Dr. Sour Puss

Working in the urban primary care safety net for nearly two decades, I've personally witnessed the growing opioid dependence problem. Hell, as a physician who trained in the era of "pain as the 5t h vital sign" I had a role in creating the problem. Fortunately, I've also played an active role in the response to this public health crisis and have been providing medication assisted opioid treatment for the past several years. One of my latest projects has been working on an innovative treatment model to deliver "low barrier" buprenorphine in unique settings, including homeless support centers and needle exchange programs. This idea is supported by data out of Boston and San Francisco that by meeting people in a non-judgmental way in a setting that removes as many hurdles as possible you see similar treatment retention and engagement rates as with traditional chemical dependency programs and at lower cost. Further, by reducing heroin use, providing naloxone f

I'm a big fan of the 10 year plan. I wrote my last one let's see...about 10 years ago! I've been carrying it with me in my work bag and it's funny because just putting it down on paper without really referring to it, I managed to achieve nearly everything that was important to 38 year old me. For some reason, I divided it into sections: "Lifestyle", "Money", and "Personal Fulfillment." Let's take a look... Lifestyle: Travel: check (England, Canada, Iceland, Vietnam, Cambodia, Dubai) Music: check (founded and played in Boeufcake which sparked the Wallingford Dad-Rock punk scene) Children: check 4 day work week: check minimum 4 weeks vacation, 6 better: check and check out of office by 6 pm: ha!  Money: mostly achieved salary goals, mostly achieved retirement planning and student loan repayment.  Personal Fulfillment: Spend less time dealing with insurance paperwork: actually, until the ACA, this was true Serving the unde

Death by a thousand clicks This is an amazingly thorough examination of the state of EHRs today and how they are intertwined with the larger dysfunctional US health care system. Includes detailed discussion of both NextGen and Epic. Required reading for all clinicians. The only thing I’d add that wasn’t addressed in enough detail is how EHRs were designed with our insane reimbursement system in mind and in turn have made that system even more insane. I don’t personally see EHRs getting any less miserable to use as long as there is a private profit driven company on the other end expending all of their effort trying to prove delivered care was unnecessary or someone else’s financial responsibility.

This is what’s going on right here. I pretty much gave everything I humanly could to make a job I loved, serving patients I loved. I meditated, I did counseling. I sacrificed family and health. I unionized. I went back to school to become a leader and a change maker all for the radical idea that health care providers and patients should be in charge of the conditions of health care delivery because they can and should do better than insurers and business people. In the end, I  was squashed by business people who are too busy or too threatened to listen to this message, under the pretense that I couldn’t hack the workload, couldn’t be a team player, complained too much. That despite putting a huge amount of energy into managing my emotions and exploring constructive solutions, I just couldn’t stuff it enough and make the money I guess. Every provider I know is going through some version of this. Many have left medicine. Some have had mental health crises. Some have committed suicide.

So it’s all true. Neighborcare and I have officially parted ways. It was an amazing 10 years of personal and professional growth and I am a far better human being because of my time there, thanks to the most amazing group of people with whom I’ve ever worked and the incredible patients whose stories and lives I had the high honor to witness were a daily gift that sustained me. I especially want to call out  Kristin Kurvink ,  Josephine Saltmarsh ,  Sandrine Ducos , Dan Kujawinski, Jessica Bergstrom, and Allison A. Fitzgerald all of whom made the impossible possible and brought magic into the world. We saved a lot of lives and even a few souls.

Here's something I wrote somewhere on the Inter-hoo after a day that was too damn long. I don't even remember what it was the got me ranting so hard. Here's the deal. I'm a motherfucking family doctor. I am a leader in the community in which I live. People come to me for medical care when they are in moments of crisis in their lives. I prescribe the pills, but more importantly, I provide the comfort, the wisdom, and the support they need to weather the crisis. I make a human connection in 15 minutes, whether you are an airline pilot, a grocery store clerk, a college student that smokes too much pot, or a delusional homeless person that thinks all white people except me are out to get you. I am the grease that eliminates the grinding of the gears of society. I am the person that can make a multimillionaire neurosurgeon see the reason why he/she should donate their time to help a struggling addict with a risky surgery because I believe with enough support this