MedHelp Welcomes New Primary Care Doctor
Dec 16, 2022 | Family Medicine | Share:
Although Dr. Joseph Shepherd is our newest primary care doctor, he’s not new to practicing medicine.
As an experienced primary care doctor in the Birmingham area, Dr. Shepherd is committed to providing outstanding medical care at MedHelp Lakeshore in Homewood. We spoke with Dr. Shepherd to learn more about his approach to patient care and long COVID treatment.
How did you get your start in medicine?
It all started with my love of physiology. Even as a little kid, I was fascinated by the science of living things. I wanted to know how life works. At Auburn, I studied biochemistry, which introduced me to the inner workings of the mitochondria. (If it’s been a while since you’ve had a biology class, your mitochondria are organelles in your cells responsible for energy production.)
Interest in the “engineering” aspect of medicine – that is, how things are structured and function together within the human body – grew and grew. So, it was no great surprise when I found, in the third year of medical school, that internal medicine was a natural fit.
It was also appealing to build a career that presents a different set of challenges each and every day. After practicing medicine for over thirty years, I can testify that every patient and every day has been wonderfully unique.
For most of my career, I practiced at Brookwood Medical Center as an internist and primary care doctor. I joined the MedHelp family in November 2021 and am excited to serve my patients here.
What is your approach to patient care?
I maintain a personal, individualized, and data-driven approach to patient care. Generally, I follow about 2,000 patients, but these folks aren’t just a chart or a number to me. I know their names, I know their stories, and I care about them. They comprise a wonderful family that I would never want to leave.
Primary care medicine springs from the doctor-patient relationship. As long as the relationship is healthy, care is healthy. While I’m there to provide outstanding medical care, I want to do it within the context of caring for the whole person. When I walk into a patient’s room, I love to greet them and start the conversation with some aspect of where we left off last time. I want everyone to know that I see them as a person first, not just a patient. And since some patients would rather get right to business, I try to take cues from each individual patient.
Every human being is unique. “We’re not machines,” as Dr. McCoy (from “Star Trek”) observed years ago. One thing you learn in medical school is that there are multiple ways to do things, and it’s important to learn as many effective methods as possible. Certain people will respond to certain treatments better than others. Good patient care requires me to look at each individual patient, history, and current need so I can provide the best possible treatment.
Each visit begins with listening. (It’s hard for me to shut up, but sometimes I can.) Most patients either give me an update or present a new problem. Some visits are more laid back - like annual checkups or prescription refill visits.
For problem-oriented visits, I listen carefully to words and body language. Patients will tell, in their own way, what’s happening. There may be single issues or multiple issues. Sometimes, labs or imaging are necessary to piece things together. Problem-solving takes many forms.
One thing I love about internal medicine is conceptualizing the person as an integrated whole, not just an arm or a liver. Establishing or substantiating a diagnosis, or helping somebody feel better has its own rewards.
Regardless of why a patient comes to see me, I want them to see the big picture - why we’re taking the approach we are taking with their health. Whether we’re treating high blood pressure or investigating something else, I will state what I’m looking for and what I’m thinking. If we arrive at a diagnosis, I will cite the diagnosis and explain the physiology behind that diagnosis. I hold nothing back.
For example, if a patient has high blood pressure, we won’t just talk about blood pressure numbers. We’ll also discuss the role of the kidney and the mechanisms it uses to regulate blood pressure. If medicines are needed, I routinely explain how they work and why some are better than others.
At every visit, I want the patient to leave with a better understanding of how their body works and how treatment plans impact them. To accomplish this, it’s important to use the office visit wisely and efficiently. This kind of comprehensive care requires extra time.
How does data inform your patient care?
While listening is a key part of patient care, it’s more effective when combined with other forms of data. Patient care is driven by evidence: Symptoms, physical findings, laboratory data, and imaging - all accurate as possible. Good evidence leads to good diagnoses and treatment plans.
On a larger scale, both clinical experience and medical research influence my medical decisions, but there are caveats. If the situation is devoid of politics, I may go with the medical “establishment.” But in situations, such as nutritional science and COVID, where politics is an obvious driving force, I tend to be more skeptical toward “official” policy.
In these situations, I dive deep into studies and chase references - listening intently to colleagues who, like me, are fact-hunting. Over the last three years, these have become old habits. Whenever possible, it’s best to examine actual numbers and diagrams and ask critical questions. I also enjoy civil discussions with those who defend false narratives. When the goal is to grasp the truth, the air within any echo chamber seems stale.
Are you seeing a lot of patients with long COVID-19? How do you approach treatment for these patients?
As we finish out 2022, long COVID is becoming more and more prevalent. Long COVID is quite an interesting scientific phenomenon. It is best conceptualized as a systemic illness. It’s widespread, long-lasting, and fantastically complex. People can experience up to 180 different symptoms.
Blood vessels are tucked into every single corner of your body, and COVID-19 impacts every one of them. Therefore, long COVID can involve any organ system and frequently involves many systems at the same time. In addition, long COVID can present in multiple ways, even in the same part of the body.
Brain fog is one of the most common symptoms of Long COVID. It’s very nasty. People struggle to concentrate, find words, and lose spontaneity after having had acute COVID disease or Covid mRNA injection. If you’ve experienced brain fog, you have loads of company.
But in the context of Long Covid, brain fog has multiple causes. Vascular inflammation, microscopic blood clots, or alterations in the stereochemistry of local brain proteins - each the product of Covid spike protein deposition - may be suspected. The good news is there is every hope that brain fog can be eliminated, but work must be done to identify the correct cause and determine the best treatment.
I have learned to approach long COVID like any other type of problem. Patients that suffer from long COVID need to know that I’m going to listen, take their concerns seriously, and do everything I can to help them get back to normal.
When a patient presents with long COVID, the first thing to do is catalog the symptoms and tie them chronologically to COVID. We also need to rule out more “conventional” causes of the symptoms. We have a growing array of diagnostic tools, some of which are astonishing. For example, we have a blood test that quantifies vascular inflammation. We have a simple questionnaire to help us distinguish between microvascular blood clots vs. inflammatory vascular disease as an underlying cause of long COVID.
Fortunately, there’s a small but brilliant group of clinicians who keep finding ways to approach and treat long COVID. When a new treatment appears, it’s my job to examine and apply the treatment’s risks and benefits to the individual. This may involve reading review articles and/or scrutinizing relevant studies and data. Since patients with long COVID need help now, my searchlight for uncompromised information is always “on.”
To summarize: Through a process of investigation and care, I take a discerning look at the science that exists and do my best to help the patient in front of me get well.
How can someone prepare for a visit with a new primary care doctor?
You don’t need to do much. It’s OK to come as you are, whether looking for Long Covid treatment or looking for a new primary care doctor in Birmingham. But one small thing I think everyone should do is have an up-to-date list of their medications, including over-the-counter medications and supplements. Ideally, this should fit like a small card in your wallet or purse.
It may seem like a silly exercise, but the medicines you take (or don’t take) tell the story of your health. Your list should include the name of your medicine, the milligram dosage amount, and how often you take it. Use a pencil; it can change. If you ever go to the emergency room, the medication list can save your life.
I know that many people may feel frustrated with the medical establishment. Bad policy has failed so many people because it’s driven by interests that are not concerned with individual health. But there are still doctors out there who are going to listen, consider the actual science, and defend the best interests of their patients. As a doctor, I love to do these things. I want to see these folks again.
Dr. Shepherd is committed to providing personal, individualized care for all of his patients. He is taking appointments Monday through Friday at our Lakeshore clinic in Homewood. Dr. Shepherd is currently accepting new primary care patients in Birmingham.