Jay Parkinson + MD + MPH = a doctor in NYC

Mar 27

The Future of Primary Care. Let’s consider a few facts: Only about 5% of graduating medical residents chose primary care as a profession for the past decade or so Primary care doctors earn $3.5 million less over their careers than specialists About 70% of primary care visits get referred to specialists About 60% of traditional primary care visits can be done over the phone or over the internet The average primary care visit is less than 8 minutes Patients forget 85% of the information told to them in an 8 minute visit Nobody is going into primary care because the pay sucks and the traditional old-school notion of office-based primary care is the wrong tool for the lifestyle-based health problems that plague our culture. The future of primary care is a completely different process. Primary care will be about communication (90% via messaging, 10% via phone), problem-solving, and triaging to match the individual up with the right professional at the right time. Primary care must have real time access to available local resources. For example, when we get a call from a patient with a cut finger, we need to go to our group of professionals who can stitch that up and see their real time availability. It’s communication and coordination and matching up local demand and local supply. Primary care needs a “God-view” dashboard of ER wait times, ER availability, specialty centers, specialists, urgent care centers, etc. It also needs technology that functions more like a CRM like Highrise mixed with a customer service system more like Zendesk, but of course, designed for medical care.  Problems need to be triaged. We’re finding that about 50% of the problems coming in to Sherpaa can be handled without a doctor. Those problems that need a doctor are then sent to our dedicated virtual Primary Care Physician— a doctor available 24/7 via email or phone to solve the clinical problems that can be handled without a physical visit. And, for the rest of the issues that absolutely need a physical visit, we triage to exactly the right available expert who is best suited to solving the problem at hand. For Sherpaa, it looks a lot like this: The primary care doctors have different roles— they emphasize communication and virtual problem solving rather than maximizing revenue from 8 minute office visits. Think of it like 311 for healthcare, but manned by local doctors with local connections to available resources. This is the future of primary care. It’s a whole different process. It’s a whole different experience. In fact, for patients, it’s a markedly better experience. Just give 311 a call. You can talk to a human in seconds. Imagine a system where you can talk to a local, super well-connected doctor in no time, exactly when you need it. Sounds wonderful doesn’t it? Photo from Eugene Smith’s Country Doctor series

The Future of Primary Care.

Let’s consider a few facts:

Nobody is going into primary care because the pay sucks and the traditional old-school notion of office-based primary care is the wrong tool for the lifestyle-based health problems that plague our culture.

The future of primary care is a completely different process. Primary care will be about communication (90% via messaging, 10% via phone), problem-solving, and triaging to match the individual up with the right professional at the right time. Primary care must have real time access to available local resources. For example, when we get a call from a patient with a cut finger, we need to go to our group of professionals who can stitch that up and see their real time availability. It’s communication and coordination and matching up local demand and local supply. Primary care needs a “God-view” dashboard of ER wait times, ER availability, specialty centers, specialists, urgent care centers, etc. It also needs technology that functions more like a CRM like Highrise mixed with a customer service system more like Zendesk, but of course, designed for medical care. 

Problems need to be triaged. We’re finding that about 50% of the problems coming in to Sherpaa can be handled without a doctor. Those problems that need a doctor are then sent to our dedicated virtual Primary Care Physician— a doctor available 24/7 via email or phone to solve the clinical problems that can be handled without a physical visit. And, for the rest of the issues that absolutely need a physical visit, we triage to exactly the right available expert who is best suited to solving the problem at hand. For Sherpaa, it looks a lot like this:

The primary care doctors have different roles— they emphasize communication and virtual problem solving rather than maximizing revenue from 8 minute office visits. Think of it like 311 for healthcare, but manned by local doctors with local connections to available resources. This is the future of primary care. It’s a whole different process. It’s a whole different experience. In fact, for patients, it’s a markedly better experience. Just give 311 a call. You can talk to a human in seconds. Imagine a system where you can talk to a local, super well-connected doctor in no time, exactly when you need it. Sounds wonderful doesn’t it?

Photo from Eugene Smith’s Country Doctor series

Mar 26

Telemedicine Predicted in 1925: The Teledactyl (Tele, far; Dactyl, finger — from the Greek) is a future instrument by which it will be possible for us to “feel at a distance.” This idea is not at all impossible, for the instrument can be built today with means available right now. It is simply the well known telautograph, translated into radio terms, with additional refinements. The doctor of the future, by means of this instrument, will be able to feel his patient, as it were, at a distance….The doctor manipulates his controls, which are then manipulated at the patient’s room in exactly the same manner. The doctor sees what is going on in the patient’s room by means of a television screen.

Telemedicine Predicted in 1925:

The Teledactyl (Tele, far; Dactyl, finger — from the Greek) is a future instrument by which it will be possible for us to “feel at a distance.” This idea is not at all impossible, for the instrument can be built today with means available right now. It is simply the well known telautograph, translated into radio terms, with additional refinements. The doctor of the future, by means of this instrument, will be able to feel his patient, as it were, at a distance….The doctor manipulates his controls, which are then manipulated at the patient’s room in exactly the same manner. The doctor sees what is going on in the patient’s room by means of a television screen.


nationaljournal: The Supreme Court’s decision on the health care case is more than just a simple yes or no. View this handy chart for possible SCOTUS decisions.  The Health Care Case’s Legal Maze 

nationaljournal:

The Supreme Court’s decision on the health care case is more than just a simple yes or no. View this handy chart for possible SCOTUS decisions. 

The Health Care Case’s Legal Maze 

(via reuters)

Mar 23

And cocaine claims another: Whitney Houston drowned, with cocaine fresh in her system, following a possible heart attack, according to her newly-released initial autopsy report. Cocaine is the most deadly drug in America…more so than heroin. There is no known safe dose of cocaine. Combining it with alcohol puts you at an alarmingly greater risk. It can kill people on their first use or their 10,000th use. If you have anything at all wrong with your heart, even a tiny amount of cocaine can kill you. Please think about this. Here are other good cocaine-related facts: In 74% of cocaine-related fatalities in the United States, another drug, usually alcohol, had been co-ingested. The addition of alcohol to cocaine increases the risk of sudden death 25-fold. Of patients with cocaine-induced heart attack, 38% had normal coronary arteries. More than two thirds were moderate-to-heavy cigarette smokers (>1-2 packs daily). The average number of additional coronary risk factors, however, was less than 1. Most acute cocaine-related nontraumatic deaths are the result of tachydysrhythmias (abnormally fast heart beat). Other causes of sudden death associated with cocaine use include stroke, subarachnoid hemorrhage, hyperthermia, and the consequences of agitated delirium. In patients with an arrhythmogenic anatomic substrate, even low levels of cocaine can cause tachydysrhythmias. (and this is the reason that if you have anything at all wrong with your heart, a tiny amount of cocaine can kill you). The hearts of cocaine users are 10% heavier than those of nonusers. Cocaine users have been found to have a 14-fold increase in risk of stroke when compared with matched controls. Of cocaine-associated deaths investigated by the Medical Examiner’s Department of Metropolitan Dade County, Florida, between 1979 and 1990, excited delirium was the terminal event in approximately 1 of every 6 fatalities. Patients with excited delirium had an immediate onset of bizarre and violent behavior, which included aggression, combativeness, hyperactivity, hyperthermia, extreme paranoia, unexpected strength, and/or incoherent shouting. All of these were followed by cardiorespiratory arrest. Cocaine is the most frequently reported substance associated with drug abuse or misuse deaths. Cocaine is reported in 39% of such drug deaths, ranging from 8-70% in various areas.

And cocaine claims another:

Whitney Houston drowned, with cocaine fresh in her system, following a possible heart attack, according to her newly-released initial autopsy report.

Cocaine is the most deadly drug in America…more so than heroin. There is no known safe dose of cocaine. Combining it with alcohol puts you at an alarmingly greater risk. It can kill people on their first use or their 10,000th use. If you have anything at all wrong with your heart, even a tiny amount of cocaine can kill you. Please think about this.

Here are other good cocaine-related facts:


Mar 21

theweekmagazine: ‘ObamaCare’ goes to court. The Supreme Court on Monday will begin an epic, three-day session to hear opposing arguments over President Obama’s overhaul of the health-care system. The court will be examining four separate angles within the case, each of which is fairly complex. The litigants will address the heart of the matter: Does Congress have the constitutional authority to penalize Americans who do not buy health insurance?  Here, a guide to the blockbuster case

theweekmagazine:

‘ObamaCare’ goes to court. The Supreme Court on Monday will begin an epic, three-day session to hear opposing arguments over President Obama’s overhaul of the health-care system. The court will be examining four separate angles within the case, each of which is fairly complex. The litigants will address the heart of the matter: Does Congress have the constitutional authority to penalize Americans who do not buy health insurance?

 Here, a guide to the blockbuster case

(Source: theweek.com)

In 2009, I was included in Esquire Magazine’s annual year end Best and Brightest list of about 20 people they think are doing wonderful things. It’s still one of my professional highlights. One of the others that year was a gentleman named Daron Acemoglu. I was fortunate enough to sit next to him for about a three hour dinner and drinks shindig put on by Esquire. Needless to say, he’s an impressive guy and currently known as the hottest economist out there. He’s just published a book called “Why Nations Fail.” The essential argument of the book is that “the wealth of a country is most closely correlated with the degree to which the average person shares in the overall growth of its economy.” According to Acemoglu’s thesis, when a nation’s institutions prevent the poor from profiting from their work, no amount of disease eradication, good economic advice or foreign aid seems to help: I observed this firsthand when I visited a group of Haitian mango farmers a few years ago. Each farmer had no more than one or two mango trees, even though their land lay along a river that could irrigate their fields and support hundreds of trees. So why didn’t they install irrigation pipes? Were they ignorant, indifferent? In fact, they were quite savvy and lived in a region teeming with well-intended foreign-aid programs. But these farmers also knew that nobody in their village had clear title to the land they farmed. If they suddenly grew a few hundred mango trees, it was likely that a well-connected member of the elite would show up and claim their land and its spoils. What was the point? This reminds me so much of physicians in America. Primary care is in such a bad state. Only about 5% of graduating residents are choosing primary care mostly because primary care doctors can expect to earn $3.5 million less than a specialist over their lifetimes. There’s really no rosy future that suggests this will get better. Currently, our medical industry is composed of 75% specialists and 25% generalists, exactly opposite of the UK and Canada, both of which rank much higher than us in nearly all health statistics. In the next decade or two, when boomers retire, primary care is essentially dead. And this is the elephant in the room for Obamacare. Obamacare depends on primary care to control costs, by creating the theoretical Accountable Care Organization. With only a tiny fraction of the physician workforce being primary care over the next decade, the ACO model falls apart.  Now back to Daron’s theory. The medical industry is 20% of our economy. It alone is something like the 4th largest economy in the world. Let’s say that the primary care doctors are the equivalent of these Haitian mango farmers. Why would they try to put any effort into making their little corner of the industry any better when, at any moment, they’ll get squashed by the specialists and the other folks in the industry who are much more politically powerful?  As one of my favorite doctors in all the world, who happens to be a primary care doc, recently said to me, “The hospitals…they always win.” There’s a was a sadness in her voice, a defeat.  But Acemoglu isn’t pessimistic. In fact, he said he’s enthralled by the Tea Party movement and Occupy Wall Street because it shows that the American people still feel like their voices can be heard. But, what happens when the police intimidate too many protesters? That’s when countries fail.  I’m only worried because primary care doctors are so overworked, so underpaid, and so few that they can’t organize themselves and muster up an influential voice with a say. What does that mean to healthcare in America? If primary care is a healthcare system’s foundation, will I have to write the book, “Why Healthcare Systems Fail.”

In 2009, I was included in Esquire Magazine’s annual year end Best and Brightest list of about 20 people they think are doing wonderful things. It’s still one of my professional highlights. One of the others that year was a gentleman named Daron Acemoglu. I was fortunate enough to sit next to him for about a three hour dinner and drinks shindig put on by Esquire. Needless to say, he’s an impressive guy and currently known as the hottest economist out there. He’s just published a book called “Why Nations Fail.” The essential argument of the book is that “the wealth of a country is most closely correlated with the degree to which the average person shares in the overall growth of its economy.” According to Acemoglu’s thesis, when a nation’s institutions prevent the poor from profiting from their work, no amount of disease eradication, good economic advice or foreign aid seems to help:

I observed this firsthand when I visited a group of Haitian mango farmers a few years ago. Each farmer had no more than one or two mango trees, even though their land lay along a river that could irrigate their fields and support hundreds of trees. So why didn’t they install irrigation pipes? Were they ignorant, indifferent? In fact, they were quite savvy and lived in a region teeming with well-intended foreign-aid programs. But these farmers also knew that nobody in their village had clear title to the land they farmed. If they suddenly grew a few hundred mango trees, it was likely that a well-connected member of the elite would show up and claim their land and its spoils. What was the point?

This reminds me so much of physicians in America. Primary care is in such a bad state. Only about 5% of graduating residents are choosing primary care mostly because primary care doctors can expect to earn $3.5 million less than a specialist over their lifetimes. There’s really no rosy future that suggests this will get better. Currently, our medical industry is composed of 75% specialists and 25% generalists, exactly opposite of the UK and Canada, both of which rank much higher than us in nearly all health statistics. In the next decade or two, when boomers retire, primary care is essentially dead. And this is the elephant in the room for Obamacare. Obamacare depends on primary care to control costs, by creating the theoretical Accountable Care Organization. With only a tiny fraction of the physician workforce being primary care over the next decade, the ACO model falls apart. 

Now back to Daron’s theory. The medical industry is 20% of our economy. It alone is something like the 4th largest economy in the world. Let’s say that the primary care doctors are the equivalent of these Haitian mango farmers. Why would they try to put any effort into making their little corner of the industry any better when, at any moment, they’ll get squashed by the specialists and the other folks in the industry who are much more politically powerful? 

As one of my favorite doctors in all the world, who happens to be a primary care doc, recently said to me, “The hospitals…they always win.” There’s a was a sadness in her voice, a defeat. 

But Acemoglu isn’t pessimistic. In fact, he said he’s enthralled by the Tea Party movement and Occupy Wall Street because it shows that the American people still feel like their voices can be heard. But, what happens when the police intimidate too many protesters? That’s when countries fail. 

I’m only worried because primary care doctors are so overworked, so underpaid, and so few that they can’t organize themselves and muster up an influential voice with a say. What does that mean to healthcare in America? If primary care is a healthcare system’s foundation, will I have to write the book, “Why Healthcare Systems Fail.”

Mar 18

Average Congresscritter gets 1,452% raises when they turn corporate lobbyist -

Former Congressman Billy Tauzin (R-LA) made $19,359,927 as a lobbyist for pharmaceutical companies between 2006 and 2010. Tauzin retired from Congress in 2005, shortly after leading the passage of President Bush’s prescription drug expansion. He was recruited to lead PhRMA, a lobbying association for Pfizer, Bayer, and other top drug companies. During the health reform debate, the former congressman helped his association block a proposal to allow Medicare to negotiate for drug prices, a major concession that extended the policies enacted in Tauzin’s original Medicare drug-purchasing scheme. Tauzin left PhRMA in late 2010. He was paid over $11 million in his last year at the trade group. Comparing Tauzin’s salary during his last year as congressman and his last year as head of PhRMA, his salary went up 7110%.

Mar 17

Walking Brooklyn with Kari on this lovely St. Patty’s Day.

Walking Brooklyn with Kari on this lovely St. Patty’s Day.

These mimic Frank Netter in many ways, but updates Netter’s legendary paintings for the digital age. Gorgeous. (via Marcin Oleksak’s Medical Illustrations at Street Anatomy)

These mimic Frank Netter in many ways, but updates Netter’s legendary paintings for the digital age. Gorgeous.

(via Marcin Oleksak’s Medical Illustrations at Street Anatomy)

Mar 16

Went to the Tilton Gallery for the David Lynch opening this fine evening. I saw one of my heroes in the flesh. Love that hair. If I were you, I’d definitely check out the show.

Went to the Tilton Gallery for the David Lynch opening this fine evening. I saw one of my heroes in the flesh. Love that hair. If I were you, I’d definitely check out the show.

[video]

18 Delightfully Artistic Vintage STD Posters They don’t make em like they used to.

18 Delightfully Artistic Vintage STD Posters

They don’t make em like they used to.

Mar 15

[video]

Mar 14

Most startup ideas should terrify you.

texturism:

don’t worry, it’s not a sign of weakness. arguably it’s a sign of sanity. the biggest startup ideas are terrifying. and not just because they’d be a lot of work. the biggest ideas seem to threaten your identity: you wonder if you’d have enough ambition to carry them through.

there’s a scene in being john malkovich where the nerdy hero encounters a very attractive, sophisticated woman. she says to him:

here’s the thing: if you ever got me, you wouldn’t have a clue what to do with me.

that’s what these ideas say to us.

this phenomenon is one of the most important things you can understand about startups. you’d expect big startup ideas to be attractive, but actually they tend to repel you. and that has a bunch of consequences. it means these ideas are invisible to most people who try to think of startup ideas, because their subconscious filters them out. even the most ambitious people are probably best off approaching them obliquely.

- paul graham, frighteningly ambitious startup ideas

this post and several idea have been keeping me up at night. in a good way.

kenyatta: “Creativity is about connecting things. When you ask a creative person how they did something, they may feel a little guilty because they didn’t really do it, they just saw something.” - Steve Jobs.

kenyatta:

“Creativity is about connecting things. When you ask a creative person how they did something, they may feel a little guilty because they didn’t really do it, they just saw something.” - Steve Jobs.