Ongoing Education

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I couldn’t believe THAT was the cause of my patient’s chronic cough!

Caroline came to me as a new patient in April with a 2-month history of nagging cough. Over the next few months it didn’t respond to the typical cough meds, antihistamines, or other treatments I could think of.

After the first visit I drew some routine labs. I was surprised to find she had severe anemia, with a hemoglobin of 8.7 (normal is 12 to 15). Normally I would have ordered all kinds of tests, but Caroline didn’t have any insurance. She makes enough money that she wouldn’t qualify for medical assistance. How were we going to investigate this in a cost-efficient manner?

We managed to find lower cost colonoscopy and EGD (stomach scope), but it still cost thousands. Nothing showed up as a cause for her anemia.

At least I could help her with bloodwork – her cost as one of my patients is quite low, $70 or $80 for a full panel of labs. But what about some IV iron to help as her hemoglobin dipped down to 6.9 despite taking iron supplements? She checked with the hospital to find out how much IV iron might cost without insurance. It would be $8400.00!! Nope, not an option.

Meanwhile she continued to cough. We arranged for a lower-cost CT scan in Bloomsburg. I wondered if we would find lung cancer. But instead we found a huge right-sided kidney tumor. With the major medical issues showing up, she finally qualified for medical insurance. The referrals began, and she was quickly evaluated and scheduled for surgery.

I can’t imagine how I would have handled Caroline’s situation in my previous traditional medicine practice, where I was booked solid with patients. I saw her in my office 10 times since April, working on this puzzle. We drew blood several times, answered her concerns, and made referrals a priority. Sue, my employee, was instrumental at getting tests and referrals scheduled.

I saw Caroline today for followup from her kidney tumor removal. She looks good. And her cough is gone!! The kidney tumor had been causing her cough!

I love my DPC (Direct Primary Care) practice, where I can provide prompt personalized health care. Medicine the way it should be!

Mutually Beneficial

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The podiatrist went shopping at my office.

He was a new patient, from 2 hours away. His girlfriend is my patient and had recommended my unique DPC (Direct Primary Care) practice, where patients pay a monthly fee in exchange for unlimited office visits and communication.

We spent the first several minutes comparing notes about our independent practices, both happy that we were free from being employees of a large system.

We discussed his medical history, I drew his blood (much cheaper than he could get anywhere else), and we made plans to connect by phone in the future unless he needed anything in person.

He knew I had bought my office building from a local podiatrist who had become employed by a large medical system. He left a lot of equipment that he didn’t need (printer, file cabinets, autoclave and more), which I appreciate so much! And he left lots of special shoes and braces. We’ve sold a couple of them, but it’s much more than we would ever use.

So we pulled out what we had, and we struck a deal. He left with boxes of equipment that he can sell or use, and we’re happy to have the space.

ER Visit Avoided

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Jimmy’s parents were worried. The 3-year-old was still breathing hard despite the nebulizer treatment. They called his old doctor, who said if he was having breathing problems he should go to the ER. But his parents didn’t think he was quite that bad, and they didn’t like the idea of prolonged wait times and unknow doctors.

A couple of the family members had already signed up with Dr. Herrington’s DPC (Direct Primary Care) practice, where patients pay a monthly membership in exchange for unlimited office visits and communication.

The child’s parents wished they had already signed up Jimmy, but they called to ask if he might become a new patient now. Within an hour the family was in the exam room, with Dr. Herrington examining the child and discussing treatments. They wanted to avoid excessive medications, but the doctor explained that Jimmy was struggling a bit, and adding in some steroid for a few days should help keep him out of trouble.

The next morning, Saturday, Dr. Herrington texted the parents, asking how Jimmy was doing. He was doing a lot better, thank God. And they knew if he had further problems, they could communicate easily with the doctor, seeking further advice. They were so happy they had found this unique medical practice.

Medicine the way it should be!

Urgent Care Costs

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My friend told me about a recent medical experience. She had a persistent sore throat. She called her doctor’s office and was told she was too sick to be seen in the office (?). They recommended being seen at urgent care.

Since she has no insurance, she asked the urgent care center for an estimated cash price. She was told $450. Wow! But she was sick and needed to be seen. She told them she had already checked for “the virus” with a home test three times. All were negative.

She said the doctor saw her for only a few minutes. She had a nasal swab for viruses (negative), as well as a negative strep test. When she left the urgent care center, she was told she would get a bill for the labs. She was shocked when the bill arrived — $1900 !! Finally with some bargaining she paid “only” $900. So that quick trip to Urgent Care cost her over $1300!!

What would she have paid at my office, Pine Creek Family Medicine? We’re the area’s first DPC (Direct Primary Care) practice, where patients pay a monthly membership in exchange for unlimited office visits and communication. She would be paying the monthly membership. But the strep test would have been free. I would have believed her home test for “the virus” and not tested for any further viruses. And if I sent in a strep culture for confirmation, it would have cost $3.18. Yes, that’s all.

Medicine the way it should be.

Self-Pay Labs

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A local doctor called me this week, asking about my Self-Pay Labs for people who aren’t my patients. He was intrigued.

He was thrilled that he could order labs without worrying about ICD10 codes or whether the patient’s insurance would pay. Like the rest of us, he has been frustrated with trying to help patients get cost-effective health care. Often insurance refuses to pay for useful labs. Or patients receive huge bills for blood tests.

Also, insurance dictates how often labs can be done, or they refuse payment. Hemoglobin A1C, which shows how the sugar has been for 3 months, can’t be sooner than every 3 months. And PSA (Prostate cancer screening) can’t be before a year. Screening for Vitamin D deficiency is usually not paid (how do you know you’re deficient if you don’t test?), yet once you have a diagnosis of vitamin D deficiency, Vitamin D blood tests are usually paid. Each insurance has its own regulations. For some things, “screening” diagnoses are best. For others, we need to add a code for a medical diagnosis. It’s a perplexing maze trying to figure all that out, among trying to care for the patient.

Some patients go to screening days offered locally. The test choices might be limited, but the prices are good.

At Pine Creek Family Medicine, patients don’t have to wait for special days. And their doctors don’t have to worry about whether insurance will pay. We have blood draws available every week. People get an order from their doctor, contact us to schedule, and have their blood drawn in a prompt friendly atmosphere. Results are sent to their ordering provider. We love being able to offer this service to patients.

Our informative order form is available at at the first link on the page.

Prompt Phone Care

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Christopher’s parents were worried. They were soon leaving him at college, two states from home, and he was complaining of stomach pain and nausea.

He often would have some brief stomach pain in the mornings at home, but this was definitely worse. Was it nerves? He hadn’t been away from home much before, and this was a new adventure. Or was there something serious going on?

Both Christopher and his mom texted their doctor’s office, and soon Dr. Herrington was on the phone with Christopher. She asked a few questions, determining that it was probably a combination of some anxiety and gastritis. She sent a couple prescriptions to a nearby pharmacy. Christopher’s parents felt better knowing he had a few things on hand if needed.

And they loved that Christopher would have access to his doctor from college, with prompt evaluation and reassurance.

They were glad they had joined Pine Creek Family Medicine’s DPC (Direct Primary Care) where patients pay a monthly fee in exchange for essentially unlimited office visits and communication.

Medicine the way it should be!

Pine Creek Family Medicine Radio Interview

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I was hesitant to be on the radio, but I finally did an interview with Bear Country Radio, 99.9 FM in Williamsport, PA area.

It’s about my DPC (Direct Primary Care) practice, which is the first in the area. I’m loving this way of practicing medicine, free from the regulations of insurance companies.

Here is the link to the interview:…/good-news-live-dr-pamela…/

Medical Mystery Solved

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At 55 minutes into the one-hour visit, we finally figured out a years-old medical mystery!

Kelly has been my patient for many years. In the past few years she has had rashes all over… dry patches, dug-open itchy spots. They have not responded to creams, ointments, vitamins, or various supplements. She had been to dermatologists without any improvement. It had been suggested she could use strong meds to decrease her immune system response, but there was no way she wanted to do that.

Over the years Kelly has realized she is allergic to corn, soy, wheat and eggs. Even with cutting out foods, she has still suffered with the rashes. We made plans to look more at her gut microbiome and function.

Could stress be contributing? Or what about when we had changed the dose of her thyroid medicine? Had that helped? What about supplements? Did anything make her symptoms better or worse?

I felt like a detective, trying to figure all this out. In the past couple of years, I’ve been learning to look for the underlying cause of problems, rather than adding more medicines. In my traditional medicine job, time was tight as I had to see many patients per day. But with my DPC (Direct Primary Care) practice, I’m usually spending an hour with patients.

Near the end of our last office visit, Kelly reminded me that she has a pork allergy. Oh my! She’s on Armour Thyroid, which is from Pig Thyroid!! AND I had just heard a podcast mentioning that Armour Thyroid has corn in its ingredients, something she is allergic to!!

So, with some begging to the insurance company, we got approval for Tirosint, a thyroid capsule, which does not have the fillers that the tablets have. No corn, no pork derivatives.

I saw Kelly today, and for the first time in years her skin was clear! It is so rewarding to have finally solved the mystery.

Medicine the way it should be.

Unexpected Costs

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Have you ever opened a medical bill and been floored by the total price?

Have you hesitated to have tests done, not knowing what they would cost?

The medical world seems to have a lot of hidden prices. Even with insurance, terms like deductibles, co-pays and ICD10 codes can leave your head spinning and your wallet vulnerable.

You probably have heard some of those outlandish prices people have had to pay. Here are a few we know about:

Hemoglobin A1C, which tells how your sugar is for 3 months, has cost two different people, through hospital labs: $161 and $400! That’s just for one test. ($15 at our place for non-patients)

One patient of ours had to pay over $2000 for her labs through the hospital, despite having insurance. They would have cost just $200 at our office if she were not one of our patients (and less as our patient).

Another woman was floored by her bill for $952 for a hospital lab draw. At our office it would have cost her $77 as our patient, and just $230 as a non-patient.

At Pine Creek Family Medicine our own patients enjoy deep discounts on bloodwork. But if you are NOT a patient, you can now get blood tests drawn at our office. Our prices are transparent, such as Lipid panel for $25, Vitamin D level for $40. Drawing fee is $10 no matter how many labs you have done. They are self-pay labs. No insurance involved. We have an awesome RN who loves to draw blood while helping patients feel at ease.

You’ll need a lab order from your provider, either their usual order, or they can use our order sheet. Check out for a downloadable copy of our lab order form, which has more information.

We look forward to helping people get the blood tests they need at transparent prices.

Communication Breakdown

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After 15 minutes on hold, I gave up. No human had come to the phone, just the recording of “Please continue to hold. Someone will be with you shortly.” Well, I guess “shortly” is a relative term!

I was just trying to call another doctors’ office for a quick discussion about a mutual patient. I would have liked to talk to the doctor, or I could have sent a message through the nurse. But alas, I couldn’t reach a human at all.

I wonder how their patients handle that lack of accessibility. Do they plan on it taking 20 minutes to reach someone? Maybe they have some magic email accessibility that I don’t know about. Or maybe they just give up and don’t bother trying to communicate.

It is so much different at Pine Creek Family Medicine. Sue often answers by the second ring. And if I know she’s busy, I will often answer. Some people are surprised that the doctor would be answering the phone, but I have time to do that. We rarely let a phone call go to voice mail, and if we do, we’re almost always responding promptly.

I love my DPC (Direct Primary Care) practice, where patients pay a monthly membership and in exchange get essentially unlimited office visits and communication. By limiting my practice to about 500 patients, rather than the typical family practice doctor with about 2000 patients, I’m able to provide prompt personalized medical care.

Medicine the way it should be!