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.

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.

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.

This is Spencer. He’s awesome. For the past year, he’s done a ridiculously important job here at Sherpaa. He’s served as the doctors’ go to person for anything and everything they need to efficiently practice their best medicine and make everyone’s lives run smoothly. But we’re very sad that he’s moving back to California and will be leaving us. That means we have to fill his extremely important role in helping the most forward-thinking doctors at the most forward-thinking healthcare company practice as efficiently as possible. Spencer worked with me to create the position. And now we’ve got to take it to the next level. 

For this job, you’ll need:

  • Strong verbal and written communication skills
  • Organizational skills
  • Strong research and analytical skills
  • Speedy, high-quality responses to day-to-day tasks required of our doctors

You’re probably someone who wants to pursue a career in healthcare. You might be pre-med or pre-nursing and want to see what it’s like to practice medicine in the future. You want to help people with their health and you want to work with our doctors out of our office here in Soho. That being said, you must live in NYC and want to work with our team of 30 here at Sherpaa. I’m very proud of our company, our service, and of Spencer. And I want to say the same about working with you. Please send me an email to with links to who you are, your personal story, and why you want to work with our team here at Sherpaa.