Dr. Lauren Wostrel

07/28/2026

Nothing says "surprise!" quite like opening your mail to find a $1,530.90 lab bill for tests you never consented to and didn't even know had been ordered... two months later.

This is exactly why informed consent matters.

At our clinic, I don't order labs without discussing them with my patients first. Before we draw blood, we talk about what we're ordering, why we're ordering it, and what it's will likely cost. Every patient receives a Good Faith Estimate so there are no unpleasant surprises.

To put this into perspective, I'd have to order some pretty wild, highly specialized testing to generate a $1,500 lab bill. In my practice, if a patient's lab costs exceed $100, it's almost always because the patient specifically requested additional testing.

Healthcare shouldn't leave you wondering what was ordered, why it was ordered, or why you're suddenly on the hook for a four-figure bill.

Transparency isn't a luxury—it's how medicine should be practiced.

07/16/2026

As a physician, I’ve noticed a growing number of posts and videos from patients—particularly women—who feel gaslit by the medical system. They describe bringing a wide range of physical symptoms to appointments, only to receive normal lab results and questions about stress. I want to address this thoughtfully and honestly.

First, it’s rarely intentional gaslighting. In most insurance-based practices, appointments are limited to 7–10 minutes. My collogues are often seeing 30–40 patients a day under intense productivity demands from hospitals and systems. There simply isn’t enough time for the deep exploration many complex cases deserve. This is a structural issue with how care is delivered, not a reflection of individual doctors not caring.

If you’re seeking more comprehensive care, consider models that allow longer visits—such as direct primary care, concierge practices, or integrative/functional approaches. These give space for the kind of thorough discussion that short visits can’t accommodate.

Second, there is real science behind the mind-body connection. Chronic stress, burnout, and unresolved trauma can drive significant physical symptoms even when standard labs are normal. Your immune system, nervous system, and inflammatory pathways can be profoundly affected. This is increasingly recognized in medicine. Two excellent books on the topic are:

The Biology of Trauma by Dr. Aimie Apigian
The Body Keeps the Score by Bessel van der Kolk, MD

Many doctors who understand this neurobiological link are trying to point toward root causes. Others may not have the training or time to delve into it during a rushed visit. Either way, the goal is rarely to dismiss you—it’s often that they are limited by the system we work in. Many of us are experiencing similar burnout ourselves.

If you’re struggling with unexplained symptoms, please know you’re not crazy, and your concerns are valid. Consider working with professionals who have more time to explore the full picture—including a membership based practice for longer appointments, a trauma-informed therapists, functional medicine practitioners, or specialists in mind-body medicine when appropriate.

I’m sharing this because I believe better understanding on both sides can improve the patient-doctor relationship. Compassion and science can coexist.

07/07/2026

It has been another morning dealing with this. . .

🤔 𝐈𝐦𝐚𝐠𝐢𝐧𝐞 𝐜𝐚𝐥𝐥𝐢𝐧𝐠 𝐚 𝐩𝐥𝐮𝐦𝐛𝐞𝐫, 𝐞𝐥𝐞𝐜𝐭𝐫𝐢𝐜𝐢𝐚𝐧, 𝐚𝐭𝐭𝐨𝐫𝐧𝐞𝐲, 𝐚𝐜𝐜𝐨𝐮𝐧𝐭𝐚𝐧𝐭, 𝐨𝐫 𝐦𝐞𝐜𝐡𝐚𝐧𝐢𝐜 𝐚𝐧𝐝 𝐬𝐚𝐲𝐢𝐧𝐠:
"𝘐'𝘥 𝘭𝘪𝘬𝘦 𝘺𝘰𝘶 𝘵𝘰 𝘥𝘰 𝘴𝘰𝘮𝘦 𝘸𝘰𝘳𝘬 𝘧𝘰𝘳 𝘮𝘦. 𝘐'𝘮 𝘯𝘰𝘵 𝘨𝘰𝘪𝘯𝘨 𝘵𝘰 𝘱𝘢𝘺 𝘺𝘰𝘶 𝘧𝘰𝘳 𝘪𝘵. 𝘈𝘭𝘴𝘰, 𝘪𝘧 𝘺𝘰𝘶 𝘥𝘰𝘯'𝘵 𝘥𝘰 𝘪𝘵, 𝘐'𝘮 𝘨𝘰𝘪𝘯𝘨 𝘵𝘰 𝘮𝘢𝘬𝘦 𝘭𝘪𝘧𝘦 𝘥𝘪𝘧𝘧𝘪𝘤𝘶𝘭𝘵 𝘧𝘰𝘳 𝘴𝘰𝘮𝘦𝘰𝘯𝘦 𝘦𝘭𝘴𝘦."

You'd probably get laughed out of the room.
𝐘𝐞𝐭 𝐭𝐡𝐚𝐭'𝐬 𝐞𝐬𝐬𝐞𝐧𝐭𝐢𝐚𝐥𝐥𝐲 𝐡𝐨𝐰 𝐩𝐫𝐢𝐨𝐫 𝐚𝐮𝐭𝐡𝐨𝐫𝐢𝐳𝐚𝐭𝐢𝐨𝐧𝐬 𝐰𝐨𝐫𝐤.

For those who aren't familiar, a prior authorization is when an insurance company requires your doctor's office to complete extra paperwork, make phone calls, submit records, and justify a medication or treatment that your doctor has already determined you need.

The interesting part? Insurance companies don't pay physicians or their staff for this work.

Years ago, a physician got so frustrated with this arrangement that he sued over the time spent completing prior authorizations. In Gibson v. Medco Health Solutions (2008), the court agreed that physicians should not be expected to perform work for free and awarded compensation for the physician's time and costs.

We happen to agree.

So beginning January 1st of this year, we started sending invoices to insurance companies for prior authorization work completed by our office.
Current score:
💰 Invoices submitted: Many
💰 Invoices paid: Zero
📬 Insurance companies confused by receiving an invoice: Several
📞 Insurance company employees trying to figure out why we sent a bill: More than a few

In fact, we're preparing to send a couple of insurance companies to collections because, believe it or not, we expect to be paid for work we perform.

Now, before anyone thinks this is about the money—it really isn't.
Our goal isn't for insurance companies to pay us for prior authorizations.

𝐎𝐮𝐫 𝐠𝐨𝐚𝐥 𝐢𝐬 𝐟𝐨𝐫 𝐭𝐡𝐞𝐦 𝐭𝐨 𝐬𝐭𝐨𝐩 𝐫𝐞𝐪𝐮𝐢𝐫𝐢𝐧𝐠 𝐮𝐧𝐧𝐞𝐜𝐞𝐬𝐬𝐚𝐫𝐲 𝐩𝐫𝐢𝐨𝐫 𝐚𝐮𝐭𝐡𝐨𝐫𝐢𝐳𝐚𝐭𝐢𝐨𝐧𝐬 𝐢𝐧 𝐭𝐡𝐞 𝐟𝐢𝐫𝐬𝐭 𝐩𝐥𝐚𝐜𝐞.

If an insurance company knows every prior authorization request generates a bill, maybe they'll decide it's easier to simply approve the medication your doctor prescribed rather than creating more paperwork, delays, frustration, and barriers to care.

We'll keep advocating for our patients, pushing back against unnecessary bureaucracy, and looking for ways to make healthcare a little more sensible.

Because your healthcare should be decided by you and your doctor—not by whoever designed the latest paperwork form. 🩺

07/04/2026

06/08/2026

🕷️ Tick season is here 🕷️

𝐎𝐧𝐞 𝐨𝐟 𝐭𝐡𝐞 𝐛𝐢𝐠𝐠𝐞𝐬𝐭 𝐛𝐞𝐧𝐞𝐟𝐢𝐭𝐬 𝐨𝐟 𝐭𝐡𝐞 𝐃𝐢𝐫𝐞𝐜𝐭 𝐏𝐫𝐢𝐦𝐚𝐫𝐲 𝐂𝐚𝐫𝐞 𝐦𝐨𝐝𝐞𝐥 𝐢𝐬 𝐭𝐡𝐞 𝐩𝐞𝐚𝐜𝐞 𝐨𝐟 𝐦𝐢𝐧𝐝 𝐭𝐡𝐚𝐭 𝐜𝐨𝐦𝐞𝐬 𝐰𝐢𝐭𝐡 𝐪𝐮𝐢𝐜𝐤 𝐚𝐜𝐜𝐞𝐬𝐬 𝐭𝐨 𝐲𝐨𝐮𝐫 𝐝𝐨𝐜𝐭𝐨𝐫 𝐰𝐡𝐞𝐧 𝐬𝐨𝐦𝐞𝐭𝐡𝐢𝐧𝐠 𝐭𝐢𝐦𝐞-𝐬𝐞𝐧𝐬𝐢𝐭𝐢𝐯𝐞 𝐡𝐚𝐩𝐩𝐞𝐧𝐬.
Tick bites are a great example.

Many tick-borne illnesses respond best when recognized and treated early. Waiting weeks to get into a traditional primary care office can create unnecessary stress and delays; especially during the busy summer months.

𝙒𝙞𝙩𝙝 𝘿𝙋𝘾, 𝙥𝙖𝙩𝙞𝙚𝙣𝙩𝙨 𝙤𝙛𝙩𝙚𝙣 𝙝𝙖𝙫𝙚:
✔️ Same-day or next-day access
✔️ The ability to send photos or messages directly to their physician
✔️ Ongoing continuity with a doctor who knows their history
✔️ After-hours access for urgent concerns when appropriate

This allows us to evaluate tick bites, rashes, fevers, or concerning symptoms quickly and determine when treatment or further evaluation may be needed.

🩺 We also believe strongly in continuing medical education and staying engaged with evolving research. Our physicians participate in a monthly journal club with other physicians around the country, and our May discussion focused specifically on Lyme disease and approaches to persistent/chronic Lyme-related symptoms.

Medicine is always evolving, and we believe patients deserve doctors who continue learning.

As always:
🌿 Wear tick protection when outdoors
🌿 Check carefully after hikes, yard work, or wooded areas
🌿 Remove ticks promptly
🌿 Reach out early if symptoms develop

Sometimes peace of mind in medicine simply means knowing your doctor is accessible when you need them.

(General educational information only — not medical advice.)

06/06/2026

As a relatively young physician, one of my greatest concerns for the future of medicine is not any particular policy, administration, institution, or scientific controversy. It is the gradual erosion of our ability to engage in respectful, rigorous debate.

Medicine has never advanced through unanimity. It advances through questioning assumptions, challenging prevailing theories, scrutinizing evidence, and testing ideas against reality. Nearly every major breakthrough in our profession emerged because someone was willing to ask difficult questions and someone else was willing to answer them with better data.

The scientific method itself is an organized form of disagreement. Hypotheses are proposed, challenged, refined, and sometimes discarded. When debate is discouraged, science does not become stronger—it becomes fragile. Consensus has value, but consensus should be the result of open inquiry, not a substitute for it.

I worry when physicians, researchers, and academic institutions become more comfortable silencing opposing viewpoints than engaging them. The proper response to a flawed argument is not suppression; it is better evidence. The proper response to an unpopular hypothesis is not exclusion; it is examination. If we lose the ability to debate openly, we risk replacing scientific curiosity with intellectual conformity.

This principle transcends politics. Every generation of physicians can point to ideas that were once considered settled science and later revised or abandoned. Humility demands that we remember our own fallibility. The history of medicine is a history of correction as much as discovery.

As physicians, our loyalty must remain where it has always belonged: with our patients and with the pursuit of truth. That pursuit requires courage, intellectual honesty, and a willingness to hear arguments we may strongly disagree with.

I do not long for a profession where everyone thinks alike. I long for a profession confident enough to debate difficult questions openly, respectfully, and without fear.

Because medicine is at its best when evidence—not authority—wins the argument.

𝑶𝒎𝒏𝒊𝒐 𝒑𝒓𝒐 𝒂𝒆𝒈𝒓𝒐𝒕𝒐 — everything for the patient.

05/21/2026

Just because my clinic is cash-pay does not mean patients can "purchase" whatever they want.

Medicine requires compassion, listening, and partnership. But it also requires discernment.

There are times when saying “yes” would be easier. Easier to avoid conflict. Easier to keep someone happy in the moment. Easier to move on to the next patient.

But good medicine is not simply giving people what they ask for.

Sometimes protecting a patient means slowing down. Asking harder questions. Choosing caution. Saying, “Not yet.” “Not this.” Or even, “No.”

Not every medication is safe for every person. Not every treatment is necessary. And sometimes the most caring thing a doctor can do is set a boundary that protects long-term health over short-term satisfaction.

Real care is not fast food medicine.

It is thoughtful, individualized, and willing to make hard decisions when safety matters.

Send a message to learn more

04/24/2026

Various doctors and legislators in Missouri have been working to create alternative pathways, and while some progress has been made, hospitals remain a major obstacle. Many hospitals strongly oppose reforms because they benefit from the current residency system. They invest in lobbyists to block legislation that could introduce competitive options for medical school graduates and bring more doctors to Missouri.
The financial structure of residency programs is a key issue. Residency salaries are largely funded through Medicare and Medicaid, meaning taxpayers—not hospitals—cover those costs. In fact, hospitals often receive additional funding beyond residents’ salaries, allowing them to profit from hosting residency programs. At the same time, residents can generate significant revenue for hospitals, often estimated at around $300,000 per year, while earning salaries closer to $50,000.
This imbalance is part of a broader concern about how the residency match system operates and why many believe it has become unsustainable and in need of reform.
This is a great video by Dr. Peter.

04/18/2026

💡 𝐃𝐏𝐂 𝐯𝐬. 𝐈𝐧𝐬𝐮𝐫𝐚𝐧𝐜𝐞 — 𝐍𝐨𝐭 𝐄𝐢𝐭𝐡𝐞𝐫/𝐎𝐫
One of the biggest misconceptions I hear about Direct Primary Care (DPC) is this:
“If I have insurance, I don’t need DPC.”
—or—
“If I use DPC, I can’t have insurance.”

Neither of those is true.

In reality, most patients who choose DPC still carry some form of insurance (or use a health-sharing plan). They’re just choosing DPC because they want better access, more time with their doctor, and predictable costs for everyday care.

Here’s the problem with the traditional model:
📅 The average wait time to see a primary care physician in the U.S. is around 3–4 weeks.
That doesn’t work when you have:
Strep throat
A sinus infection
A new issue that needs timely attention

So what happens?
➡️ You end up in urgent care…
➡️ Paying a higher fee and higher co-pay
➡️ Seeing someone who doesn’t know you

And that cycle repeats.

DPC flips that model:
✔️ Same or next-day access in many cases
✔️ Direct communication with your physician
✔️ Focus on prevention and ongoing care—not just sick visits

Then insurance (or a health-sharing plan) is still there for what it does best:
🏥 The big, unexpected things — hospitalizations, surgeries, major illnesses

🧠 Think of it this way:
DPC = your day-to-day care, access, and relationship
Insurance = protection for the “what ifs”

They’re not competitors.
They’re tools and they work best together.

If you’ve ever felt frustrated with access to care, long wait times, or bouncing between urgent care visits… you’re not alone. There is another way to structure your healthcare.

𝐖𝐡𝐚𝐭 𝐃𝐨𝐞𝐬 𝐈𝐭 𝐑𝐞𝐚𝐥𝐥𝐲 𝐂𝐨𝐬𝐭 𝐖𝐡𝐞𝐧 𝐊𝐢𝐝𝐬 𝐆𝐞𝐭 𝐒𝐢𝐜𝐤? 👶
We looked at our actual patient data; here is how often young kids come in for sick visits.

🏥 𝑾𝒊𝒕𝒉 𝑰𝒏𝒔𝒖𝒓𝒂𝒏𝒄𝒆
Based on real visit frequency:
👉 Over a year of co-pays:
$𝟔𝟕𝟓 𝐭𝐨 $𝟐,𝟎𝟎𝟎+ 𝐨𝐮𝐭 𝐨𝐟 𝐩𝐨𝐜𝐤𝐞𝐭

❤️ 𝑾𝒊𝒕𝒉 𝑫𝑷𝑪
One flat monthly fee
Same-day visits included
After-hour access by phone for urgent needs
No copays, no surprise bills
👉 𝐓𝐡𝐚𝐭'𝐬 $𝟒𝟔𝟖-𝟓𝟖𝟖/𝐲𝐞𝐚𝐫

💡 The Difference
When care is easy to access, parents come in when they should; not when they’re forced to wait.
We’re not guessing on these numbers; they’re based on how often families actually need care.

Insurance still plays an important role for major events like emergencies, surgeries, and high-cost medical conditions (ie. cancer).

DPC is designed to make the day-to-day, expected healthcare simple, accessible, and affordable.

04/16/2026

🧬 𝐇𝐨𝐫𝐦𝐨𝐧𝐞 𝐓𝐡𝐞𝐫𝐚𝐩𝐲 𝐈𝐬 𝐏𝐨𝐰𝐞𝐫𝐟𝐮𝐥 𝐚𝐧𝐝 𝐈𝐭 𝐒𝐡𝐨𝐮𝐥𝐝 𝐁𝐞 𝐌𝐨𝐧𝐢𝐭𝐨𝐫𝐞𝐝 𝐂𝐚𝐫𝐞𝐟𝐮𝐥𝐥𝐲

Hormone Replacement Therapy (HRT) can be life-changing when used appropriately. I’ve seen it help both men and women regain energy, improve mood, support metabolic health, and overall feel more like themselves again.

But like any medical treatment, it’s not “set it and forget it.”

One pattern I’ve noticed over time — across different care settings — is that sometimes hormone therapy is started, but ongoing monitoring doesn’t always happen the way it should.

𝐇𝐞𝐫𝐞 𝐚𝐫𝐞 𝐚 𝐟𝐞𝐰 𝐤𝐞𝐲 𝐭𝐡𝐢𝐧𝐠𝐬 𝐩𝐚𝐭𝐢𝐞𝐧𝐭𝐬 𝐬𝐡𝐨𝐮𝐥𝐝 𝐤𝐧𝐨𝐰:
🧪 Labs should be part of your care plan
When starting or adjusting hormones, labs help ensure levels are therapeutic — not too low, and not too high.
👩 For women on HRT:
Once stable on a consistent dose and feeling well, labs are often checked about once a year (sometimes sooner depending on symptoms or changes).
👨 For men on testosterone therapy (TRT):
Monitoring needs to be more frequent.
Typically, labs every 3–4 months is appropriate.

⚠️ 𝐖𝐡𝐲 𝐭𝐡𝐞 𝐝𝐢𝐟𝐟𝐞𝐫𝐞𝐧𝐜𝐞?
Testosterone therapy can increase red blood cell production, which in some cases leads to secondary polycythemia; a condition where the blood becomes thicker.
If not monitored, this can increase the risk of complications such as clotting events.

This doesn’t mean TRT is “bad.”
It means it needs to be managed intentionally and monitored appropriately.

💡 Bottom line:
If you are on hormone therapy, it’s reasonable to ask:
“How often should my labs be checked?”
“What specifically are we monitoring?”
“What risks are we watching for over time?”

Good medicine isn’t just starting treatment; it’s walking with patients over time and adjusting safely along the way.

𝘋𝘪𝘴𝘤𝘭𝘢𝘪𝘮𝘦𝘳: 𝘛𝘩𝘪𝘴 𝘱𝘰𝘴𝘵 𝘪𝘴 𝘧𝘰𝘳 𝘨𝘦𝘯𝘦𝘳𝘢𝘭 𝘦𝘥𝘶𝘤𝘢𝘵𝘪𝘰𝘯𝘢𝘭 𝘱𝘶𝘳𝘱𝘰𝘴𝘦𝘴 𝘰𝘯𝘭𝘺 𝘢𝘯𝘥 𝘪𝘴 𝘯𝘰𝘵 𝘮𝘦𝘥𝘪𝘤𝘢𝘭 𝘢𝘥𝘷𝘪𝘤𝘦. 𝘏𝘰𝘳𝘮𝘰𝘯𝘦 𝘵𝘩𝘦𝘳𝘢𝘱𝘺 𝘴𝘩𝘰𝘶𝘭𝘥 𝘣𝘦 𝘪𝘯𝘥𝘪𝘷𝘪𝘥𝘶𝘢𝘭𝘪𝘻𝘦𝘥 𝘢𝘯𝘥 𝘮𝘢𝘯𝘢𝘨𝘦𝘥 𝘪𝘯 𝘤𝘰𝘯𝘴𝘶𝘭𝘵𝘢𝘵𝘪𝘰𝘯 𝘸𝘪𝘵𝘩 𝘢 𝘩𝘦𝘢𝘭𝘵𝘩𝘤𝘢𝘳𝘦 𝘱𝘳𝘰𝘷𝘪𝘥𝘦𝘳 𝘦𝘹𝘱𝘦𝘳𝘪𝘦𝘯𝘤𝘦𝘥 𝘪𝘯 𝘏𝘰𝘳𝘮𝘰𝘯𝘦 𝘙𝘦𝘱𝘭𝘢𝘤𝘦𝘮𝘦𝘯𝘵.