Dr. Sour Puss

Of the thousands upon thousands of pages of policy I’ve been reading for school lately about health care reform, one recurring theme is how primary care is going to save healthcare. With our almighty power of coordinating the care of patients, paying attention to their quality metrics, making them do preventive care, switching them to the cheapest generic meds on their health plans, and viewing the latest fancy high tech interventions with our skeptical scientific eyes, we, the simple heirs to the old GPs, favor the time tested and cost effective evidence based care over the shiny and glamorous expensive new stuff that pays for our colleagues' Italian sports cars but makes little difference in the quantity or quality of our patients' lives. In his account of the Affordable Care Act’s design and passage, one of the key advisors in the Obama administration, Dr. Ezekiel Emanuel (Rahm's brother) writes of the role envisioned for primary care doctors in the Accountable Care Or...

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 suici...

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.