The WellMax® Advantage


Dr. Daniel S. Cosgrove, Medical Director of WellMax Center for Preventive Medicine

Dr. Daniel Cosgrove, Medical Director of WellMax®, takes time to answer questions from a prospective patient about the benefits offered by WellMax® and how it compares with other clinics.

WellMax patient


Dr. Cosgrove, How is WellMax different from other medical clinics and doctor encounters?

Dr. Daniel S. Cosgrove

Dr. Cosgrove:

That’s really a big question, but it comes down to a few principles.

1. Pursue quality, not quantity.

When we launched WellMax, the vision was to practice the best medicine possible. What would that look like? If I were, for example, told to take care of the most important, most valuable person in the world, what tests would I do, and how much time would I need to take from this important person to do it? How much would the very best healthcare cost? It turns out that it’s not that expensive for an individual.

In most clinic scenarios, third party billing dictates that doctors are forced by management to ask, “How fast can I complete this interview? How many patients can I process today?”

WellMax is tremendously rewarding for me, because when I sit down with you as a patient, I get to ask, “How well can I take care of this one patient sitting before me right now?” Before we get up from the table, I ask myself, “What else can I do for this patient?” The fact is that there is usually more to do, and patients are grateful that I take the extra time.

This idea of pursuing excellence in patient care is central to our unique medical culture. Instead of scheduling several “history and physical” slots in one day, we schedule one for the morning, and maybe one for the afternoon. I love working here, because instead of standing in an exam room with one hand on the door trying to answer your question quickly and hoping it’s your last question, I get to sit down with you. I make sure I’ve answered all of your questions, and then I always have many more questions for you.

Newsweek once wrote a story about WellMax. The reporter wrote that I provide the best examination one could get… except at a coroner’s office! Then he asked, “Isn’t it health care for the rich?” I answered “I guess so. But when you come to my clinic, I’m not concerned about the national health-care picture. I’m concerned about you.”

2. Be methodical. Measure when possible. Track changes over time.

Our slogan at WellMax is “If it matters, measure it. Disciplined response. Then re-measure it.” The way that we approach that is to build --- for each patient --- a WellMax Personal Health Portfolio™. The Personal Health Portfolio™ (PHP) is a trademarked approach designed by me, and I’m still working on it, to make it even better. It’s really a bunch of checklists with algorithms. It allows us to identify then address each medical issue.

Then, unlike most health care or concierge medicine programs, we want transparency. We share the PHP with you. We contact other doctors for you. We’re not competing with your other doctors; we’re making their job easier for them, but also holding them accountable on your behalf. You can access your lab tests or CT scan or medical reports from your executive physical by using our private secure website or just a USB “jump drive” with all of your medical records in one place.

3. Make the experience personal.

Ultimately the goal is not just completed checklists. It’s not all measurements. If we imagine the patient is a close relative, then we can focus on making the process as minimally threatening and scary, and focus on optimizing each individual patient’s health. Remember at the outset I said to imagine this is the most important, valuable person in the world? Then it is an honor to care for them, to be part of this highly personal part of their life. It must be an integral goal to have the patient’s overall experience be pleasant. Our goal of obtaining measures for the early detection of disease leads to highly personal questions; needles; poking and prodding; it is not inherently a pleasant experience. So instead of tile floors and alcohol smell and bright lights, we situated the clinic at a nice resort with lots of flowers outside, and carpet and indirect lighting inside. We decided to maintain “unconditional positive regard” for each patient, each person. Doctors and nurses can do this: it is a collective intention.

WellMax patient


Why don’t all doctors practice this way? Some doctors take insurance? You don’t?

Dr. Daniel S. Cosgrove

Dr. Cosgrove:

It would surely be prohibitively expensive to have Medicare or Obamacare or Canada’s National Health System provide the very best to everyone. They have a different vision: universal coverage for medically necessary health care services provided on the basis of need, rather than the ability to pay. That is an honorable, great vision. But it is not the WellMax vision. In my experience practicing medicine for 18 years prior to WellMax, I discovered that “medically necessary” is a loaded word. If it’s medically necessary, then “they” ---insurance, Medicare, or some other third party payor with finite and inevitably overstretched resources --- must pay for it, and pay for it times millions of people. So there is a strong practical, economic pressure to limit what is medically necessary and this inevitably, always, limits the quality of healthcare that you receive. That’s why at WellMax we can’t just “take insurance.” Patients may not realize that insurance almost never pays what is billed. They decide what is “medically necessary” and then pay what is “allowed.” So WellMax can help get reimbursement with diagnosis codes, etc. but we don’t work for “third party payors.” We are responsible to each patient.

WellMax patient


How do the WellMax Executive Physical programs and Concierge Medicine compare to the Scripps Executive Physical program in San Diego?

Dr. Daniel S. Cosgrove

Dr. Cosgrove:

Scripps is an excellent high quality medical institution. But their executive physical is meant to be profitable and efficient.

  • Carotid Ultrasound and IMT. Just loosen the collar and with no radiation, we can see how much plaque is in the big carotid arteries supplying blood to the brain. We can measure the wall thickness (IMT) and these measures correlate with how much atherosclerosis is present elsewhere, i.e. ones risk for stroke and heart attack. Scripps' executive physicals doesn’t do it at all. They don’t offer it.

  • Coronary calcium score can detect accumulation of plaque in the coronary arteries, the little arteries that supply the heart muscle. If these get blocked, you have a heart attack, and you may die. Scripps doesn’t do this test.
  • Abdominal and pelvic ultrasound provides images of the aorta to screen for aneurysm, and images of the liver, spleen, kidneys, prostate or uterus and ovaries, bladder, and much more. Scripps does not do these tests as part of its executive physical.

Screening for early detection of disease is an important goal. What about kidney cancer? It can be seen with ultrasound. No radiation, just a wand on the side of your abdomen can provide images of the kidney. Kidney cancer in the earliest stages, before symptoms, is curable. Most kidney cancer is discovered from symptoms, when it is in more advanced stages, and it is not curable. At WellMax, we take the time, we use the ultrasound, and we screen for kidney disease (and about 20 other diseases and cancers). Scripps does not.

But Scripps has the inexpensive (for them) “lifestyle specialist” chat with you about diet and exercise. And at the end of the day you get a massage. So you leave happy. But did they screen for heart disease? NO. They screened for habits that might lead to it. They measured cholesterol, because in large groups of patients, those with high cholesterol levels tend to have more heart attacks than a large group of patients with low cholesterol levels. But as many as half of heart attacks (or more) are NOT in patients with high cholesterol levels! It’s a very inexpensive measure, but it should NOT be the only one. At WellMax we actually screen for any evidence of this process of plaque building up in both coronary and carotid arteries (with carotid ultrasound, IMT measures, and CACS).

There are many cancer detection tests that Scripps does not use. WellMax does. The list is a long one. Instead of trying to tell you on a website page exactly how to bake a cake, ask yourself: are you buying a cake from a bakery pursuing excellence and quality? Or are you buying assembly line Twinkies because they look similar, and they’re cheaper? This is your health care. We’re talking about the process of early detection of cancer and heart disease. This isn’t the situation where you shop price first. Start with quality. You’re worth it!

In defense of Scripps, it’s a big company. Their market is usually corporations that offer their executives a physical. The companies want it inexpensive, take little time, and they want the employee to have a nice time. Call it efficient. Enjoy the massage. But don’t call it high quality preventive health care!

Call us at WellMax at (760) 777-8772.

Tell us what you’re concerned about. Then let’s schedule some time together.