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...