@jayparkinson

27
Last night, I had the pleasure of having dinner with Gabby Giffords and Mark Kelly. David Karp graciously invited me. Gabby and Mark recently started Americans for Responsible Solutions “to encourage elected officials to stand up for solutions to prevent gun violence and protect responsible gun ownership.” Here are my takeaways from the conversations of the evening.When Gabby was shot, 6 others were killed and 12 were wounded. This took roughly 15 seconds. A bystander, armed with a gun was across the street inside a pharmacy, heard the shooting and ran out with his weapon. He raised his weapon and aimed it at a guy trying to tackle Gabby. He said he was milliseconds away from pulling the trigger. Of course, this was a gentleman trying to protect Gabby. In the situation, a wannabe hero will likely do more damage than good. The Aurora shooting where 12 people were killed and 70 were injured took a total of 30 seconds. Mass shootings are quick, deadly, and confusing. The belief that arming “the good guys” who took a safety class 4 years ago to take down the “bad guy” active shooter is a horribly unrealistic argument. In battle, as Mark explained, you have to resort to base instincts of survival, not calculated, Clint Eastwood-esque calm and collected cool. He would know. He’s been shot at, in fighter planes, around 30 times. And this is a guy calm and collected enough to be shot into space as the commander of the Space Shuttle. The armed hero in America that saves the lives of others in a mass shooting has yet to happen. It never will. Women are particularly vulnerable in our society as they are often the victims of intimate partner violence. 52% of women murdered with guns are killed by spouses or family members.Mass shootings, equally terrifying and sensational, rally the troops. It scares middle class suburbia, which is where these things tend to happen. Mental illness is highly associated with mass shootings. But this is just a distraction from the real situation— inner city poverty-stricken black, and less so Hispanic, youth where black market guns are ubiquitous and they are used for aggression. Illegal guns are trafficked into these urban areas circumventing local gun laws. Some cities, like NYC, have laws mandating prison time for anyone caught with an illegal gun. This sets the onus on police to find hidden guns as a means of prevention. But the real problem is the attitude amongst these urban young men that guns are a solution. In 2015, gun-related deaths will surpass car crash-related deaths in America. Roughly 33,000 people are killed each year with guns and 100,00 people are shot. Cars are getting safer due to an industry-led approach to making cars safer. Guns are not. Safer guns are actively opposed by the industry. Pretty ridiculous to think about.But I feel that things are coming to a tipping point. The NRA has run amok in national and state legislative bodies as the lobbying giant for gun companies and gun owners. They’ve spent roughly $30 million a year on expanding access to guns throughout America, under the guise of freedom and the Second Ammendment. But the reality is gun sales are down. Good job America. Prior to the last few years, there have been no significant gun control lobbying efforts. As the NRA was spending $30 million a year, gun control lobbying was typically less than $100,000— nationally. Gabby and Mark saw that this was a problem. Combined with Mayor Bloomberg’s efforts at Everytown for Gun Safety, the NRA is now equally matched with dollars and efforts. Through initiatives aimed at issues like background checks and ensuring convicted felons and domestic abusers cannot legally purchase guns, they are tackling the legislative side of gun control. Big tobacco was defeated through data, lobbying efforts, and a multi-pronged educational effort describing the harmful effects of smoking. In 1964, the Surgeon General published a report saying smoking was harmful at a time when 50% of the population smoked. Fifty years later, roughly 10% of New Yorkers now smoke. Big behavioral changes in our culture take a long time. But that effort was initiated in a different time. There may be some evidence that big cultural changes may take less time. Look at gay marriage and legalized marijuana. I strongly believe that America always chooses the right path over time, but the path is just a messy one. So I am hopeful that cultural attitudes toward guns as a form of aggression will improve.The real problem is our gun culture. Guns are still ever present in movies. Many households have guns that are 20 times more likely to be used against them than as protection. The Second Amendment rallies the Preppers. Gun companies are trying to increase their sales through ads aimed at women and young adults. You can still purchase massive amounts of ammunition at a time. Convicted felons can be let out of prison and, on that same day, legally purchase a gun. Convicted or accused domestic abusers can still legally purchase guns. Many in our culture still believe that armed heroes will save lives in mass shootings. Guns are still cool and an accepted means of aggression in certain populations of young men. How we connect Mark Kelly, Gabby Giffords, and Mike Bloomberg to the cultural attitudes in these urban communities is the real question. You can’t expect these kinds of initiatives to resonate with those cultures. Urban communities must have their own conversation and devise initiatives on their own to change their local attitudes. This is my hope. It’s wonderful that Mark, Gabby, and Bloomberg are starting the conversation, but urban communities must sustain and shape it. And that will be an exciting thing to see.

Last night, I had the pleasure of having dinner with Gabby Giffords and Mark Kelly. David Karp graciously invited me. Gabby and Mark recently started Americans for Responsible Solutions “to encourage elected officials to stand up for solutions to prevent gun violence and protect responsible gun ownership.” Here are my takeaways from the conversations of the evening.

When Gabby was shot, 6 others were killed and 12 were wounded. This took roughly 15 seconds. A bystander, armed with a gun was across the street inside a pharmacy, heard the shooting and ran out with his weapon. He raised his weapon and aimed it at a guy trying to tackle Gabby. He said he was milliseconds away from pulling the trigger. Of course, this was a gentleman trying to protect Gabby. In the situation, a wannabe hero will likely do more damage than good. The Aurora shooting where 12 people were killed and 70 were injured took a total of 30 seconds. Mass shootings are quick, deadly, and confusing. The belief that arming “the good guys” who took a safety class 4 years ago to take down the “bad guy” active shooter is a horribly unrealistic argument. In battle, as Mark explained, you have to resort to base instincts of survival, not calculated, Clint Eastwood-esque calm and collected cool. He would know. He’s been shot at, in fighter planes, around 30 times. And this is a guy calm and collected enough to be shot into space as the commander of the Space Shuttle. The armed hero in America that saves the lives of others in a mass shooting has yet to happen. It never will.

Women are particularly vulnerable in our society as they are often the victims of intimate partner violence. 52% of women murdered with guns are killed by spouses or family members.

Mass shootings, equally terrifying and sensational, rally the troops. It scares middle class suburbia, which is where these things tend to happen. Mental illness is highly associated with mass shootings. But this is just a distraction from the real situation— inner city poverty-stricken black, and less so Hispanic, youth where black market guns are ubiquitous and they are used for aggression. Illegal guns are trafficked into these urban areas circumventing local gun laws. Some cities, like NYC, have laws mandating prison time for anyone caught with an illegal gun. This sets the onus on police to find hidden guns as a means of prevention. But the real problem is the attitude amongst these urban young men that guns are a solution.

In 2015, gun-related deaths will surpass car crash-related deaths in America. Roughly 33,000 people are killed each year with guns and 100,00 people are shot. Cars are getting safer due to an industry-led approach to making cars safer. Guns are not. Safer guns are actively opposed by the industry. Pretty ridiculous to think about.

But I feel that things are coming to a tipping point. The NRA has run amok in national and state legislative bodies as the lobbying giant for gun companies and gun owners. They’ve spent roughly $30 million a year on expanding access to guns throughout America, under the guise of freedom and the Second Ammendment. But the reality is gun sales are down. Good job America. Prior to the last few years, there have been no significant gun control lobbying efforts. As the NRA was spending $30 million a year, gun control lobbying was typically less than $100,000— nationally. Gabby and Mark saw that this was a problem. Combined with Mayor Bloomberg’s efforts at Everytown for Gun Safety, the NRA is now equally matched with dollars and efforts. Through initiatives aimed at issues like background checks and ensuring convicted felons and domestic abusers cannot legally purchase guns, they are tackling the legislative side of gun control.

Big tobacco was defeated through data, lobbying efforts, and a multi-pronged educational effort describing the harmful effects of smoking. In 1964, the Surgeon General published a report saying smoking was harmful at a time when 50% of the population smoked. Fifty years later, roughly 10% of New Yorkers now smoke. Big behavioral changes in our culture take a long time. But that effort was initiated in a different time. There may be some evidence that big cultural changes may take less time. Look at gay marriage and legalized marijuana. I strongly believe that America always chooses the right path over time, but the path is just a messy one. So I am hopeful that cultural attitudes toward guns as a form of aggression will improve.

The real problem is our gun culture. Guns are still ever present in movies. Many households have guns that are 20 times more likely to be used against them than as protection. The Second Amendment rallies the Preppers. Gun companies are trying to increase their sales through ads aimed at women and young adults. You can still purchase massive amounts of ammunition at a time. Convicted felons can be let out of prison and, on that same day, legally purchase a gun. Convicted or accused domestic abusers can still legally purchase guns. Many in our culture still believe that armed heroes will save lives in mass shootings. Guns are still cool and an accepted means of aggression in certain populations of young men. How we connect Mark Kelly, Gabby Giffords, and Mike Bloomberg to the cultural attitudes in these urban communities is the real question. You can’t expect these kinds of initiatives to resonate with those cultures. Urban communities must have their own conversation and devise initiatives on their own to change their local attitudes. This is my hope. It’s wonderful that Mark, Gabby, and Bloomberg are starting the conversation, but urban communities must sustain and shape it. And that will be an exciting thing to see.

22
A new report out today says that 44,000 people in America die each year due to drug overdoses and 52% of those are due to prescription drug overdoses. Drugs, cars, and guns are the three biggies responsible for injuries being the leading cause of death in America for ages 1 to 44, causing nearly 193,000 deaths per year. Looking at the map, there’s an obvious correlation with a state’s average socioeconomic status and drug overdoses. It’s all about the social infrastructure that an increased standard of living enables.

A new report out today says that 44,000 people in America die each year due to drug overdoses and 52% of those are due to prescription drug overdoses. 

Drugs, cars, and guns are the three biggies responsible for injuries being the leading cause of death in America for ages 1 to 44, causing nearly 193,000 deaths per year. 

Looking at the map, there’s an obvious correlation with a state’s average socioeconomic status and drug overdoses. It’s all about the social infrastructure that an increased standard of living enables.

11

Sherpaa is looking for a senior UX/UI designer

Design has been at the core of Sherpaa since day one. And because of that, we’ve created an entirely new genre of healthcare delivery and fundamentally changed how doctors and patients communicate.

When I started Sherpaa, I sat down and process-mapped my vision for the ideal healthcare experience from both and the patient and doctor perspective. That’s where we started. Then we built the technology to enable that ideal process while building a brand that we thought would prove we’re a new kind of healthcare. We don’t look, feel, or talk like anything else in healthcare. But we function better and are delivering healthcare in the most efficient and effective way possible.

Sherpaa is a little over three years now and Florian Fangohr has been our main designer since day one. Florian is simply the most talented designer I’ve ever had the pleasure of working with. He’s principled, devoted to simplicity, passionate, and always fighting for the most elegant experience without cutting corners. We push each other forward, and through discussion and collaboration, we’ve managed to produce a game-changing healthcare experience. We’re looking to continue that spirit of design.

We want an academic, obsessed, passionate, experienced designer who wants to work on something big and important. Doctors, patients, company admins, internal Sherpaa admins, health insurance guides, medical assistants…these are our users. They all have their own set of tools within the platform to deliver care and make healthcare as simple and transparent as possible. We have a team of about 30 people and we’re growing. 

Healthcare is heavy and complicated and some design decisions can literally be the difference between safe and deadly. It’s one of the most important problems designers can work on. If you’re up for it, please contact me at jay@sherpaa.com and include your portfolio.

50

Back in 1998, when I was a fourth year medical student at Penn State, I did a “rural medicine” rotation in Williamsburg, PA. The only thing keeping this town alive was an envelope factory. There were roughly 1,300 people living in the town composed of 98.4% white people making roughly $30,000 per year per household.

My rotation was with the Williamsburg Family Practice run out of a large house in the main part of town. Just a few months prior to my arrival, the practice had been taken over by a thirty-something year old family practice doctor. I found out on my first day that the 80-something year old doctor who had made it his life’s work to be the Williamsburg town doctor passed away just a few months prior where he lived in the second floor of the house. And guess where I was supposed to stay for this month-long rotation? In the second floor of the house. There was an empty third floor, but I was told it was off-limits. Just outside the bedroom window was an old Civil War graveyard. I lasted a night and a half in that place by myself. But that’s another story.

The young doctor who took over the practice was taken aback by two things. First, the doctor had been practicing out of that house for a little over 50 years and had delivered babies that were then 50 years old or so. Each person’s entire life’s medical records were on a few 3x5 index cards. It was that simple. And, second, and most surprising, was that most of the adults, especially the little old ladies of the town, were being prescribed an anti-anxiety medication that went out of vogue in the 1970s. It was a “nerve pill.” Essentially this old doctor had the entire town all chilled out and dependent on him. Not a great policy at all, but I’m sure something that happens all over the country in rural areas. Literally entire counties, if they have doctors, are at the mercy of how that one doctor practices. It’s easy to forget that living in NYC. But roughly 20% of people in America live in rural areas where doctors are scarce. Thirty-five counties in Texas have no physicians at all. There really are two Americas.

28
“But very soon, perhaps within a year, the poppy will no longer be the only way to produce heroin’s raw ingredient. It will be possible for drug companies, or drug traffickers, to brew it in yeast genetically modified to turn sugar into morphine.”This is a game changer. Here’s how this works. The pharmaceutical industry produces painkillers. Doctors prescribe painkillers. They have to be designed so that they are easy to take for legitimate users and, at the same time, designed so they discourage abuse by addicts. 80% of heroin addicts started with prescription painkillers prescribed by doctors. Those prescription medications become harder and harder and more expensive to get, so addicts turn to heroin because it’s cheaper and easier to procure. And it looks like the cost of heroin is going to get even cheaper because now heroin won’t depend on fields of poppies in Afghanistan. All an illicit drug producer needs to procure is this fancy yeast designed for Big Pharma. Here’s a chart of the number of painkiller prescriptions written by doctors in the last 20 years:And here’s the subsequent rise in heroin addiction and overdoses. Nationally, overdoses are getting younger and whiter. The most recent federal data show 19,154 opioid drug deaths in 2010, with 3,094 involving heroin and the rest painkillers. Eighty-eight percent of those who died from heroin were white, half were younger than 34, and almost a fifth were ages 15 to 24. Heroin deaths of teenagers and young adults tripled in the first decade of this century.But don’t forget…cocaine is just as deadly as heroin. It just kills you in a much more dramatic way from sudden cardiac death. Instead of going to sleep and stopping breathing you snort some coke and instantly die from your heart stopping. 

“But very soon, perhaps within a year, the poppy will no longer be the only way to produce heroin’s raw ingredient. It will be possible for drug companies, or drug traffickers, to brew it in yeast genetically modified to turn sugar into morphine.”

This is a game changer. Here’s how this works. The pharmaceutical industry produces painkillers. Doctors prescribe painkillers. They have to be designed so that they are easy to take for legitimate users and, at the same time, designed so they discourage abuse by addicts. 80% of heroin addicts started with prescription painkillers prescribed by doctors. Those prescription medications become harder and harder and more expensive to get, so addicts turn to heroin because it’s cheaper and easier to procure. And it looks like the cost of heroin is going to get even cheaper because now heroin won’t depend on fields of poppies in Afghanistan. All an illicit drug producer needs to procure is this fancy yeast designed for Big Pharma. 

Here’s a chart of the number of painkiller prescriptions written by doctors in the last 20 years:

image

And here’s the subsequent rise in heroin addiction and overdoses. 

image

Nationally, overdoses are getting younger and whiter. The most recent federal data show 19,154 opioid drug deaths in 2010, with 3,094 involving heroin and the rest painkillers. Eighty-eight percent of those who died from heroin were white, half were younger than 34, and almost a fifth were ages 15 to 24. Heroin deaths of teenagers and young adults tripled in the first decade of this century.

But don’t forget…cocaine is just as deadly as heroin. It just kills you in a much more dramatic way from sudden cardiac death. Instead of going to sleep and stopping breathing you snort some coke and instantly die from your heart stopping. 

29
Motorcycles are no joke. My parents got me a dirt bike when I was 12 years old or so. It wasn’t a huge engine but going through a field at 60mph at that age was nothing to shake a stick at. I also survived the era of lawn darts. Whew.via

Motorcycles are no joke. My parents got me a dirt bike when I was 12 years old or so. It wasn’t a huge engine but going through a field at 60mph at that age was nothing to shake a stick at. I also survived the era of lawn darts. Whew.

via

11
Buddy and I went to my friend Jon’s wedding in Kent, CT this weekend. It was one of the finest weekends in many years. And it was Buddy’s first wedding. He even got a bath and smelled all fancy.

Buddy and I went to my friend Jon’s wedding in Kent, CT this weekend. It was one of the finest weekends in many years. And it was Buddy’s first wedding. He even got a bath and smelled all fancy.

22
“I now have a clear view of our assigned runway ahead. I disconnect the autopilot and silence the whoop-whoop of the siren that warns me I’ve done so. We lower the landing gear and complete the extension of the flaps that expand and alter the wing. We read the landing checklist. The air is bumpier now.”This is one of those articles that I’ll remember for quite some time. If you’ve ever wondered how pilots fly all over the world, start here. How do planes know their altitude? How are the skies organized? How are you still mesmerized by the Northern Lights after seeing them almost every day?Nearly 45,000 flights a day in the US take off and land. And we’ll sometimes go years as a country without a major catastrophic crash. But why is it that more than 100,000 people a year die in America due to contact with the American Healthcare Industry?Because doctors and pilots possess very different attitudes and behaviors. And if doctors could be more like pilots, far less people would die, life expectancy would increase, and our country’s health could be markedly improved.Doctors are educated and trained in a dog-eat-dog hyper-competitive environment that rewards egos and stifles teamwork. Graduating number one in your medical school class is something most medical students fight it out for. For those in the top of their class, it’s a positive feedback loop that feeds their egos and sets the stage for your name and career as a physician. For example, the brand of Johns Hopkins and Harvard is almost as powerful as you being called the best brain surgeon in the country. You don’t become the best without being the top of your class, then the Chief Resident, and then by having a reputation for being perfect. But no doctor can be perfect in a silo. They have a whole team of a rotating cast of nurses, aides, partners, etc. However, the team doesn’t get credit. And Harvard or Hopkins kind of gets credit. But the doctor’s name gets all the credit. It’s simply an ego thing that starts on the first day of medical school.But what happens when doctors screw up? It’s on them. They are the target of the malpractice case. Their name gets tarnished and it’s on the permanent record forever. But…the vast majority of the time, they still get to practice. The patient suffers, or maybe even dies, but the physician moves on. It’s part of the game. Death and bad things happen to us all the time, you gotta shake it off. You have to desensitize yourself just to survive the psychological strain of dealing with so much death and disease. Essentially, we get mulligans all the time.If we went down with the ship every time we made a mistake, and not only we died, but we took out 300 of our patients along with us, we’d probably start thinking and acting a lot more like pilots.Commercial pilots understand that they are a cog in the wheel, supported by a team, and if they make a big mistake, they lose their life too. Because of this, they almost worship process, teamwork, and respect for the machine. A checklist and your team saves your life every time you fly. And when bad things happen, it’s in the news and the news is about the airline’s crash, not the pilot’s name. If 100,000 people a year die from medical mistakes, this would be the equivalent of an airliner a day crashing in America consuming a huge part of the news cycle. Being a great doctor is not about you. It’s about your team. But the system that creates us rewards the wrong things. We should be rewarded for teamwork. We should be rewarded for worshipping a tried-and-true process. We should understand that we’re just a cog in the wheel of our nation’s health. We need to think of our operating rooms or our exam rooms more like planes that we need to respect because our patients’ lives depend on the machine. We should think of our careers as a social good designed to create the safest framework for our patients. And if we could do this, we’d save far more lives than anything doctors have ever invented.

“I now have a clear view of our assigned runway ahead. I disconnect the autopilot and silence the whoop-whoop of the siren that warns me I’ve done so. We lower the landing gear and complete the extension of the flaps that expand and alter the wing. We read the landing checklist. The air is bumpier now.”

This is one of those articles that I’ll remember for quite some time. If you’ve ever wondered how pilots fly all over the world, start here. How do planes know their altitude? How are the skies organized? How are you still mesmerized by the Northern Lights after seeing them almost every day?

Nearly 45,000 flights a day in the US take off and land. And we’ll sometimes go years as a country without a major catastrophic crash. But why is it that more than 100,000 people a year die in America due to contact with the American Healthcare Industry?

Because doctors and pilots possess very different attitudes and behaviors. And if doctors could be more like pilots, far less people would die, life expectancy would increase, and our country’s health could be markedly improved.

Doctors are educated and trained in a dog-eat-dog hyper-competitive environment that rewards egos and stifles teamwork.

Graduating number one in your medical school class is something most medical students fight it out for. For those in the top of their class, it’s a positive feedback loop that feeds their egos and sets the stage for your name and career as a physician. For example, the brand of Johns Hopkins and Harvard is almost as powerful as you being called the best brain surgeon in the country. You don’t become the best without being the top of your class, then the Chief Resident, and then by having a reputation for being perfect. But no doctor can be perfect in a silo. They have a whole team of a rotating cast of nurses, aides, partners, etc. However, the team doesn’t get credit. And Harvard or Hopkins kind of gets credit. But the doctor’s name gets all the credit. It’s simply an ego thing that starts on the first day of medical school.

But what happens when doctors screw up? It’s on them. They are the target of the malpractice case. Their name gets tarnished and it’s on the permanent record forever. But…the vast majority of the time, they still get to practice. The patient suffers, or maybe even dies, but the physician moves on. It’s part of the game. Death and bad things happen to us all the time, you gotta shake it off. You have to desensitize yourself just to survive the psychological strain of dealing with so much death and disease. Essentially, we get mulligans all the time.

If we went down with the ship every time we made a mistake, and not only we died, but we took out 300 of our patients along with us, we’d probably start thinking and acting a lot more like pilots.

Commercial pilots understand that they are a cog in the wheel, supported by a team, and if they make a big mistake, they lose their life too. Because of this, they almost worship process, teamwork, and respect for the machine. A checklist and your team saves your life every time you fly. And when bad things happen, it’s in the news and the news is about the airline’s crash, not the pilot’s name. If 100,000 people a year die from medical mistakes, this would be the equivalent of an airliner a day crashing in America consuming a huge part of the news cycle.

Being a great doctor is not about you. It’s about your team. But the system that creates us rewards the wrong things. We should be rewarded for teamwork. We should be rewarded for worshipping a tried-and-true process. We should understand that we’re just a cog in the wheel of our nation’s health. We need to think of our operating rooms or our exam rooms more like planes that we need to respect because our patients’ lives depend on the machine. We should think of our careers as a social good designed to create the safest framework for our patients. And if we could do this, we’d save far more lives than anything doctors have ever invented.

22
A few years ago, I spoke at a conference at the Mayo Clinic and, afterward, shared a ride to the airport with John Hockenberry, the host of The Takeaway on NPR. Back in 1976, while he was hitchhiking in Pennsylvania, he was involved in a car crash that left him paralyzed from the waist down. He now lives in Red Hook, Brooklyn, one of the most remote parts of NYC in terms of public transportation, with his wife and 5 kids. For the most part, he takes public transportation wherever he goes. So I asked him which app he uses to get around NYC’s subway system in his wheelchair. He responded “I don’t use an app.” I was surprised to hear that because not all 468 subway stops in NYC support wheelchair access.“How do you know where you can get on and off and where you can’t? Why don’t you use an app?”“Because I have not found an app that shows real-time updates on wheelchair accessibility. And the first time I used an app that purported to show this information, it was wrong because they were doing construction that day blocking the exit I needed for my stop. So I had to go to the end of the line and hope that the wheelchair exit was functional. Luckily it was functional but it took two hours that day for me to go to the end of the line and back just to get out of the subway system. And my time is so precious that I can’t afford to make those kinds of mistakes. So I’ve just learned the stops that are redundant and are safe for me to enter and exit and I just use those. I mean, when an app is 90% or 95% accurate, but the consequences of the inaccuracies are so large, you just can’t trust them.”That last statement hit me hard and it’s really shaped how I design Sherpaa’s apps. Trust is everything— in love and in apps. If one of our doctors sees information within our app, and it’s not accurate once, they’ll let it slide. But if it’s not accurate twice, they’ll break up with it. The consequences can literally be life or death in not knowing a critical piece of your medical history when diagnosing, say, a blood clot in your lungs. For example, say your online profile you created 9 months ago upon signing up for Sherpaa says you weren’t taking a birth control pill, a significant risk factor for blood clots. But 6 months ago, you started taking one. Five months ago, you started smoking. Today, you contact our doctors complaining of some shortness of breath. And what if our doctors simply looked at your online profile and trusted that, since you forgot to update it with your new medication and also didn’t mention that you smoke cigarettes, they just assumed you weren’t taking one and you were a non-smoker? These huge parts of the story that could point our doctors toward something very serious were simply missing and inaccurate.Online Personal Health Records were all the rage about 8 years ago. Even Google got into the game and created Google Health. This was the place you could go online and create a list of medications you take, diseases you’ve had in the past and currently have, etc. What a great idea right? We even built one into our app. But over time, we’ve found that an online personal health profile is ignored by both our doctors and our patients. It’s ignored by our patients because it’s static and boring. And it’s ignored by our doctors because it’s ignored by our patients. Therefore, it can’t be trusted by our doctors. From a user’s perspective, this had to be the most boring concept healthcare people could invent. It’s static information that you must maintain on an irregular basis when any kind of change in your health happened. It’s about as exciting and helpful as watching paint dry. Following the healthcare pack was the wrong move for us. The right move is asking pointed questions during today’s interaction to get real-time up-to-date information that’s relevant and trustworthy.No wonder Google shut down Google Health. No wonder Personal Health Records never took off and never will take off. They suffer from a lack of trust, with potentially horrible consequences. Trust is the foundation of relationships with not just your lover but also, your apps. Trust is built over time with accurate and consistent data and behavior. If they’re bipolar, you gotta dump them.

A few years ago, I spoke at a conference at the Mayo Clinic and, afterward, shared a ride to the airport with John Hockenberry, the host of The Takeaway on NPR. Back in 1976, while he was hitchhiking in Pennsylvania, he was involved in a car crash that left him paralyzed from the waist down. He now lives in Red Hook, Brooklyn, one of the most remote parts of NYC in terms of public transportation, with his wife and 5 kids. For the most part, he takes public transportation wherever he goes. So I asked him which app he uses to get around NYC’s subway system in his wheelchair. He responded “I don’t use an app.” I was surprised to hear that because not all 468 subway stops in NYC support wheelchair access.

“How do you know where you can get on and off and where you can’t? Why don’t you use an app?”

“Because I have not found an app that shows real-time updates on wheelchair accessibility. And the first time I used an app that purported to show this information, it was wrong because they were doing construction that day blocking the exit I needed for my stop. So I had to go to the end of the line and hope that the wheelchair exit was functional. Luckily it was functional but it took two hours that day for me to go to the end of the line and back just to get out of the subway system. And my time is so precious that I can’t afford to make those kinds of mistakes. So I’ve just learned the stops that are redundant and are safe for me to enter and exit and I just use those. I mean, when an app is 90% or 95% accurate, but the consequences of the inaccuracies are so large, you just can’t trust them.”

That last statement hit me hard and it’s really shaped how I design Sherpaa’s apps.

Trust is everything— in love and in apps. If one of our doctors sees information within our app, and it’s not accurate once, they’ll let it slide. But if it’s not accurate twice, they’ll break up with it. The consequences can literally be life or death in not knowing a critical piece of your medical history when diagnosing, say, a blood clot in your lungs. For example, say your online profile you created 9 months ago upon signing up for Sherpaa says you weren’t taking a birth control pill, a significant risk factor for blood clots. But 6 months ago, you started taking one. Five months ago, you started smoking. Today, you contact our doctors complaining of some shortness of breath. And what if our doctors simply looked at your online profile and trusted that, since you forgot to update it with your new medication and also didn’t mention that you smoke cigarettes, they just assumed you weren’t taking one and you were a non-smoker? These huge parts of the story that could point our doctors toward something very serious were simply missing and inaccurate.

Online Personal Health Records were all the rage about 8 years ago. Even Google got into the game and created Google Health. This was the place you could go online and create a list of medications you take, diseases you’ve had in the past and currently have, etc. What a great idea right? We even built one into our app. But over time, we’ve found that an online personal health profile is ignored by both our doctors and our patients. It’s ignored by our patients because it’s static and boring. And it’s ignored by our doctors because it’s ignored by our patients. Therefore, it can’t be trusted by our doctors. From a user’s perspective, this had to be the most boring concept healthcare people could invent. It’s static information that you must maintain on an irregular basis when any kind of change in your health happened. It’s about as exciting and helpful as watching paint dry. Following the healthcare pack was the wrong move for us. The right move is asking pointed questions during today’s interaction to get real-time up-to-date information that’s relevant and trustworthy.

No wonder Google shut down Google Health. No wonder Personal Health Records never took off and never will take off. They suffer from a lack of trust, with potentially horrible consequences. Trust is the foundation of relationships with not just your lover but also, your apps. Trust is built over time with accurate and consistent data and behavior. If they’re bipolar, you gotta dump them.

20
Nice piece in Wired today: Why Telemedicine Needs to Redesign the Doctor’s Appointment. Essentially, I again make the case that video visits with doctors are essentially a bunch of nonsense. First of all, video visits with random strangers is weird and when things are weird they don’t become ingrained cultural behaviors. Here’s how online communication with doctors should work:Ninety-eight percent of online communication should be asynchronous, email-like messaging within a secure app and 25% of those communications should have photos attached. When this kind of communication is inadequate, jump on the phone. This should happen about 1.5% of the time. When a doctor needs to actually visualize the movement or expression of someone, initiate a video chat. This is a very rare situation, roughly 0.5% of the time, and only applies when email, phone, and photos are inadequate. When consumers are involved, in the end, they always win. And they win by using the best designed solutions that jive with how they want to behave. Video visits as a thing in healthcare are a fad, because they were designed via paternalism without considering patients’ normal behaviors and expectations.

Nice piece in Wired today: Why Telemedicine Needs to Redesign the Doctor’s Appointment. Essentially, I again make the case that video visits with doctors are essentially a bunch of nonsense. First of all, video visits with random strangers is weird and when things are weird they don’t become ingrained cultural behaviors. 

Here’s how online communication with doctors should work:

Ninety-eight percent of online communication should be asynchronous, email-like messaging within a secure app and 25% of those communications should have photos attached. When this kind of communication is inadequate, jump on the phone. This should happen about 1.5% of the time. When a doctor needs to actually visualize the movement or expression of someone, initiate a video chat. This is a very rare situation, roughly 0.5% of the time, and only applies when email, phone, and photos are inadequate. 

When consumers are involved, in the end, they always win. And they win by using the best designed solutions that jive with how they want to behave. Video visits as a thing in healthcare are a fad, because they were designed via paternalism without considering patients’ normal behaviors and expectations.

40

To the man who taught me how to fish, shoot a bow, live off the land at age 6 (it was the height of the Cold War), waterski, hunt for morels, catch some fish and fry them up over a fire along the banks of the White River, how to live in an Airstream, how to drive an old WWII army jeep up some Ozark mountain paths, how to leave a javelina alone, and how to be a man’s man, may you rest in peace. He was married for 70 years and no matter what, he held my grandma’s hand as they went to sleep. He didn’t graduate from 8th grade. But he was a dairy farmer. He fought in World War II. He built gorgeous walnut furniture that was far ahead of his time. He worked at McDonnell Douglas and managed the team of laborers who built Apollo and put some men on the moon. He got to watch the moon landing live knowing that, without him and his vision for craftsmanship, those guys may not have made it up their safely. He never really bought meat, he lived off the land. He fished and hunted anything with a bow and arrow. He killed a bear and we made bear sausage pizza. He shot it right through the heart with that arrow and saved the heart and put it in formaldehyde to do a little showing off. He held a few world records in wild game. He always won gold in the national Senior Olympics for archery for his age. And when he got too old to climb a tree to go deer hunting, he bought a small motion-sensing digital camera and put it on a tree. Every few days, he’d go get the flash card, take it to Wal-Mart to get developed, and see what time deer would show up on the trail every morning. It didn’t take him long to snag a deer without being in a tree. And then he’d have food for a month or so.

But most importantly, my grandfather ensured every single one of his kids had their college education paid for by him. He didn’t want any of his kids to work as hard as he had to. And by doing that, he completely changed the course of this big branch of the Parkinson family tree. Education was everything to him. And he was so damn proud of me because I became a doctor. 

Not everyone has the same opportunities, but absolutely everyone has the freedom to have a vision for what you want your life to be and how you want to influence your family and the world around you. He taught me that you didn’t need money or education to make a a massive difference in the world. It’s not about your profession. You could be a poor dairy farmer in the middle of Missouri and have a vision. You want a wonderful family and you want to instill the values most important to you in them and you want to lead by example. And by doing that, all of the generations that stem from you get to experience the world in a markedly better and more interesting way. When I hear people say something about how they want to do something with their lives and move beyond, say, serving as a hostess at a restaurant, I always correct them saying they have just as much a potential to make their mark on the world as me. Maybe it’s through just being kind to your family or strangers, or being curious and sharing ideas via sparked conversations that lead to something greater than you’ll ever know. Everything you would ever need can be found in your hustle and your vision for milking life and making this world a better place. My grandpa milked this life for all it could offer. I’d be half the person I am if it weren’t for him. 

He told me once, “you know what son, if you sit down, you’ll never get up.” Gramps, you can sit down now. You won.

I made this video of him just a few years ago in what would be his last Senior Olympics competition. My dad and my brother and I flew to Houston to watch him compete. There wasn’t but a few people in that auditorium watching him practice, but I edited the video and threw in some stadium applause for effect. He sure did get a kick out of that.

9

Sherpaa does to the world what email and texting did to the phone and handwritten letters.

Prior to the invention of email, texts, and within-app messaging, we depended on things like telephones and meetings to communicate, relay messages and make decisions. Everything had to happen “synchronously.” Communication was difficult, decisions took longer to make, and execution of a strategy depended on expensive, time-consuming meetings. This was a pain, it was complex, and for the most part highly inefficient. Especially when considering that most transmission of information does not require syncing up schedules. Not everything is important enough to take to the next level and go through the challenge of expensively syncing schedules. And the kind of situation where this is needed falls into the old classic category of “you know it when you see it.” That’s why meetings are called. Or instead of texting you pick up the phone and call the person. Or instead of emailing you walk down the hall and pop your head into your coworker’s office and spend two minutes discussing something to make a decision— something that would have taken multiple email exchanges to solve. When given the option, humans have great intuition to choose the most appropriate method of communication. We’re social creatures from day one. It’s literally in our DNA to communicate efficiently and effectively.

In the last twenty years, we witnessed a huge transformation in how humans communicate. Asynchronous communication, like email and texting, is such a profound change that it’s highly likely that sociologists will eventually split the history of human communication into pre and post-synchronous communication.

And that’s why what we do at Sherpaa is such a profound change in healthcare. Ninety-eight percent of communication that happens between our doctors and patients happens via secure asynchronous messaging within our app. Only about 2% of the time do we step it up to the phone. Sherpaa does to the world what email and texting did to the phone and handwritten letters. It enables things to get done in an entirely new and efficient way. And it gives us options, both doctors and patients, to use our intuition to communicate most effectively. It’s a new era and a new genre of healthcare. One that I know will eventually change healthcare into a new epoch of opportunity.