After completing a residency in pediatrics and one in preventive medicine at Johns Hopkins, I started a practice for my neighborhood of Williamsburg, Brooklyn in September 2007. People would visit my website; see my Google calendar; choose a time and input their symptoms; my iphone would alert me; I would make a house call; they'd pay me via Paypal; and we'd follow up by email, IM, videochat, or in person.

Fast Company calls me The Doctor of the Future. I've got a design and consulting firm called The Future Well. Read more about me here.

  • I took a trip to Philadelphia yesterday to take a tour of Eastern State Penitentiary. It was built in 1829 and became known as the most influential prison in both design and strategy in the entire world. It was the first large building in the United States to have central heating and running water. Of course, neither worked really well— toilets were flushed by the guards only a few times a week. One guard could see down all seven of the hallways at one time due to it’s hub and spoke design and mirrors. It looks like a castle and was built 2 and a half miles outside of Philadelphia’s city center at the time. The spooky castle on a hill was designed to intimate the population into behaving well.
It housed 250 prisoners in 250 cells, in solitary confinement for typical sentences of 2 to 6 years. The most common crime was horse theft. The root word of penitentiary is penance. It was thought that if you put criminals in solitary confinement in a church-like setting, they will have nothing else to think about but remorse and Jesus. They also taught the criminals a trade, like boot-making, so when they got out they could be productive members of society. It even had its own hospital. Contraband was typically smuggled in from outsiders throwing hollowed out baseballs over the walls.
As time went by the penitentiary suffered from overcrowding, riots, disease, and encroachment by the city. It was finally shut down in 1971.
The designers of this prison tried to solve multiple societal problems— how to rehabilitate criminals, how to design a physical place that would foster rehabilitation, and how to prevent criminality. The person that designed this was a genius— not because of his theories on criminality, but because he actually got this thing built. The White House in 1829 didn’t even have running water. But the prison on a hill for 250 criminals outside Philadelphia did. Imagine the politics of that simple statement.
It’s almost 200 years later, and our solution is to throw 3% of our population in privatized prisons and expect that they’ll just get better. In 1829, the entire state of Pennsylvania had 1.35 million people. And only 250 people in its state prison, most doing time for horse theft. Given today’s rate of 3%, they should have built a prison for 40,500 people.
The issue that hit me the hardest was that in 1829 criminologists were dealing with the exact same issues as we are today— how best to rehabilitate criminals. We’ve got the world’s knowledge at our fingertips, but have very little idea how to fix crime. It’s a big fat hairy problem. And 200 years later, we’re really no closer to the solution than we were in 1829. In fact, it’s worse. The rates of criminality needing rehabilitation are astronomically higher.
How many other problems in our society will we be no closer to the solution 200 years from now? How to deliver equitable healthcare to a population of diverse people? How to educate our children? As an optimistic curmudgeon, I’ve always believed in humans’ ability to solve problems. But what if the last 20% of big fat hairy problems are unsolveable because they’re politically motivated human behavior problems? 
The real issue is that these issues can’t be solved with theories. They can only be moved along every so often with politics and cultural changes. Two hundred years, on the grand scale of things, isn’t that long. It’s a few generations. We, hopefully, all play our part in helping society progress. But our lives are just so, so short. I recently talked with someone who said, if you’re an entrepreneur, you should find an idea, build it out, and spend at least 5 years fully dedicated to that idea. At the end of five years, if the idea is working or not working, move on to the next big one. That means, if a typical person works 45 years, they have nine ideas they will work on in their lifetime.
Nine. It isn’t that large of a number. And of those nine, how many of your ideas will truly impact society for the better?  

    I took a trip to Philadelphia yesterday to take a tour of Eastern State Penitentiary. It was built in 1829 and became known as the most influential prison in both design and strategy in the entire world. It was the first large building in the United States to have central heating and running water. Of course, neither worked really well— toilets were flushed by the guards only a few times a week. One guard could see down all seven of the hallways at one time due to it’s hub and spoke design and mirrors. It looks like a castle and was built 2 and a half miles outside of Philadelphia’s city center at the time. The spooky castle on a hill was designed to intimate the population into behaving well.

    It housed 250 prisoners in 250 cells, in solitary confinement for typical sentences of 2 to 6 years. The most common crime was horse theft. The root word of penitentiary is penance. It was thought that if you put criminals in solitary confinement in a church-like setting, they will have nothing else to think about but remorse and Jesus. They also taught the criminals a trade, like boot-making, so when they got out they could be productive members of society. It even had its own hospital. Contraband was typically smuggled in from outsiders throwing hollowed out baseballs over the walls.

    As time went by the penitentiary suffered from overcrowding, riots, disease, and encroachment by the city. It was finally shut down in 1971.

    The designers of this prison tried to solve multiple societal problems— how to rehabilitate criminals, how to design a physical place that would foster rehabilitation, and how to prevent criminality. The person that designed this was a genius— not because of his theories on criminality, but because he actually got this thing built. The White House in 1829 didn’t even have running water. But the prison on a hill for 250 criminals outside Philadelphia did. Imagine the politics of that simple statement.

    It’s almost 200 years later, and our solution is to throw 3% of our population in privatized prisons and expect that they’ll just get better. In 1829, the entire state of Pennsylvania had 1.35 million people. And only 250 people in its state prison, most doing time for horse theft. Given today’s rate of 3%, they should have built a prison for 40,500 people.

    The issue that hit me the hardest was that in 1829 criminologists were dealing with the exact same issues as we are today— how best to rehabilitate criminals. We’ve got the world’s knowledge at our fingertips, but have very little idea how to fix crime. It’s a big fat hairy problem. And 200 years later, we’re really no closer to the solution than we were in 1829. In fact, it’s worse. The rates of criminality needing rehabilitation are astronomically higher.

    How many other problems in our society will we be no closer to the solution 200 years from now? How to deliver equitable healthcare to a population of diverse people? How to educate our children? As an optimistic curmudgeon, I’ve always believed in humans’ ability to solve problems. But what if the last 20% of big fat hairy problems are unsolveable because they’re politically motivated human behavior problems? 

    The real issue is that these issues can’t be solved with theories. They can only be moved along every so often with politics and cultural changes. Two hundred years, on the grand scale of things, isn’t that long. It’s a few generations. We, hopefully, all play our part in helping society progress. But our lives are just so, so short. I recently talked with someone who said, if you’re an entrepreneur, you should find an idea, build it out, and spend at least 5 years fully dedicated to that idea. At the end of five years, if the idea is working or not working, move on to the next big one. That means, if a typical person works 45 years, they have nine ideas they will work on in their lifetime.

    Nine. It isn’t that large of a number. And of those nine, how many of your ideas will truly impact society for the better?  

    88 notes    /   Comments    /   Posted 4 months ago
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    16. matthewdipaolamd said: Curmudgeon? Your eyebrows look nothing like Andy Rooney’s. . Impossible. I hear you friend. But maybe the solution to a politically created problem is not politics at all.
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      great essay - The good Doctor need...modern prisoning, private, for profit prisons
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