doctors have been exceeded.  We can help you with these referrals and speak directly to these offices on your behalf.  With most offices now having a website, many patients like to do their own "shopping."  Whatever you decide, we will help you make arrangements and attempt to be a liason between you and the specialty office.  Certainly, it is best for you to be communicating directly with the specialty physician, but we can also come along side and help you when you still have questions.  Another plus for a Direct Primary Care practice!

Friday, November 8, 2024--Are you on a budget with most expenses around your home?  We are too!  Why is it that many medical practices cannot tell you what something will cost before it happens?  That can lead to hesitancy to do something for your health that may indeed be beneficial.  The worst case scenario is not doing something which might lead to a very bad medical outcome.  At this practice, we want to be completely transparent about our medical costs.  Our monthly membership fee for the various plans and our home visit charge for our Mini-Plan are the only charges you will ever see from us.  Check out our plan page for up-to-date pricing information.  Note:  we have adjusted pricing for all plans as of September 19, 2024.

Friday, November 15, 2024--Virtual Medicine is here to stay.  I admit that, as an Internal Medicine and Pediatrics doctor, where much of what I do is based on "hands-on, in person" communication with and examination of the patient, Virtual Medicine was a stretch.  However, I have seen where it may be beneficial and have incorporated it into my practice.  The most critical aspect of that communication is the back and forth communication by email, text, or phone on what is going on with you or your family.  I cannot help that which I do not know about.  So up-to-date information is exceedingly helpful.  It allows us to make decisions on when to suggest in-home visits or when to simply offer advice for you to carry out.  Keep communicating!

Friday, November 22, 2024--Have you ever bought a car?  For most adults, the answer is "yes."  I bet you went to the dealership or homeowner, looked the car over, asked many questions, and then, maybe, you bought it.  We believe that signing up for a Direct Primary Care medical practice should offer the same transparency.  We want you to feel fully convinced that this is what you want for you (and your family).  We offer to come to your home free of charge to allow you to ask questions, give us scenarios to consider, ask specific questions about hot topics, and throw in a few questions about your medical conditions.  While we feel that this website offers quite a bit of information, it is not perfect.  So we welcome coming to you before you "sign on the dotted line."

Friday, November 29, 2024--Having medical insurance is a luxury.   While there are many good things about medical insurance, one less-well-known thing is that it does not give blanket coverage for everything (for example, there are limitations as to how much of your drug costs it will pay or how many physical therapy visits it will be pay for).  The second more-well-known thing about insurance is that it is expensive.  Most of us are only able to afford it if the government or an employer subsidizes it in some way.  How many of us could pay the full $24K (families) or $8.5K (singles) that the Kaiser Family Foundation found to be the average cost for medical insurance in 2023?  That is why Direct Primary Care (DPC) medical practices can generally beat the costs of medical insurance plans several times over.   Check out our monthly and yearly membership fees and use these numbers to motivate you to joint today!

Friday, December 6, 2024--In our medical practice, we offer three (3) medical plans for your consideration.  Today we talk about the plan which offers the most benefits.  Our Maxi-Plan offers unlimited virtual communication, free in-home visits when necessary, six covered lab tests, and at least sixteen covered procedures.  This plan is available to one person for $89/month, two persons for $109/month, and three+ (family) persons for $129/month.  Sign up for this great value today!

Friday, December 13, 2024--Let's continue on from where we left off last week.  Besides the Maxi-Plan, we offer a Mini-Plan, a less-costly alternative for many families.  The Mini-Plan is constructed for those families that believe that they would not likely need many visits during the year, but would still like to be able to communicate their health needs, if needed.  So the Mini-Plan provides unlimited virtual communication but each visit (after the initial intake visit) is $85.  If such a visit is needed, the six covered lab tests and the sixteen covered procedures are free of charge, if needed.  This plan is available for $49/month for one person, $59/month for two persons, and $69/month for three+ (family) persons.  This is an exceptional value!

Friday, December 20, 2024--Over the last 2 weeks, we have talked about the Maxi-Plan and the Mini-Plan, the two signature plans of my medical practice.  Today we talk about the newest plan, the Virtual-Only Plan.  This plan offers the subscriber the ability to communicate with me via technology about medical questions.  Since I am licensed in Virginia and Ohio, I can accept patients in the Virtual-Only Plan in these states.  If you were to sign up for this plan, I provide unlimited virtual communication about your medical conditions.  We cannot provide physical exams, in-house labs, or in-house procedures.  The cost for one person is $39/month, for two persons is $49/month, and for three+ persons is $59/month.  This is a great value!

Friday, December 27, 2024--As we approach the end of the year, a topic that one must consider when evaluating which primary care office should become your medical home is the experience of the practitioner(s) that comprise(s) the medical staff at that office.  As a seasoned practitioner of 35 years, I have "seen it all."  I have taken care of both adults and children during all of these years.  I have maintained board certification in both Internal Medicine and Pediatrics  and have held three different academic appointments (St. Louis University, Tufts University (Baystate Medical Center), and Liberty University).  Recently I have decided to withdraw from the American Board of Pediatrics General Pediatrics Maintenance of Certification Program after 35 years of continuous certification.  I did not see any continued benefit in an expensive Pediatrics certification, given my current medical practice.  Whether or not one participates in these programs is probably not as important as whether one continues Continuing Medical Education (CME) in these fields.  CME will continue in both Internal Medicine and Pediatrics.  Incidentally, my Internal Medicine certification is lifelong and remains intact.

Friday, January 3, 2025--"The most frequent complaint about health insurance is the cost. The cost of employer-sponsored insurance (ESI) for a hypothetical family of four in 2024 was $32,066, according to the actuarial firm Milliman. Of that total, about 58 percent would typically be paid by the employer." (Epoch Times, 1/4/25).  Elsewhere in this website, I quote the Kaiser Family Foundation on 2023 costs for a similar "family plan" for health insurance ($24,000).  It seems that in just one year, costs have gone up $8,000.  All of our plans had cost of living adjustments this past year and do you know how much that was?  Rather than $8,000/year, it was $120/year.  Who or what is paid with the extra $7, 880?  Now is the time to change over to this DPC practice and actually save some money!

Friday, January 10, 2025--Primary Care providers have come under scrutiny recently for several reasons.  The first reason is that there are not enough of them.  The second reason is that more primary care providers are nurse practitioners and physician assistants.  The third reason is that there is a perception that primary care providers are only "gatekeepers" to route patients to specialists and actually do not have the skills or acumen to actually take care of most of the medical problems that come to them.  At this practice, we would like to reverse these trends.  First, we offer this practice as a Primary Care practice in an attempt to reverse the attrition seen elsewhere.   Second, we offer the skills and acumen of an MD level provider.  Third, we attempt to take care of most problems that are presented to us in this office and not simply refer them to the respective specialty office.  We like to believe that "the buck stops here."  Consider this practice as your Primary Care practice of choice...we'd love to talk to you about it!

Friday, January 17, 2025--Reviews have now become a standard for assessing the value and reliability of a business.  We look at reviews when we book our hotels, buy a dishwasher, or go out to dinner.  Likewise, a medical practice needs to have consistency and excellence (among other things) as its badges of honor.  We are gathering reviews over time.  The best place to view them is on the Testimonials page of this website.  These have been placed there in unedited form and should give you a sense of what this practice offers as experienced by the patients who call this their medical home.  Other reviews may be placed directly on the internet for the convenience of those who write them.

Friday, January 24, 2025--The "flu season" is upon us.  If you feel that you have the "flu" (influenza), consider the "four cardinal signs" of the flu:  fever, headache, muscle aches, profound fatigue.  Certainly there are other symptoms and signs, but these four are highly associated with influenza.  Many times, one can "wait it out" and only use OTC medications such as ibuprofen or tylenol.  However, there may be reasons to start more specific anti-viral medication (such as oseltamivir or Tamiflu) within 48 hours of initial symptoms (if you have chronic illness such as diabetes, heart failure or COPD).  One needs to have a specific flu test to confirm that you do, indeed, have the flu (to avoid unnecessary use of medication).  At this practice, we do provide flu tests free of charge when we feel it important to get someone started on specific anti-viral medication for influenza.  The flu test is one of six point of care tests that we provide free of charge.

Friday, January 31, 2025--It won't be long until we see cases of streptococcal pharyngitis ("strep throat") circulating in the community.  The "four cardinal signs" of "strep throat" (the Centor Criteria) are fever, exudative pharyngitis (the white patches in the tonsillar area), tender anterior cervical lymph nodes, and the ABSENCE of cough.  Those with all four of these criteria are more than likely (>50%) to have strep.  If you have less than four criteria, it is wise to have a point of care rapid strep test, which we provide free of charge, if clinically needed, in this practice (it is included as a part of the membership fee).  Don't be caught waiting forever in waiting rooms of Urgent Care Centers to have your case of sore throat evaluated.  Consider what our direct primary care practice can do in situations of acute illness (like strep throat).  Sign up today!

Friday, February  7, 2025--We are in the season that is affectionately known as "flu season."  This is because influenza virus circulates during the winter months in the Northern Hemisphere and is a major cause of both morbidity and mortality.   Our blog post 2 weeks ago addressed what to do when one has fallen ill with influenza.  But what if you are simply trying to prevent getting the flu?  It is not unreasonable to use some natural remedies to try to boost the immune system so as to ward off influenza in the first place.  For example, some use vitamin D, vitamin C, and zinc.  There is an increasing amount of literature that would support this.  Some get influenza virus vaccine, but the actual ability of this vaccine to prevent illness has been very low in some studies.  During the COVID pandemic, it was found that nasal washes with xylitol or with povidone/iodine helped decrease illness for COVID.  It is not unreasonable to assume that the anti-viral activity in these preparations can extend to other viruses as well.  Some other simple things that you can do to prevent influenza would be to wash your hands frequently, avoid touching your face, cover your coughs and sneezes, clean up surfaces that may have been contaminated with viruses, avoid crowds of people, and avoid people who are sick.  Although wearing a mask for COVID viruses was shown to not be helpful, wearing a mask for influenza viruses has shown some help with decreasing the burden of passing on the virus.  So there are potentially many things that you can do to prevent influenza this winter.

Friday, February 14, 2025--You would think that if you have been able to get over the "flu," that is all that you have to worry about.  Influenza is a virus and indeed causes enough misery in and of itself.  As we posted on January 24th, the "cardinal signs" of the influenza virus are fever, headache, muscle aches, and profound fatigue.  But there is more!  Any virus, and influenza especially, can set up the body for invasion of bacterial illnesses such as pneumonia (lung infection), otitis media (ear infection), sinusitis (sinus infection), and even sepsis (blood stream infection).  These "secondary" infections need to be optimally treated with antibiotics.  Since sorting out where the virus leaves off and where the bacterial infection begins can be difficult, it is wise to consult with your doctor about this.  Your doctor needs to take a very good history and address the physical exam in these areas (at the least) to try to sort this out.  You can help him/her by keeping an accurate log book of your symptoms and signs during your illness.

Friday, February 21, 2025--Virtual medicine has become a more accepted mode of taking care of patients and, indeed, this practice offers a Virtual Only Plan.  But there are limits to virtual medicine in that many elements of the physical exam (or needed lab tests) are not able to be incorporated into the data that one uses to make medical decisions.  Three simple examples will show how to think about virtual medicine.  If someone thinks that they have a sinus infection, then it is true that history alone is sufficient for knowing who needs treatment and who doesn't.  The most recent medical literature discounts the value of any physical exam or radiology testing that once were thought to be important to knowing if one had a sinus infection.  History wins here and, therefore, is sufficient to make a diagnosis.  This can be established virtually.  If someone believes that they have an ear infection, however, physical exam is absolutely mandatory to document the tympanic membrane findings that need to be in place before treatment can be initiated.  History of ear pain may be absent, especially in young children.  So virtual medicine cannot reliably diagnose ear infections.  If someone thinks they have "strep throat," both physical exam and history, either separately or together, cannot reliably diagnose the presence of Group A, beta-hemolytic strep.  A rapid strep test (or culture for strep) is absolutely mandatory to reliably diagnose the presence of this organism.  Therefore, virtual medicine cannot reliably diagnose "strep throat."  So the next time you think you might have one of these common ailments, remember the limitations of virtual medicine.  For 2 out of 3 we mentioned, seeing a medical doctor for either a good physical exam or lab work is mandatory.

Friday, February 28, 2025--How do you communicate medical symptoms, problems, or results to your doctor?  Do you feel that you know the right words to use or do you feel inadequate with medical terminology?  It is true that some patients do better than others in communicating medical symptoms.  But the one advantage we now all have over other times in history is that we can ask questions of the internet in regard to how to describe and phrase medical terms.  Often you can find helpful articles on how to describe pain in a certain area or to describe a new skin abnormality.  Beyond reporting on symptoms, one can find patient check lists that help organize questions to be asked when seeing your doctor.  This check list should include making a list of medications that you take and keeping this current.  Many diabetics keep a log of their blood sugars.  Many patients with hypertension keep a log of their blood pressures.  Sometimes keeping track of what you eat and drink can be helpful in sorting out symptoms. When you are faced with a symptom(s) that your doctor has asked you to report on, consider a log book to list occurrences of the symptom(s) by date and time.  The most common thing lacking when I interview new Internal Medicine patients is an up-to-date immunization record.   Doing diligence to track down all of your immunizations can be extremely helpful to your doctor.  Communicating with your doctor may take a little work but, in the end, it can save your life.

Friday, March 7, 2025--I would like to update anyone who is reading this as to our current status as a practice.  We have been officially "open" since July 1, 2023, so we have 20 months under our belt.  What do we know during that time period?  We have 145 patients split between 62 adults and 83 children.  Most of our patients come from young families with children.  Interest continues in the practice with several inquiries each week regarding membership.  Of course, not all of those choose to proceed to membership, but it is encouraging that the interest continues.  I am appreciative of the way these families are interested in healthy lifestyles and being proactive in taking care of each medical situation.   I can say that several patients have passed on advice regarding certain medications or conditions that have educated me.  Who says that you can't teach an old dog new tricks?  We are starting to get to a time in the practice when all of our patients will be renewing their memberships.  We only require a 6 month commitment so coming into membership does not last forever.   We know that everyone who signs up does so for different reasons and has expectations that may only require our services for a limited time.  I am glad to be able to serve those who sign up with this practice for as long as they need the service.  If you are not a member of this practice yet, why don't you consider joining the many patients that have joined (and are renewing their memberships).

Friday, March 14, 2025--We have now entered the warmer time of the year.  Time for getting outside and enjoying all that the Virginia countryside has to offer.  Soon we will see the grass growing, leaves appearing on the trees, and pollen appearing...everywhere!  Those of you with nasal allergies know what I am talking about.  There are a lot of us that suffer from upper airway (usually nasal) and lower airway (asthma) manifestations of allergic disease.  Upper airway symptoms can manifest in the nose, eyes, throat, and ears.  Itching, sneezing, sinus or ear pain, congestion, drainage, cough from post nasal drainage...all can be bothersome.  Many grab an OTC medication to help, but which one should you choose?  Nasal steroids like fluticasone provide local relief to nasal symptoms.  Non-sedating antihistamines provide systemic relief to the same symptoms but have the potential for sedation, even though they are touted as being "non-drowsy."  Some use one of the sedating antihistamines and, while they provide relief of symptoms, are much more sedating than the newer products.  There are other potential medications which are used less frequently.  One thing that is forgotten in this discussion is the identification of what is actually causing your symptoms.  One should visit an allergist to have prick testing done to determine the etiology of your symptoms.  Then one can determine a game plan to avoid these allergens going forward.  Sometimes, desensitization shots are necessary to lower one's reactivity to certain obnoxious allergens.  This is especially important if one has developed an allergy to bee stings.  Next week, we will look at asthma as a manifestion of allergies in the warmer weather.

Friday, March 21, 2025--Asthma can be a manifestation of allergic disease.  As the spring allergens start to manifest in the warmer weather, we often find that patients start to complain of wheezing, chest tightness, shortness of breath, and cough.  The key to the diagnosis of asthma is the fact that the (lower) airway obstruction is reversible with medications such as Albuterol, which is designed to "relax" bronchial smooth muscle and inhibit immediate hypersensitivity mediator release, particularly from mast cells.  A simple device called a peak expiratory flow meter (PEFM) can help to quantify one's ability to breath air out quickly and can be used to assess the severity of one's asthma.  The changes that one can pick up with a PEFM usually come before other more noticeable symptoms mentioned above.  So every asthma patient should have one and use it on a daily basis.  For a patient who has asthma, two basic categories of medications are available.  Knowing how to use these medication categories (and balance their use with each other) is the key to success with asthma.  Medications such as Albuterol are needed for worsening acute symptoms ("I need to breathe better right now.").  Medications such as fluticasone, budesonide (inhaled corticosteroids), salmeterol, and formoterol (long-acting beta agonists) are used as controller medications to keep asthma symptoms quiet over long periods of time.  It might be that a patient only needs Albuterol every so often, but if that happens to be more than twice a week, one may need to add a controller medication in so that the number of acute asthma flares are reduced.  Following your PEFM results help to keep track of how often these flares are occurring, even though your symptoms are minimal.  One of the things that we can do in this practice is to formulate an Asthma Action Plan to help patients manage their asthma and know what to do in each asthma situation.