Host Dr. James Flowers, Co-Host Robin French and VIP Guest Dr. Anu Davis from the River Oaks Doctors Group in Houston discuss thyroid disease, chronic illness and personalized patient care.
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Listen to the podcast here
Personalized Patient Care with Anu Davis, MD [Episode 35]
Welcome to the show.
Robin, how are you?
Good, how are you?
I’m good. I’m so excited that we have Dr. Davis here.
I know. Welcome.
How are you?
Good. First off, before I read your bio, there are a lot of women out there, I think, that I want them to tune in and have their friends tune in because you’re really going to address some issues that a lot of women are dealing with right now, female issues and thyroid issues and diabetes and a lot of these things. Please tune in and share this with your girlfriends. I can humor all of you with a quick bio here, and then we’ll get into some good conversation.
Dr. Anu Davis practices medicine with the River Oaks Doctors Group. River Oaks Doctors Group is an internal medicine and endocrinology practice servicing patients in Houston, Texas. Dr. Davis’ medical interests include general endocrinology, diabetes management, thyroid dysfunction, nodular thyroid disease, thyroid cancer, polycystic ovary syndrome, and endocrine dysfunction in pregnancy. She is married and has two children. Welcome.
I think you cut her bio by about 75% because there’s so much more to you.
We only have a limited amount of time.
I know. Is there anything about you that she didn’t mention that you’d love for everybody to know?
I’ve been in Houston my whole life and I don’t think we’re leaving. That’s part of our practice and the way we practice medicine. It really comes from both me and my partners that we’ve all been here forever.
I love that. Same, were you born in Houston?
No.
Me either but I came to Houston when I was in the summer of my eighth-grade year. I went to high school here. That’s the way our practice is. It’s the same. We feel like we’re just rooted in Houston and the therapists that work here, we’ve all been here a long time.
I’ve been here since I was four and like I trained here. I trained both at UT and at Baylor. When you do that, by the time you finish, you’ve met a lot of people.
You’re rooted in Houston. I know that you have an amazing concierge practice right here in the River Oaks area. It’s personalized care, similar to what we do, but of course on the medical side. Tell everybody who’s listening about concierge medicine and what’s the difference between concierge medicine and practice really in a traditional medical practice.
Concierge Medicine
The main difference is the idea that you actually have access to your physician. There are lots of different models of concierge practices, but the main issue is that because of the way insurance companies contract with physicians, a lot of times patients are having to change doctors every couple of years and that continuity goes away. That’s why I said at first, none of us are ever leaving. We’re here and we’re staying and we’re sitting in that office and we’re always accessible by phone or email or text or anything.
That’s nice. I have a concierge physician as well, and it’s nice just to have a cell phone that you can text and ask a quick question to. They limit the size of their practice, which I’m sure you do as well.
In some ways, yeah.
It’s nice to be able to have that relationship and not have to depend on changing insurance at the end of the year saying, “That doctor is now out of the network or what have you.”
Correct. The main thing is when you went to medical school, you went to take care of patients. When you get out in the world, sometimes that patient care gets disrupted by all the other rules. We took away some of the other rules.
When you went to medical school, you went to take care of patients. When you go out to the world, sometimes that patient care gets disrupted by all the other rules.
Diabetes And Infertility
You have a little bit of a nuance on Concierge Medicine just because of the location that you’re in Houston. You’re right here in the River Oaks area down the street from us at J. Flowers Health Institute off of San Felipe and Kirby. What are some of the nuances? A lot of times we’ll work with psychologists and psychiatrists and we’ve had a lot of psychiatrists and psychologists on the podcast that work with high-net-worth individuals. Quite frankly, that’s most of your population and it’s our population. What do you think the difference is? I know that you treat people the same regardless of income or race or anything else but when you have a high-end concierge practice, there are nuances to that. Talk a little bit about that.
I think the main issues that come up are that time is a big deal. Time is money and people need their time respected. One of the things about general medicine practices is that’s not even a part of that. In our practice, that’s a priority, time, and privacy. Those are the biggest things to get people moving through the system as quickly as possible.
They can just get back into their life and get going.
Understanding that they’re going to be doing their whole life while you’re doing it. Actually getting them to stop is a challenge. They need to do everything and their privacy needs to be maintained and they need to be functioning in their world. The goal is always to get people back.
Speaking of privacy, one of the things I think that you do for privacy is you actually make a lot of house calls. You go to people’s homes every day, right?
We do. We make house calls and all the physicians in our practice make house calls. We do home management for when people are discharged from the hospital just for that couple of weeks or that transition time. A lot of times we discharge people from the hospital and I mean the instruction is poor, right? How to manage the pain? Is a pill bottle really going to tell you how to manage those things? We will go visit people in their houses. The other thing about seeing people in their houses is that you really get a sense of what their support system is and help them access their support system.
The other thing about seeing people in their houses is that you get a sense of what their support system is and help them access their support system.
That’s very cool. I was talking to my niece last night about you coming on the show and she goes, “What a small world.” The other Dr. Davis in your practice works with my niece’s father-in-law and she said it’s just changed their lives because they’re all busy and they all work and the children work. In fact, Dr. Davis helped him move from his home into an assisted living type, independent living home, and is having some medical issues but they said the service that you guys provide to their family has just been invaluable.
One of the things about that is just having people who know how this works. You don’t have to reinvent the wheel every single time someone has to move from their home to it but you do have to have an understanding of how that stuff is paid for and where the different options are for paying for it and addressing it and how quickly things can move. Some assisted living facilities will have medical floors and you need to know what have some expectations. What the patients are going to need, and be able to anticipate that so that you can help them make better choices. We have a case manager who works with us, she’s been in Houston for longer than all of us. She can help navigate our patients through a lot of them.
You have a long career. How did you go from practicing in a general type medical way into a concierge-type practice?
For me, it was totally by accident.
Was it? Yeah.
I was a faculty at the medical school and I was hanging around working on a big quality project for the Memorial Harmon System. I met my partner’s wife working on a big project. She was like, “You should meet my husband.” It was the way he practiced medicine and the way that they were doing it. They were just at the beginning of branching out. Endocrinology is a good specialty to add to internal medicine because Jay and Amy, my two partners, are both general internists but endocrinology it has little niches, but there’s a lot of general medicine. It’s an easy thing to both be narrow in and also be broad in.
Speaking of endocrinology, just a little statistic, is that more than 34 million Americans have diabetes, which is about 11% of the U.S. population. That is huge. Do you see that a lot in your practice?
Most endocrinology practices are about 80% diabetes. Mine is probably closer to 40% to 50% diabetes, but still quite a lot of diabetes, a lot of pre-diabetes. Diabetes changed a lot and the management of it and the prevention of complications has changed a lot in the last decade. It’s a fun thing to do. It’s one of the places where it’s very comprehensive. You need dieticians and you need educators and you need people who understand the new technology. We do all of it all at once.
Nice. Robin, I think you were going to say something and I cut you off. I’m sorry.
No, not at all. What is the age range of your patients from the youngest to the oldest?
I probably see patients as young as sixteen and well into their 80s and 90s. It runs the gamut.
You’re probably in the second generation of families.
We take care of whole families from top to bottom. That’s really cool. It’s pretty fun.
As far as diabetes, what do you think the main cause.? What is the biggest issue, is it just something that they’re passing on from generation to generation or is it just for food?
I mean family history and lifestyle. Lifestyle is a big issue when it comes to diabetes.
People just aren’t taking care of themselves.
People are getting better, but we want to be better but we still run very busy lives.
Fast food is just fast.
The foods that we eat and desserts that we eat.
People are trying and want to be better, but lifestyle management is a huge thing. One of the things I’ve really always been interested in is polycystic ovary syndrome, which is it’s the number one cause of infertility, and it’s a pre-diabetic state. It’s a place where you have a lot of opportunity for intervention and a lot of opportunity to work on the prevention side of diabetes. It’s a population because if women are trying to get pregnant and working on infertility, they’re motivated.
It’s a great place to work on prevention. One of the things I like most and why my practice is a little bit less diabetes and a little bit more other endocrinologist is because I do a lot of prevention and polycystic ovary syndrome. That’s where I brought in to young girls and like high school and college age students is in that and I mean post-college too but that’s how I get some of the younger.
Catching it before the infertility issues start.
Catching it earlier before infertility issues become a problem.
What are some of those symptoms that send them to you?
Symptoms of polycystic ovary syndrome or acne, excess hair growth where you don’t want it, irregular menstrual cycles, and weight gain, especially when you see weight gain in young adolescents that’s outside of their family. They don’t look like their family. That’s when you start to think about those things. Irregular menstrual cycles, weight gain, and then we look at blood work, so abnormal sugars, we start to see that early.
Impact Of COVID
How did COVID affect your practice last year? Both really you and your family, how did it affect you guys? More importantly, or equally important, how did it affect your practice because you go into people’s homes every day?
We’re very grateful in my family that we’ve been safe from the COVID but I mean, practice just changed and our patients use the phone a lot more. For a few months, it was just about phone access, and educating people. One patient at a time. As much as you can educate, people were hearing the news, and there was so much information coming their way, but it was like, “How do I get my kids back from college? How do I get how do we traverse all this?”
Should we do it?
Should we not? Managing the COVID that came up, we had lots of lots of people that got sick. I mean, thankfully, most of them did very well. The practice changed just from a phone like we probably did a lot more phone and telemedicine. We were set up to do the phone and telemedicine even before that. It’s just a shift for us but definitely we’ve chatted with a lot of people this last year. We did. I mean, we were able to send someone to people’s houses to get tested and things like that, which adds convenience. You weren’t standing in lines and in the CR and that stuff.
Mental Health And Chronic Illness
Did you see an increase in your patient population really across the population mental health, depression, the anxiety increase last year?
I think even in the last six months, I’ve seen a lot of baseline anxiety. People who already had a diagnosis of anxiety, you could watch it even people who had never had any, it showed up.
You guys get to spend so much time with your patients, like we do in more of a concierge practice, it’s not rushed and you don’t see 50 or 60 patients a day. You get to see the number that you need to see or that you want to see in a day and you really develop a therapeutic alliance and a medical relationship with your patient. When you see little things pop up like maybe, “Is he drinking a little more right or is she drinking a little more and she called in early for a refill or something like that? What’s going on?” How do you handle situations when you notice something just a little askew?
One thing about is that we have a lot of communication with our patients and they’ll tell us. It’s nice when that relationship’s already established, then we’re the point of care. They actually will tell us when they feel like things are going in the wrong direction. We still pick up the phone and talk to other doctors. We talk to people’s therapists, we talk to people’s psychiatrists if we know they’re struggling or if we know that they’re in a situation where they’re going to struggle. It’s not like five doctors sitting in different offices. We try to make a team for the patient in some way.
Good.
You treat a lot of patients with chronic illness.
I do.
Do you want to tell the audience about that?
Diabetes of course is chronic with multiple complications and we have patients with kidney disease and patients who have circulation issues because of diabetes which can be debilitating over time. We try really hard to anticipate each patient’s differences. What they’re going to have trouble with is based on them. If we’re able to anticipate a little bit more and help them have a sense of where things are going and what the timelines are in front of them, they’re able to prepare for that.
That’s a big thing and getting help and building their support system as the disease has become more debilitating. I see a lot of thyroid disease which sometimes comes along like with other inflammatory processes and autoimmune stuff. Although I’m not a rheumatologist, I end up managing a little bit and I’m working very closely with the rheumatologists.
Self-Care
What’s your self-care? I mean you’re so busy taking care of everybody else. What do you do to take care of you?
I am a really good sleeper.
Are you?
I am and I do a lot of yoga. Those are my main. If I’m going to yoga and I’m sleeping and I’m reading books. That’s my little triangle. I do really well with that. If one of those things falls off, it all starts to fall off. I think it took a lot of time to figure out what, like that’s my minimum and I have to do my minimum to do all the other things.
In fact, you encouraged me to go to your yoga studio over off of WAA and Allen Parkway and I haven’t gone yet. I’m a retired marathon runner, and I picked up swimming recently. It is a whole different ballgame. I was like, “I’ve run marathons. I’ve done 28 marathons. I run 100-mile races. That cardio is going to be easy.” It is so different.
What do you do in the lap pool at the Houstonian?
Yeah.
Are you?
That is hilarious.
It is hysterical. I swam two links, I guess, which was one lap.
On the flip side of that, I grew up swimming and my daughter’s a swimmer. We went to run the loop at Rice one day, and she’s like, “What is your problem? This is so easy.”
I know, right? “Come on Mom, I can do that.” I know. Adam over here is a yogi too, right? What’s the studio?
Big Power Yoga.
I need to get in there. I’ve got to get in there. I’m still going to keep swimming and get my cardio, like heart rate down and cardio up but yeah, swimming’s my new thing right now.
Those are the things I do. What do you do?
Yeah, what do you do?
I used to get up and run 6 or 8 miles and now I’ll I’ll walk 4 or 5 miles. I love to work out early. I’m an early morning person so I’ll get up and go to the gym and do my workout. This morning I went to the gym and did swimming from 6 to 7 and then worked out from 7 to 8 and that it is amazing walking out of their home, much better I feel. When my alarm went off at 5:00 AM, I was like, “Do I really want to go swimming today?” I was like, “Yes, get up and go.” You do it and you get in the water and it feels refreshing and then you start swimming and I’m trying to work on my rhythm and learning how to bring my head out of the water. There are a lot of things to remember in swimming.
Do you have a swim coach? Do they have a swim coach there?
No. I’m a typical male. I’m going to do it on my own for a while. I’m going to try it on my own.
That’s hilarious.
I’m getting a little bit better. I swim and I do a Zen class. Typically if I’m home by 5:30, I’ll do a Zen class with the Houston Zen Center from 5:30 to 6:00. On Sunday mornings I’ll do another Zen from 8:50 to 10:00 which is nice.
That’s good.
Meditation.
Have you done meditation at the Cisterns?
No. Friends of mine went on Easter Sunday though.
It’s pretty cool.
I’ve never been to the Cistern, have you been?
No.
It’s off of Allen Parkway, isn’t it? Tell us about it because I want to go.
Tell us about it.
They do meditations with the meditation bells, and it echoes in the Cisterns. It’s great.
It’s supposedly just amazing, so we should go do that.
We should. That would be fun.
I think they do it every weekend.
Do they?
Like a patient told me about it, so it’s nice.
How about an on-location podcast?
I was reading through the Chronicle one day and saw that there was some special event there that they were doing with some world expert that comes and does this singing mole. Have you been? No, you would love it.
No, it’s great.
You would really love it. We all need to go down there. Anyway, that’s what I do but I used to do hot yoga, Bikram. I used to do it six days, sometimes seven days of the week. I was in love with it. I was like this rigid yoga person. One day I was like, “I am so hot.” I’m literally burned out. I quit doing it for about two years. I really want to get back into yoga because I miss it.
You’re going to love it.
Do my muscles and my hips.
All the things.
Yeah, all those things.
How old are your girls?
13 and 15.
Family Life
Tell us about the kids. Are they very different?
They have two different personalities and they’re a lot of fun and growing like weeds.
I bet, yeah.
13-year-old and 15-year-old.
That’s something. I mean, to have teenagers and be a busy physician and I don’t know how you do it. I’ve got two dogs and still a lot.
One day at a time.
What we call this is understanding the human condition. How do you balance having two daughters, a husband, a successful career in this life that you have and your own human condition of staying healthy?
It took a long time to figure out, like I told you, what my things were. I work really hard to make sure I’m doing all those things. You can skip one day, but if you skip like two, it gets iffy really quickly.
It sure does.
I’m a morning person also, so I’m really careful about taking that time out for myself first. My days are very crazy because, I mean, 300 people have my cell phone number. I tell people, it’s like having 300 family members that you’re responsible for their medical care, and so it can go any which way. I just have to be ready for that. The best way to be ready for that is to wake up ahead of everyone else.
The best way to be ready is to wake up ahead of everyone else.
It is. I know. I was talking to a friend of ours. You and I share a friend, Virginia Araiza. I always say her name incorrectly, but I was talking to her she’s an avid runner, right? She gets up every single day and I just envy that right now. The other Saturday she came running by and she stopped at the house and I was like, “What mile are you on?” She’s like, “21.” I’m like, “What?”
She’s just like that. She’s an endocrinologist with her two kids.
That’s right. She manages all of it. I was asking her, I was like, “How do you do this with these kids, and your husband, and your house? Your mother was behind you. You’ve got all of these things.” She’s like, “You got to do it.”
You just do it.
You just get up and do it. That’s what I tell my patients. I just have to listen to myself.
True, yeah. Give advice, we need to take our own advice, right?
Exactly.
You don’t worry about yesterday and how you didn’t do it quite right yesterday. Don’t worry too much about tomorrow, and if you can make it, you just do it right now.
Signs And Symptoms Of Diabetes
Back to diabetes. What are some of the symptoms that you can educate the audience as to what to look for? What are some of the signs?
The main thing with diabetes to remember and the main thing about a lot of this stuff to remember is that you need to go see a doctor once a year.
Get your blood drawn.
You need to get your blood drawn. I mean, after probably 35, I mean, that needs to happen once a year. There are just things, there’s questions that the doctors can ask. There’s blood work. You’re not going to feel diabetes right at the outset. It can be asymptomatic for a long time. You want to find those things as early as possible because when you intervene early, you protect the cells that make the insulin and that means a longer period of time in a healthy state with just a managed disease as opposed to catching it when you’ve already had complications.
You’re not going to feel diabetes right at the outset. It can be asymptomatic for a long time. You want to find those things as early as possible.
Is there four different types of diabetes I think?
There are lots of different types but there’s type one and type two.
Type one and type two, what’s the difference?
Type 1 diabetes is an autoimmune disorder. It has two peaks when we see it. This is the one that we usually call childhood diabetes because most people are diagnosed in childhood but there is actually another peak in the 60s and 70s. People do get diagnosed later in adulthood also.
Wild. Why is that?
Why are there two peaks?
Yeah. I don’t know. I don’t either.
There are.
Who knows what there just are.
What are you seeing the most of in your practice right now?
Right now I see a lot of polycystic ovary syndrome and a lot of thyroid, and I do a lot of weight management and obesity. Those are the pillars of prevention. You work on all those things and when you work on obesity and weight management, then the blood pressure goes away and the diabetes goes away and the heart disease, like all those things. One of the things that’s nice about having time with people is that you get to know where they’ve been. Once you know where people have been, it’s easier to help them and guide them to somewhere else.
In fact, we’ve shared a couple of patients, I think, historically. That’s what it’s all about is helping people find what is it out there about yourself that you can dig deep in and look at, why am I stuck? How did I get either with diabetes? How do I get out of this syndrome? How do I eat better? How do I exercise better? The key really is working with a multidisciplinary team of people, I think.
It helps.
It seems like that’s what you guys do in your practice as you have different specialists that you guys will utilize to work with the families with whom you work which is amazing. It’s so cool.
You want to build relationships but you also just I mean you want to give people I mean I try to tell people, “You always want to be better three months from now than you are now.” At least to manage it because you have to keep your headspace correct to manage.
That’s hard.
Yeah. In today’s day and age.
No matter where you are, it’s hard, it’s difficult.
Are most of your patients word of mouth then, just referrals?
Most of our patients are word of mouth. We’ve been in our location right now since 2012, so we’ve been there for a while. We’ve all been in the Houston Texas Medical Center system for 20-plus years. It’s a lot of work to mount.
Right there in the corner on Kirby, that great building. I love that building.
It’s a great old building.
It’s got to feel good to go to work every day in that building.
We have good views.
Tell people how to reach your practice if they want to reach it.
The best way to reach us is to call. It’s 832-504-9889 or it’s RiverOaksDoctorsGroup.com.
Very cool. Robin, how do people get a hold of J. Flowers Health Institute?
Go to JFlowersHealth.com. Actually, when you go to JFlowersHealth.com, if you’d like to see some of our other podcasts, if you go to the tab that says Meet Our Team, underneath that it says Our Podcasts, all 34 of our podcasts are on there.
Very cool.
You don’t have to miss an episode. That’s awesome.
Nice or they can go to iTunes?
They could. There are six podcast platforms and YouTube as well for the video version.
That’s great. Cool.
Thank you everyone. Thank you.
Thank you, Dr. Davis.
