Our Practice Philosophy

APCC Care: All-Around, Personalized, Continuous, Coordinated Care

Dr. Fong is committed to providing "APCC Care", that is, All-around, Personalized, Continuing, and Coordinated Care. With this care, he has kept his patients healthier: according to Medicare data for the 5 years 2010 to 2014, after adjusting for disease severity, Dr. Fong's patients are admitted to the hospital 35% less than the local county average and 44% less than the national average.

1. All-Around Care

All-around care means, because he is a generalist doctor, with broad training that cuts across all body parts and organ systems, he can take in most any problem that the patient presents and devise a solution for it. The solution may be a prescription, a treatment, a piece of advice, a test, a procedure, hospitalization, a referral to a colleague specialist doctor, or a referral to another provider like a physical therapist.

All-around care means that the patient is looked at, not just as a body part or an organ system, but as a whole individual, and all the problems, not just piecemeal, followed up. All-around care means attention to how all the patient's different medical and other conditions, as well as the lifestyle and activities, interact, plus how all that and the proposed treatment may interact. Also, because Dr. Fong is a generalist doctor, he can follow up several problems at one visit, thus enabling him to balance all the treatments and conditions, and to intervene in a more timely manner without waiting for another appointment with another provider for that organ or body system.

This kind of all-around and continuous approach is especially important in older, sicker, more complex patients with multiple ongoing chronic medical conditions. Not only do multiple conditions often interact with each other to give confusing signs and symptoms, but also they require multiple treatment regimens that often adversely interact with and even contradict each other. An all-around and continuous care approach is much better suited to efficiently following up on multiple conditions, figuring out the myraid signs and symptoms, fine-tuning the treatments, balancing or mitigating the contradictions that arise with the different treatment regimens for the various different problems, and thus optimizing the overall outcome. Further, the more efficient follow up of multiple conditions, all at one time, can often mean that problems that arise can be dealt with early, without waiting, when they are still mild and easy to solve, which is often of critical importance in older, sicker, more complex patients.

Also, Dr. Fong believes that a generalist doctor, by dint of his broad, overall training, experience and outlook, which cut across all body parts and organ systems, is often the professional to go to for figuring out which body part or organ system a symptom or a problem comes from, especially when the disease is at an early stage. Sometimes the source of a symptom may not be obvious at all, such as the shoulder pain that is not an orthopedic problem of bone or tendon but actually a cardiac one of angina or a gastrointestinal one of gallbladder.

Dr. Fong also believes that, again due to broad training, experience and outlook cutting across all body parts and organ systems, a generalist doctor is often the professional to go to for evaluating and managing vague, undifferentiated symptoms that come from diseases showing up at a very early or a very mild stage. At such stages of disease not only is it often difficult to decide which body part or organ system such symptoms come from, but also it is often difficult and sometimes impossible to distinguish them, even with very expensive and potentially harmful invasive testing, from minor, transient illness or illness with a strong psychological component. A generalist doctor who is used to evaluating, managing and following such symptoms can avoid testing up a number of long expensive blind alleys and the subsequent delays to timely diagnosis of potentially serious disease, or even abandonement of any attempt at diagnosis at all. Instead, skilled, close follow-up, along with appropriately timed and carefully chosen tests or therapeutic trials, can often lead to timely diagnosis and appropriate treatment.

Dr. Fong believes that the essence of generalist care is not comprehensiveness, as in one doctor doing it all, which is only a remote area or horse-and-buggy-day scenario. The essence of generalist care is first, a broad focus, on the overall patient, and second, training, experience and outlook that cut across all body parts and organ systems.

Even when it comes to referral to a specialist colleague, Dr. Fong provides value by first, ensuring an appropriate referral, to the appropriate specialist. Second, by giving the specialist colleague input when necessary about the overall picture of the patient, Dr. Fong helps the specialist customize the patient's care. Third, Dr. Fong can coordinate the care among different specialists. Finally, fourth, Dr. Fong continues to follow up as the general physician on the patient overall even after a specialist is seeing the patient for a certain problem.

Dr. Fong definitely does not consider himself to merely be a "gatekeeper".

2. Personalized Care

Personalized care is what many patients want nowadays, the kind that the family doctor provided back in the "good old days".

With all-around care, the ability to take in all problems enables the patient to come see Dr. Fong repeatedly for different matters, and thus he gets to know all the patient's problems, not just those of one organ system. Furthermore, he also gets to know the patient and his or her goals and preferences more personally. Thus, the doctor becomes an expert on the patient, and can personalize any care delivered. In turn, the patient comes to know, trust, and communicate well with the doctor and the staff.

Also with all-around care, the care can be personalized and tailored all-around, to all aspects of the patient, as a whole individual. Dr. Fong takes care to personalize management, to juggle and balance the often conflicting treatments, and to balance the burden of treatment with the patient's goals and preferences. This thoroughgoing personalized talored care, along with the trust and communication that gets built up, enables much better shared decision making by doctor and patient, much more timely and precise adjustment and fine-tuning of treatment, and therefore much better outcomes.

Dr. Fong also deliberately keeps his office small, so that the staff get to know the patients and their needs on a more personalized level.

3. Continuous Care

Continuous care is to ensure that the all-around, tailored, personalized treatment logic continues, especially when the patient is at his or her sickest and most complicated, like when they are in hospital. Continuous care means that there is always management by the doctor who knows the patient overall and who knows the treatment overall.

Continuous care means the patient sees the same doctor over time, and this is very much more so with the all-around care that Dr. Fong provides, as he can see the patient for different problems, not just those of one body part or organ system.

To provide continuous care means that Dr. Fong sees his patients when they are hospitalized, since that's when they are the sickest and most in need of continuity of the all-around, tailored, personalized treatment logic. He admits his patients to the John Muir Walnut Creek Hospital and will go to the hospital to be overall in charge, that is, to be the attending physician, of his patients throughout their stay. When his patients are admitted under a specialist colleague as attending physician for say, surgery or for testing, he will also go see them if requested, that is, to act as consulting physician, and work together with the specialist colleague to provide all-around care during the hospitalization.

Again to ensure continuity of all-around care, Dr. Fong sees his patients when they go into the nursing home. He goes to all four nursing homes in Walnut Creek.

Also, to help ensure continuity and timeliness of care, Dr. Fong has extended hours on Saturday mornings.

Finally, as part of continuity and timeliness of care, Dr. Fong is available to be reached by his patients for urgent matters after hours.

4. Coordinated Care

First, coordinated care means that all the care the patient gets from Dr. Fong plus from different providers like the doctors of different specialties, physical therapists, pharmacists, home health and so forth, are customized and coordinated according to the patient's individual overall health and wishes and goals. This way the treatments from different providers complement each other and therefore are able to achieve the best effect for the patient. Also, this way we can make sure the treatments from different providers don't conflict with each other. When needed Dr. Fong will also bring to the attention of the different specialities what he and other specilaties ae doing that may be relevant.

Second, coordinated care means that a generalist like Dr. Fong, who has both an overall view of things and a medical understanding of what the specialties are doing, can, especially when a number of different specialties are involved, explain the different aspects of care to the patient and help him or her get an overall view and make sense of things.

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Dr. Fong's commitment to APCC Care, that is, All-around, Personalized, Continuous and Coordinated Care, is career-long and unchanging.


The Oath of Hippocrates (ca. 300 B.C.E.)

Dr. Fong stands by this famous oath. Click here to see the full text of the Oath.