Dr. Andrew Nance:

Relationships are important to me. My mother was a in-home hospice nurse and my grandfather was a family medicine doctor who did house calls. So, growing up, I knew that health happened in the home. And when I went into residency, I realized there’s a lot of challenges with the health system. The relationship that I wanted with patients, I wasn’t making and forming, and that was really disheartening for me.

After I graduated residency, I learned about the American College of Lifestyle Medicine through the Cabarrus Health Alliance. And so I said, “Well, why not?” I’m going to do one of the trainings. And I did the training. And then I said, “Well, why not? Why not just try with a few patients?” And so I tried in clinic, and I noticed that some patients wanted more information. And I was like, “Wow, I wish I could spend another hour with you to really go over even more details.” I felt like I was coming up short, so I said, “Well, what if I just go to your home, and we continue this conversation?”

The first time I saw Ebony was in 2021 as a clinic patient.

Ebony Benjamin:

I was in fear just of the world in general. I was in a terrible mental space. It caused me not to be able to or want to even go outside of my home. By smoking a lot and drinking a lot, I ended up having a very bad severe cough, so I was forced to like, go into the clinic and see Dr. Nance.

Dr. Andrew Nance:

In January of 2023, our visit was different. It was remarkable. When I walked in, I felt a heaviness in the air. She looked distressed, and I realized that I would not be doing my job if I just left and gave her the prednisone and the doxy and said, “See you next time.”

So I asked her, I said, “Would it be helpful if we spent more time together? I feel like there’s more to learn about you.”

And she was like, “What do you mean?”

And I said, “Well, I do home visits. I make house calls for patients and families that are highly motivated to be healthier, but they need just a little more guidance on what to do next.”

Ebony Benjamin:

And he said, “I can come visit you at your home, since it’s a challenge for you to come out of your house.”

So I’m like, “Oh, yeah, sure. Are you going to come and visit me? Okay.”

Dr. Andrew Nance:

I say, “Hey, it gives me a chance to get to know you. Maybe we talk about healthy eating, just kind of get you back on track.”

She said yes immediately.

And that’s been a common thing is that when you offer a home visit from a provider and you want to help them on their lifestyle journey, people say yes.

And it’s really key when people are motivated that you meet them where they are, and you meet them now.

And we did that home visit the next day.

Ebony Benjamin:

I did not believe that Dr. Nance was going to show up at my front door. It made it very, very personal for me. I invited him in the house and just kind of sat there, and he allowed me to just speak.

Dr. Andrew Nance:

I usually take a few minutes to say, “Look, what I want to do is spend about 30 minutes getting to know who you are. What’s important to you? What is driving you to be healthier? What is life like?”

Ebony Benjamin:

And then he reiterated my story back to me to let me know he was listening to every word I said. I began to just open up.

Dr. Andrew Nance:

I noticed a burden release from her. Her shoulders relaxed. She smiled.

At the end of that 30 minutes, I usually hand them a lifestyle medicine at home card that has those six areas of lifestyle medicine, and I recommend that they focus in on one or two areas. And we came up with very specific goals for Ebony.

Ebony Benjamin:

He definitely individualized the goals for me, like made it realistic.

Dr. Andrew Nance:

Maybe walk to the mailbox twice a week on Monday or Thursday. One handful of grapes on the weekend when you’re at the farmer’s market.

Ebony Benjamin:

So with that prescription and my discipline, it all came together.

I even called Dr. Nance like “I have so much energy, I don’t know what to do.” And he’s like “Ebony, just walk it off. Just walk it off.” I was a totally new Ebony.

Dr. Andrew Nance:

Six weeks later, I messaged Ebony and I said, “How are you?” Now, I had started Lexapro and I had started some other medicines for her and she says, “I am doing great.”

And I said, “Well, what if our next meeting let’s meet, and let’s go for a walk?”

We met at the research campus, and we walked together. And what was really striking about what Ebony talked about is she asked me, “How did you help me get here? What did you, you know, how did you help me this much?”

So I started talking to her about motivational interviewing, and she kept asking me more questions. And then she asked me more questions about lifestyle medicine. And I said, “Wait a minute. Ebony, like you’re a completely different person than I remember six weeks ago. You really want to learn a lot. I’ve got five and a half hours of CME from American College of Lifestyle Medicine. Let’s try it.”

She finished the five and a half hours of CME in the weekend.

I was surprised that I had only had one visit and had not had any more conversations with her, yet she took this information and ran with it. And I also was surprised that she really never started the Lexapro. For her, it was all lifestyle, and, you know, I’m going to prescribe medications when needed. But patients find it very helpful to know that it doesn’t have to be only medications.

She messaged me a couple of weeks later and said, “I’d like to start a walking group.”

Ebony Benjamin:

I was walking for my own healing.

And he just asks, you know, “Would you like to walk with my patients?”

And I’m like, “Sure, I’ll walk. They can come walk with me. I would love it. I would love a walking buddy.”

So I started out with one patient. We were walking and walking. Then, before I knew it, I had like five.

Dr. Andrew Nance:

I said well why don’t you put a flier together and say, this is going to be Ebony’s walking group and put some details? And I helped her think through some logistics. I want you take that flier, and I’d like you to present this to me and Roy.

Roy Hawkins

When I met her, she was able to espouse to me the benefits of the program unscripted.

Andrew had been running the program for about a year or so, and he said that he needed support. He needed a support team. We worked to get the budget for it, and he wanted to hire. He says, “My first hire will be Ebony,” and we all stood behind him 100%. Who else to advocate for the benefits of Lifestyle Medicine at Home other than someone the program has truly changed their life.

Dr. Andrew Nance:

As a peer support specialist, she works closely with patients on their own journey.

Ebony Benjamin:

It was always in me to help, but this was the path right here. I walk right into my passion literally.

Roy Hawkins

The approach to caring for people comprehensively, from the inside out, has a lifetime impact on these individuals. And I truly believe that all of our efforts around addressing health equity, eliminating health disparities, I believe the LM at Home program does all of that. As health care providers, as healthcare as a business, if we create access, more people will be able to have the healthcare services that they deserve.

Dr. Andrew Nance:

In the clinic, I do not feel obligated to spend as much time with patients before LM at Home, I was notoriously behind. After LM at Home, when I look at my panel of my clinic day, and I realize that I’ve seen home visits for 50% of these patients, I’m okay spending 8 minutes in the room. And what I found is that they don’t need to see me as often. When you get patients off their insulin, they don’t need to check up with you every three months.

Roy Hawkins

And most times you’re impacting their families as well.

Ebony Benjamin:

It’s not uncommon for one house call to be three generations with five patients. So the idea that you can only see one person per household is not the case. The whole house is having a lifestyle shift versus just the one patient. So this is like a ripple effect. Lifestyle medicine is so important to incorporate in our future healthcare.

Dr. Andrew Nance:

I’ll never not practice this. This is how I practice. And for Ebony, it was really powerful because not only did it help give her a little hope, it gave me hope that I could actually help.