— Richard
Richard was being told to have spine surgery and bariatric surgery, by two surgeons who agreed only that the other should go first.
The Challenge
When Colleen and her brother reached out to Carte, their father Richard had been hospitalized twice, first for a fall and then for a wound that kept getting infected, requiring stronger and stronger antibiotics. Each time he came home weaker.
Richard's kids were trying to piece together how to turn things around. They were also working full-time jobs hundreds of miles from their dad.
2
RECOMMENDED SURGERIES WITH LOW-PROBABILITY SUCCESS
1 yr
Unable to walk after his fall
5+
Specialists, none coordinating
Richard, three years into Stewardship · 1 min 47 sec
The Investigation
Carte’s first step was to look at the surgical recommendations independently. We checked what had been ruled in and what had not yet been ruled out.
01
Dr. Siddiqui reviewed every test, scan, and note that had been gathered to argue for surgery. She personally examined Richard’s back. Her conclusion: Richard’s symptoms had several non-surgical options that hadn't been exhausted yet.
02
Carte convened its own bariatric surgeon, spine surgeon, and obesity-medicine specialist to review Richard’s case. None of them had any financial relationship with Richard or his treating physicians. The independent specialists agreed on a comprehensive, multidisciplinary plan — that was non-operative.
“The whole idea of second opinion, these various medical procedures that I was considering — just getting around to meeting with a back surgeon, meeting with the bariatric people, is a full plate when you’re trying to do a full-time job. So you all handle all that. You take that burden off my shoulder.”
— Richard
“It was two steps forward and one step back. While we knew there were some key lifestyle shifts that needed to happen to support progress on our dad’s chronic conditions, we kept getting sidelined by urgent concerns and health crises that were landing him in the emergency room.”
— Colleen, Richard’s daughter
Before Carte
CASE FILE · RICHARD
Things Richard’s kids were tasked with doing
Recommendations that had not been reconciled
The Care
Stopping the surgical default was Richard’s first month with Carte. The next three years were about day in, day out execution.
“The first surprise was probably access. Pick up the phone, your guys are there. I can text you, I can text Gina, I can text people in your office, and everything’s managed for me.”
— Richard
03
Richard had tried GLP-1 therapy unsuccessfully before. We brought the right experts so this time it was done correctly. Carte's physical therapist shaped Richard's exercise programming to one that produced results.
Most importantly, we monitored across Richard's conditions proactively to keep him out of the hospital. With Carte, his wounds kept continually improving, breaking the cycles of ‘two steps forward and one back.’
04
We assembled the best specialists for Richard's care and collaborated 1-on-1 with each of them between visits.
We iterated on Richard’s wound care and trained his aides on the best techniques. We prepared better supplies for his trips to Martha’s Vineyard.
We called Richard regularly to facilitate appointments, and we adjusted the plan in real time. When his legs were swelling, we uncovered that a broken recliner was the culprit and we stepped in to replace it.
The Result
Surgical intervention, before Carte → today
2 recommended → 0 needed
Weight, before Carte → today
Decade plateau → 70 lbs lost
MOBILITY, BEFORE CARTE → TODAY
Pain seconds after standing → Walking pain-free
Richard avoided two major surgeries recommended to him — surgeries that, by both surgeons’ own admission, were unlikely to help.
Instead, he's been on a custom regimen that includes physical therapy three times a week. He's back to things he loves: on the stage at his law school's alumni events, and enjoying summer on Martha’s Vineyard with his kids.
The Method:
01We listen.
He was ready to work hard to avoid surgery. No one had given him the tailored tools and plan.
02We check assumptions.
When we re-examined the spine and the tests, the case for surgery didn't hold up.
03We find experts.
Independent bariatric, spine, and obesity-medicine review. New cardiologist, nephrologist, and primary care doctors.
04We follow through.
Three years of hands-on, end-to-end execution produced continuously compounding results.
The system Carte used to finally elevate Richard’s medical care. Written as a practical guide for anyone trying to improve their health.
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