Taking Healthcare by Storm: Industry Insights with Dr. Anuruddh Kumar Misra

In this episode of Taking Healthcare by Storm, Quality Insights Medical Director Dr. Jean Storm speaks with Anuruddh Kumar Misra, MD, FACP, FAMSSM, QME, DIP ABLM, a triple board-certified physician and non-operative sports medicine specialist.

Dr. Misra shares insights on the significance of lifestyle medicine in transforming healthcare and how it complements traditional and telemedicine practices to address chronic diseases. He highlights the pandemic’s impact on care delivery and offers thoughtful perspectives on the future of medicine, including the growing influence of AI. 

If you have any topics or guests you'd like to see on future episodes, reach out to us on our website.

Publication number QI-112125-GK

Transcript

Welcome to "Taking Healthcare by Storm: Industry Insights," the podcast that delves into the captivating intersection of innovation, science, compassion, and care. 

In each episode, Quality Insights’ Medical Director Dr. Jean Storm will have the privilege of engaging with leading experts across diverse fields, including dieticians, pharmacists, and brave patients navigating their own healthcare journeys. 

Our mission is to bring you the best healthcare insights, drawing from the expertise of professionals across West Virginia, Pennsylvania and the nation.

Subscribe now, and together, we can take healthcare by storm.

 Hello everyone, and welcome to another episode of Taking Healthcare by Storm. I am Dr. Jean Storm, the medical director of Quality Insights, and today we're gonna be exploring the future of healthcare through innovation. Expert opinion and Changemaking. Today's guest is Dr. Anuruddh Kumar Misra, MD, FACP, FAMSSM, QME.

He's also a diplomat of in the American Board of Lifestyle Medicine. He's triple board certified. Physician with a deep expertise in internal medicine, non-operative sports medicine and lifestyle medicine. He has a very unique perspective trained by some of the most respective names in medicine, including Dr.

James Andrews. Dr. Misra brings a unique blend of high level clinical expertise, experience, and whole person care. We're going to be talking about what led Dr. Misra to pursue certification through the American College of Lifestyle Medicine, why lifestyle based care is more important now than ever, and how he's applying these principles in growth.

Traditional and telemedicine settings, which you may not think are different, but they really are. You have to have a different way of approaching both settings. We're also gonna be touching a little bit on how the COVID-19 pandemic changed the healthcare landscape,  what's ahead for lifestyle medicine and what advice he has.

For clinicians looking to shift toward more preventative root cause, focus care, which is really where we should be focused right now. I'm very excited about this conversation and I'm really excited to jump into this conversation with Dr. Misra. Thank you so very much for joining us today.

 Thank you Dr. Storm for having me. And actually I would  have one little funny thing to share with you. We're just talking about  my name. It's so funny. Actually, my last name has an invisible letter in it. There should be an H in there. It's actually pronounced Misra.

Dr. Micra, thank you so much for that. Uh, I, I appreciate it. I wanna pronounce it correctly. You wouldn't know. Yeah, I don't, I don't fault you.  So let's get started. You've had Sure. Expressive journey in through internal medicine, sports medicine, and now lifestyle medicine.  Can you walk us through what led you to pursue certification through the American College of Lifestyle Medicine?

 Yeah, I think, well, it starts with. Medicine. Right. Starting off with choosing a choice of life into making a career as someone in the medical field. Right.  It's actually interesting timing. I've been perspective one's journey and a career. Next month, we'll actually mark 30 years. Of patient oriented care  for my first day as a medical student.

So it is something which is at our very essentials of wanting to be of service to people. And then sort of that gets more refined as you go along your journey. We all know, and then deviations and things happen in our career, which brings us to where they do. In summary, I always was attracted to athletes because of how they seem to be the embodiment of maximum best optimal health. In the course of this, what sports medicine as a field has been. There's been considerable evolution of that since my initial passions as a teenager, really to become a doctor and then to serve such a population. But of course  the tail doesn't wag the dog.  I'm an internal medicine physician.

Fundamentally, that's my core and primary specialty. Everything else adjuncts. That and makes me a better intern is fundamentally so the lifestyle medicine side of it became something which was very evidently missing in just the very sort of structural macros of how our,  health system is designed  which is very obviously reimbursement oriented and fee for service oriented, which sort of didn't have a great positioning of lifestyle medicine.

So seeing that, that got codify as a formal board and curriculum was very attractive to me once it  became something that ostensibly was largely how I was practicing already, but then to really have the expertise  stamped what the certification was important to me, so that's why I went forward.

Yeah  and I will say you know, chronic disease management prevention is really in the news. So I, I think that's why lifestyle medicine is, really gaining momentum. I just read recently. The reser, the certification exam this year, they just closed their registration and they had a record breaking number of individuals registered to take the exam.

So that's super exciting. It is. Yeah. It's really wonderful. So why do you think it's especially important right now in the broader context of healthcare? Well, I think there are two big things, which obviously just stare us in the face.  Anyone who works in any environment would see that their, the population health is just very poor, and it's something I think we often have to do.

I actually harken back to internal medicine side of it wherein let's say you have a normal cholesterol panel that's drawn on somebody and it doesn't look great.  And it's also a reminder that we have to tell. The patient in front of us that, hey, understand even if it looks normal, understand that these are made based on population health, which is not great.

And even something which is normal may not be great or may not even be very good. So keeping in mind we are saturated in this soup of chronic disease, you have to have some channel by which it's being  attacked. I don't feel that pharmacology is. The answer to metabolic problems entirely. It has a role to play.

It can help.  But we need to be able to deal with the root cause of how come we're in this problem. And lifestyle medicine has every sort of redress to help make the burden on the sort of reactive side of the medical arm of the American healthcare system become less burdened. Yeah. So we touched briefly on you have a, kind of a hybrid practice in-person telemedicine.

So can you describe the types of patients you typically see  in your hybrid practice? Sure. And how does biomedicine play a role in your treatment plans?    Right. I, I, I think the leap off to lifestyle medicine in the context of what, I do was facilitated by the sports medicine sort of area, and here's kind of maybe how I would speak to that.

And then there's overlaps naturally in those fields with respect to nutrition performance. you know, Of course physical activity there, there's a lot of common channels there that, that are co travel, so to speak.  So, as I said, I'm fundamentally internal medicine physicians, mainly what I do.

And. Where the lifestyle medicine side of it started to come in was because on the sports medicine, sort of emphasis for why some people come to see me this desire to excel in performance, whether that is. There are recreational runners, weekend warriors, actual athletes, competitive rock climbers, whatever it might be  became an area where there was a demand for it, where people were saying, Hey, look you know, I don't understand why my sleep is not good.

I don't understand why, whatever. And those answers don't. They, I would say those problems sort of slip through the cracks very conventionally when you're dealing in a model, which is, again, you can say RVU based reimbursement fee for service centric compared to just looking the eyeball test of the person.

So for example there was an article some years ago I read about, so the top 10 diagnoses these doctors miss most, and one of 'em was sleep apnea. Now, by definition, shorter, the people who have  airway issues is palate, high palate or whatever.  These are usually people who are overweight, obese.

And how can it be? That's something so stark. If you just miss it, you shouldn't be missing it.  So it's also this aspect of okay, what is lifestyle medicine sort of designed to redress? So it's all these things, right? Chronic conditions  overweight, obesity, poor sleep, stress, life. And how to make that stress in life as less as a burden as possible.

So   it's just sort of obvious in the context of essentially a primary care medical home for somebody in my case, driven as an internal medicine physician  that you're kind of really missing the boat if you're not paying attention to lifestyle medicine side of. Yeah  I would definitely agree.

  you know, I wanted to touch on your training. You've been trained by some of the top minds in medicine, and you have seen healthcare from both the academic and practical side as a I have, and I, I feel like it's a unique perspective. I think  seeing from both sides, what do you see as some of the most urgent or overlooked issues in modern medicine today?

you know, It's funny, something can be overlooked and underlooked at the same time and I think that what we're seeing, for example, with this recent to the scene advent of GLP one agonists there to address obesity. I think that is an example where people do look, unfortunately for the, I.

Quick and dirty. Answer the cut in line. Silver bullet. But I was at my annual sports medicine meeting this year in Kansas City, the American Medical Society for Sports Medicine. It was a gentleman who gave a talk speaking to well, sure someone can get on. You know, The best appropriate, refined dosing for GLP one agonist to do that.

But. If the lifestyle medicine side of it isn't coming along for the ride, it's going to be real problem for them, and particularly with skeletal muscle loss.  And this is a very underappreciated aspect of that class of medications, right? So you can have something where there's all the attention in the world and obesity, but then when you look at sort of the granularity of really.

The long-term health of the person  people can be set back for different reasons, such as that if a person has lost a considerable amount of skeletal muscle mass  that's very hard to recover.  And then how do you make sure that it isn't just kind of a hollow arrival at that point of I lost X number of pounds?

 They may not be necessarily. A lot healthier.  If they aren't taking care of themselves more broadly, as lifestyle medicine sort of calls us to call attention towards. Yeah, I, I will agree. And I think that's huge. And I think that those individuals who have been on these medications, I think this is gonna be a huge problem coming.

Yeah, so we'll see. You do practice telemedicine, as they said  kind of a hybrid practice and telemedicine is. Been such a major tool in healthcare delivery. I  probably during the pandemic it really gained popularity. What do you see as the strengths and limitations in telemedicine, particularly when you're applying the principles of lifestyle medicine?

Well, I think one major boost, one of the few silver linings which came out of the pandemic, was the advancement of, telemedicine, really, frankly, prior to which we weren't effectively doing it at all. I don't know I, how much that is the case across the country, but I imagine it advanced it as a sort of into the Overton window of normal practice compared to where it had been prior to the pandemic.

To that end. Lifestyle medicine. And when we think about sort of, 'cause you know, people who are maybe less familiar with lifestyle medicine don't know how, what does it mean?  Just be healthy. It's largely for us as practitioners of lifestyle medicine, educationally oriented. So I think it would be useful to just quickly do a cursory touch on all six of those things, which are nutrition, physical activity, restorative sleep, stress management, avoiding the bad stuff, risky substances, drugs, alcohol and social connection. So right away, in less than a minute, one can enumerate those things and then speak to maybe an area that is a particular weak spot for a said person and

really drill down on it and keeping in mind how much sectarianism there is and the nutrition wars online, social media between the keto people and the vegan people and the whatever people. Right. We can bring a very matter of fact, real conversation where the rubber hits the road because one of the major criticisms that's out there is a lot of physicians don't feel confident speaking in confidence with respect to how to do negative and positive prescription writing for food.

If they don't, this is something which I found to be a very good tool learned in the board prep as it was feeding toward the A BLM exam.  How it is important to be granular about  exclude X, Y, and Z specifically include X, Y, and z. That goes a long way for people as opposed to just saying eat healthy, see you later.

 This is kind of often where it goes and that is just not good enough. People need specific granular directions on what to exclude and include.  And the same thing goes for even just the very basics, physical activity, 150 minutes a week you know, that's not really taught a lot or it. When I was in residency that again, these are always getting updated, whatever, and on and on.

These are all things which, you know, fundamentally as a physician we're teachers. and if we don't know how to articulate these things, I mean, back to the nutrition one, one of the simplest things when people bring, like their sick dog to the veterinarian, the first question very often the veterinarian will ask is, what did he, what did you feed him?

What did he eat? We don't even ask humans this. Yeah, I agree. you know, so some just first principles, common sense, like keeping in mind that these are the areas of six pillars of lifestyle medicine, we can do so well. But you know how you feel if you go to a lecture. So you leave feeling, you learn something.

 That's how people should feel when they exit an appointment wherein some principals left on medicine were  given the proper attention. I really appreciate you mentioning the pillars. I think  that was a very important part of our conversation. And we mentioned, just touched on how the COVID pandemic kind of really brought telemedicine into the forefront.

So I just wanna briefly touch on the book, on the COVID Pandemic. We know Sure, sure. Every aspect of healthcare, but like how has, how do you think it's reshaped how we approach chronic disease and overall wellness? Yeah  I think it's a good double click on that because it's still in the psyche, but certainly not as dominant as it had been before.

And I'm, I mean, now we have the benefit of looking back at it.  So I think there's a couple things to say.  Well, What we came to learn was nearly 80% of people who perish, unfortunately, secondary to COVID, were either overweight or obese. One could easily look back at the six pillars of lifestyle medicine and say every one of those things would help reduce or redress just that issue.

 And again, this goes back to what we were talking about earlier with GLP ones, but again, that's. One channel by which we could look at  of the chronic disease problem. It's a multidimensional lens, not a unidimensional lens, right? So it enables us to reengage, right? So, and COVID just became this dominant.

Elephant in the middle of the room that we had to suddenly talk regarding and it was uncharted territory. Let's be serious. You're well-meaning people who made recommendations and things, which ended up not being correct, but they were thought to be at the time.  So it was a very humbling interval of time for all of us.

'cause no one could really speak authoritatively in this uncharted territory. But it was also hearkening back to. If you have chronic conditions, it's all more, all the more imperative that you do better with them. 'cause you'll likely get less sick if you have them trending the correct direction. So they sort of intermarry with one another. Yeah. I'll agree. And I think that is the lesson. So you mentioned sports medicine  you're involved in sports medicine at a high level. So how does your sports medicine background influence your approach to lifestyle medicine and vice versa? Well, I think it's a great. Parallel to kind of put against one another because in the sports medicine arena, so in my fellowship trainings, I spoke to a Dr.

Andrews when I was down in  in the southeast at the Andrews Institute in Pensacola, Florida, or Gulf Breeze, specifically in the city. It was very interesting to me to come out of conventional practice. I was in practice for about five years. Left. Did this one year sabbatical, then went back to practice.

And I think that was very refreshing for me 'cause I was able to bring clinical experience in years as a medical director to that world. And that's a different line of sight in one sense because it was very interesting to be in that model where you had sports nutritionists, you had sports psychologists, you had the biomechanics lab.

There were so many aspects of. Evaluation and redress that I think were very useful to me as sort of a ground, so like a leveling ground to add lifestyle medicine. On top of that, it is also the case that the American Medical Society for Sports Medicine of late  I don't know exactly when this started, has a combined, there's a, those of us who are certified both in sports medicine and lifestyle medicine  one of the people who is in this, there's a dedicated talk.

At the annual sports medicine meeting each year related to how these fields  interplay with one another. So I think it's when people think about healthcare, oh, I got a cold, or I got a headache, or whatever they got, I'll just go to the clinic and I'll get whatever and I'll leave. They don't think of the greater holistic side of.

Complete wellness and complete redress.  Just not  again, the sports medicine world body composition analysis. Another big part of what I do in my current practice was something I really never even thought about, but it was something which came about very front and center in my sports medicine fellowship.

It was one of the aspects of what hiring athletes often are evaluated on. So  these are all so much information. Conventional public isn't getting all that  and I think we could do better. I agree. I agree. So I wanna talk just a little bit about the Lifestyle Medicine certification.

I mentioned that the registration for certification this year just had a record number of applicants. So what advice would you give to physicians or any healthcare professional who are curious or unsure about taking the path to Lifestyle Medicine certification? No, I think it's a great question and I think that a lot of it comes back to, because, you know, so much competes for our time and attention.

 I mean, Goodness, I don't know if you can even keep up with your email. I can barely get through it in a given day. Yeah. You know, So when people learn they generally all like it.  There's no problem with the concept of it, but it is something which requires prioritization, budgeting time. And what will often become why one chooses to do anything or not would be not only personal gratification, edification their own education, their own health and wellness, which I think themselves should be the reason why anyone would want to do it, but also for education at the point of care and being able to stand authoritatively as that being board certified in lifestyle medicine.

 But it's an endeavor. And you and I know, right? You have to attend at least one in-person, count a meeting. I went to two before my test. And you gotta do all the online stuff. You have to submit a case where you applied lifestyle medicine principles and they were meaningful and successful to whatever extent they were.

And then of course, you gotta get in there and do that secure exam, right? So I think it's a very good endeavor to undertake. It does make us, I think it rounds us out, especially because. In the context of our sort of LCME medical school curriculum as such. I think because of specialization, take nutrition for example, there's a whole field of just nutritionists.

So it is a little tempting for physicians to say, well, listen, not my area. Why don't you go talk to the nutritionist about your diabetes? Not that they shouldn't otherwise send them anyways, but it's to say that they can do better by way of them in large measure because patients want to hear it from the doctor.

Not that they don't wanna hear from a nutritionist, but they may need echoing of the same from a physician. But if a physician doesn't feel confident to be able to speak to it. Come on. Diabetes is not some sort of rare disease, but if we're like, Hey look you know, I don't know. I should be talking about this and I heard about keto and I don't know if it's good or bad, and  if you're kind of all over the map throwing it all out there like that, it doesn't engender much confidence in the listener  because it would be understood. Those things would cross over to other areas so they would expect or anticipate them to be expert regarding. So I think it's very important for those reasons. Yeah  I would agree. And, and I'm really excited to see, how it moves forward.

Leading to my next question, where, what do you envision for the future of lifestyle medicine, both in clinical practice and in healthcare systems at large? One thing which I think none of us can avoid and I think we appreciate is very much right on top of us, is this phenomenon. With ai and I think that's worth a little extra time to kind of kick around here.

I'm a little closer to it. I have some people in my personal life who are very involved. In ai and I think that we are uniquely positioned because I would say those who excel in the science and art of lifestyle medicine are going to be the ones that can bring to the point of care with more credibility how AI translates forward.

We know it's all pretty impressive stuff. Some of it anyways, some of it is not that impressive.  But I think that it's almost like that Star Wars thing, like resistance is futile. We have to live in the real world and understand this thing is accelerating at a pace that we can't really get our you know, the, the human brain is not evolve to, to take in that logarithmic explosion of what's going on.

It's more stepwise. For example, I don't know if you saw, there was a announcement, if you will, or news flash from China, which the Chinese scientists achieve breakthrough in reversing, aging in primates. Okay? And apparently this is all downstream from how their investments in AI are going.  There was another one where China invented a new quote unquote, bone glue that repairs bone fractures in three minutes.

Wow. Without surgery or surgical intervention. So we could be back in the stone age going  clicking two stones together, going click, click fire while all this is going on. Yeah.  So, so, okay. People still want to have a human in the chain of understandings. Yeah. I'm sure you appreciate this. In practice, people will come having chat, gtd everything to the end of the universe and back, but they still come, don't they?

Because if that really edified or satisfied them, they wouldn't need to talk to us or come in the door. So I believe in a world where we have AI in front of ai, so this human intelligence is human intelligence, right? So the understanding, as I stated earlier in our conversation  a little humbling for me to think how fast almost three decades of interface with clinical medicine has been for me in my career.

Well, At that time we didn't even have smartphones or any, and we can't even imagine, like it's just unthinkable, right?  There was nothing like that at that time. Now you can't even imagine life without it.  But that's what it was, right? So things are changing very quickly and I think lifestyle and medicine practitioners, they show the.

Impetus to be proactive, not just in their own health and that of their patients, but just generally in their passion for the field of medicine, which again, is spoke regarding at the top of our conversation, which is, well before you get into any specialty, just the choice to move forward in life, to do medicine as a profession.

 And then you drill down on someone who may wanna be an ENT physician or something else.  Whatever, but. This is here right now. This is happening and we can't just pretend it isn't. And I think it's a very exciting time in our profession.  And we have to take the bull by the horns. And I'll tell you last year at the internal medicine update, there was a gentleman here in the community who presented at that a CP meeting, and he said, we're at a place now where any physician that can be replaced.

AI should be replaced by ai, which is to say we should be able to augment and use it, and there's a lot of resources in the A CLM curriculum and all that, which we can, I would say force multiply by way of ai, so we should use it as sort of a secret weapon, not as an adversary. We shouldn't look at it that way.

I will say, I wrote down AI ahead of ai I love that I recently read a book about how AI might be gonna destroy all of us. So  I like that, that, that's a very positive way, I think, to look at AI going forward. Oh well, yeah, no, I mean, yeah. Otherwise, um.   I'm a Gen X guy.

I mean, I grew up watching Terminator. I mean, I mean, It is so funny how  those things, you seem to kind of almost be predictive of the future to some degree. Like look at Star Trek and cell phones or whatever it might be. We have to also know that these things are all  very new in one way, Let's look at I mean, something I think you and I can relate to, what is the, probably the first. Way with which AI made any sort of impact in our careers was, do you remember the interpretation of the EKG preliminary read by the machine? Yeah. It was terrible. You could, You could kind of say that was a first version of an ai.

Now let's say in a stone cold perfect, normally EKG, it may just say that normal sinus, EKG, sinus rhythm, EKG, 70 Bs per minute, no. You know, whatever. Right? Yeah. So, okay. Useful, but it doesn't mean it's always right. Yeah. Yeah. So it is super interesting. We could probably talk about AI for a long Oh yeah. Oh, sure.

So  I know you're passionate about education and mentorship. I am. I've been a program director for a residency. What message do you hope to leave with the next generation of healthcare professionals about the power and promise of lifestyle based care or just medicine in general? Well, One thing I think lifestyle medicine did was because it's a very progressive way of thinking compared to the old school conventional, quote unquote doc in a box concept.

Now we have this new generation of people who are being raised on the internet and smartphones and social media and all this, right? I think we need to  step forward with their chin out, confident that we can. Use all of these resources to help us excel.  I was listening to a gentleman who's a PhD.

He's talking about how at a university that he went to go speak at, he was extremely popular with his lecture to the children or to the students, I should say, but not to the faculty. 'cause what he said was, there should be no tests. And the reason he said that is. Everyone would have be armed a hundred percent of the population with the chat GPT,  in their pocket, or some commensurate version thereof.

So what is the need of even having these tests? And there's plenty to be said, by the way, about this, and I'm sure you would appreciate the whole battle of.  Maintenance of certification, something that's always kicked around as  is this just an added burden? Does it really add value? Is it  whatever.

So I think the way I think of it is it, I don't wanna say it gives you straight up license, but it certainly does speak to if you are a lifestyle medicine physician, that you have definitely made that proactive. To go above and beyond, because very few people will look at it through the prism of, okay, well what do I get for this?

How do I bill for this? How do I get money outta this?  If I don't get that, I don't wanna deal with it. I don't have time for that stuff, and I can completely understand that.  But it's to say like, that isn't the totality of all of medical practice. And also people expect more. Now let's be real people expect people to be more responsive with portal messaging replies  how to get back by email, whatever.

We live in this world, which is very, very different than which where you and I started our medical careers with. So  I look at it from the standpoint of this is. The Wild West and a beautiful opportunity to just blow the doors off on how lifestyle medicine can be delivered with the advent of AI and again, AI before it  to really help exact outcomes.

And  I'm sure in your practice, and I cite examples in mind of people's lives who were changed are, would even say saved by really having them do better. By one combination permutation on the other of lifestyle medicine principles, along with of course, our primary specialty.   What I tend to find is, this is what I explain to patients is like, let's say someone has like a really bad cholesterol or glycemic profile.

And I use the analogy of football, I say well, what I find is people very often end up needing both. It isn't so that they can completely win the entire ball game, just only with lifestyle medicine, but they can really move the ball between the twenties pretty well. And sometimes what happens is they can only exact so much change that once they get in the red zone, they may need a little bit of medicine to help them get over the.

But that's where the intersection of these things come from, our primary specialty, which is to say the tail doesn't wag the dog.   Fundamentally I'm an internist, but I wouldn't be a particularly effective, I'd be a less effective internist if I didn't have lifestyle medicine armed as part of my armamentarium.

Yeah, one of the leavers we're pulling multiple leavers medicine and like the whole lifestyle approach. Agree. Yes. Yeah. Dr. Anuruddh Misra, thank you so very much for being with us. I really enjoyed the conversation. If people want to learn more about you, your practice, how to get in touch with you, how can they do that?

Sure. My website is www ak misra md.com. All right. We will link that in the podcast description and people will, I encourage everyone to take a look at, at your website and thank you again for being with us.

Wonderful. No, thank you. And, and, um, Jean, gosh, thanks for this. 

Thank you for tuning in to Taking Healthcare by Storm: Industry Insights with Quality Insights Medical Director Dr. Jean Storm. We hope that you enjoyed this episode. If you found value in what you heard, please consider subscribing to our podcast on your favorite platform.

If you have any topics or guests you'd like to see on future episodes, you can reach out to us on our website. We would love to hear from you.

So, until next time, stay curious, stay compassionate, and keep taking healthcare by storm.