From Dr. K

Imagine calling your doctor’s office because you’re feeling unwell, only to be told your primary care physician (PCP) has “moved on” or that you’ll be seeing a different nurse practitioner (NP) or physician assistant (PA) every time you visit.
For many, this isn’t a hypothetical—it’s the new reality. Recent data highlights a troubling shift: 94% of physicians report that corporate and administrative burdens have made operating a solo practice nearly impossible, leading to the widespread acquisition of independent offices by large hospital systems. This corporate consolidation is the primary driver behind why so many patients feel like they are in a “revolving door” system where they rarely see the same provider twice.

What is Continuity of Care?

True continuity of care isn’t just about having a medical record; it’s about a long-term relationship with one physician who knows your history, your family, and your health goals. When you see the same doctor over years, you aren’t just getting a diagnosis—you’re getting a partner in your health.

The Problem: Corporate “Switch-Ups”

In large corporate clinics, doctors are often employees who are moved between locations or replaced by mid-level providers to cut costs. While NPs and PAs are vital parts of the medical community, many patients feel “slighted” or frustrated when they are unable to see their actual doctor for complex or ongoing needs.

This fragmentation leads to:

Wasted Time: Re-explaining your history at every appointment.

Missed Cues: A new provider might not notice subtle changes in your health that a long-term doctor would catch immediately.

Poorer Outcomes: Research shows that losing a consistent PCP leads to a significant increase in emergency department visits and higher overall healthcare spending.

The Rare Exception: East County Internal Medicine

While independent solo practices are becoming unheard of on both a local and national scale, East County Internal Medicine remains dedicated to the “old school” way of practicing medicine.
Since 2013, patients in Lakewood Ranch and Bradenton have enjoyed the rare privilege of seeing the same physician: Shaan Kunwar, DO.
As an independent, physician-owned practice, we don’t answer to corporate boards or insurance quotas. This independence allows us to offer:

Direct Access: When you book an appointment, you see Dr. Kunwar—every single time.
Better Results: Patients who have a long-term relationship with their doctor report significantly higher satisfaction and better management of chronic conditions.

Trust: We know your name, your history, and your health.

In a world of corporate healthcare, finding a doctor who stays is a big deal. At East County Internal Medicine, we aren’t just treating symptoms; we’re honoring the lifelong partnership between doctor and patient.
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“An informed patient is a healthier patient.”

Shaan Kunwar DO

941-727-7771

At East County Internal Medicine (ECIM), we believe in empowering our patients with more than just high-level summaries. For patients managing the intersection of hyperlipidemia and diabetes, the decision to initiate high-intensity therapy like Atorvastatin 40mg is rooted in robust, evidence-based data that quantifies risk reduction with precision.

Clinical Analysis: One Year of High-Intensity Atorvastatin 40mg
For a 47-year-old male with controlled diabetes and hyperlipidemia, the goal of therapy extends beyond just “lowering numbers.” It is about a fundamental shift in the 10-year and annual risk of Major Adverse Cardiovascular Events (MACE).

1. Quantifying Relative Risk Reduction (RRR)
Large-scale clinical data, including the CARDS trial (specifically focused on diabetic populations) and the ASCOT-LLA study, provide a clear framework for what a high-intensity dose can achieve:

Overall MACE Reduction: Approximately 37%. This composite endpoint includes non-fatal myocardial infarction (heart attack), stroke, and coronary revascularization procedures.

Stroke-Specific Prevention: A notable 48% reduction. Stroke prevention is a critical component of statin therapy in diabetic patients, often showing statistical divergence from placebo groups within the first 12 to 18 months.

Acute Coronary Events: Approximately 36% reduction in the risk of myocardial infarction.

2. Absolute Risk Reduction (ARR) and NNT

While relative percentages are striking, absolute risk reduction (ARR) provides a more technical look at the actual number of events prevented in a real-world setting:

Annual Impact: In a high-risk population, starting therapy prevents approximately 9 major events per 1,000 patients in the very first year.

Long-term Projection: Over a 4-year period, this translates to preventing roughly 37 major vascular events per 1,000 patients.

Number Needed to Treat (NNT): For diabetic patients with additional risk factors, the NNT to prevent one major cardiovascular event over 4-5 years is often as low as 27, making it one of the most efficient preventive interventions in modern medicine.

3. Pharmacological Impact on LDL-C

Atorvastatin 40mg is classified as high-intensity therapy, designed to achieve a reduction in LDL-cholesterol of 50%. For patients with diabetes, current [AHA/ACC guidelines]

Target an LDL-C of < 70 mg/dL, or even < 55 mg/dL if additional “risk enhancers” are present.

The ECIM Approach: Beyond the Prescription

At East County Internal Medicine, Dr. Kunwar emphasizes that evidence-based medicine is not a “one-size-fits-all” model. For a 47-year-old, we also monitor:

 Metabolic Synergy: Ensuring that statin therapy does not negatively impact glycemic control, though the cardiovascular benefit of the statin nearly always outweighs the minor risk of blood sugar elevation in controlled diabetics.

Safety Monitoring: Regular assessment of liver transaminases and vigilance for myalgias (muscle pain) to ensure long-term adherence.

Personalized Risk Scoring: Utilizing the ASCVD Risk Estimator to tailor therapy based on your specific biomarkers and lifestyle.

It’s an important discussion to have with your patients so they can make an informed decision on this pertinent healthcare topic.

“An informed patient is a healthier patient.”

Shaan Kunwar DO

941-727-7771

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At East County Internal Medicine (ECIM), a referral isn’t a “hand-off”—it’s a guided transition. One of the most common complaints in modern healthcare is that patients leave a specialist’s office feeling overwhelmed or confused about an upcoming procedure. Shaan Kunwar, DO , changes that dynamic.

The Specialist’s “Blind Spot”
Specialists are experts in their technical craft, but their focus is often narrow. They may explain a procedure in highly technical terms or assume a level of medical knowledge that most patients don’t have. This can lead to anxiety, missed preparations, or a lack of clarity about the recovery process.

The “Better Explanation” Experience
Patients at ECIM frequently report a surprising trend: Dr. Kunwar explains their upcoming procedure better than the specialist performing it.

Because Dr. Kunwar acts as your primary diagnostician, he understands your specific physiology and how a procedure fits into your overall health “puzzle.”

He takes the time to:

Translate the Jargon: Breaking down “medical-speak” into plain English.
Set Realistic Expectations: Explaining exactly what you will feel, how long the recovery takes, and what the “day-of” looks like.
Answer the “Why”: Ensuring you understand how this specific procedure solves the diagnosis he previously identified.

Why We Only Partner with the Best
Because Dr. Kunwar knows exactly what to expect from his affiliates, he only refers to specialists whose work—and outcomes—he trusts implicitly. When he walks you through what to expect, he is speaking from years of experience with these specific practitioners

A Partnership for Your Peace of Mind
When you receive a referral from East County Internal Medicine, you aren’t walking into the unknown. You are walking into a procedure with a clear map provided by a doctor who knows you best.

At ECIM, we don’t just find the problem; we make sure you are 100% comfortable with the solution.

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“An informed patient is a healthier patient.”

Shaan Kunwar DO

941-727-7771