Using the ER for Dental Problems – Symptom of a Non-System for Health Care

More patients with routine dental problems turn to hospital emergency rooms –

I know that patients I see defer so much care for dental issues. This report confirms what I see in the clinic every time I’m there.


Compassion – Tell Your Story

I have long been a collector of stories.  As a physician, I am privileged to hear very intimate stories that reflect the greatest joys and the deepest sorrows of human beings.  I am amazed at the healing power of even seemingly small acts of compassion and their long-lasting impact.  Check out this TED video and then go to the Charter for Compassion to tell your story.

Compassion – Tell Your Story

A Useful Article About Change in Health Care Settings

Change Management in Health Care Organizations

This article presents a useful approach to thinking about change and transitions in health care.  Robert J. Campbell speaks of many steps in the change process, but I am particularly struck by his discussion of “managing endings” and “managing beginnings.”  We have all heard the phrase, “when one door closes, another one opens.”  What sometimes gets lost in that truism is that it sometimes takes TIME between the closing and the opening of doors.  Friends of mine refer to this period as “hanging out in the dangle.”  It can feel like an abyss, and while sometimes it is a mercifully brief interval, there are times when it is not.  Remembering that this is part of a normal process is key to surviving the “hanging out” period. Having a support system and remembering to manage self-care during this time are also critical survival strategies.  And on the other side, managing the beginning, and setting realistic goals for the new adventure provide a framework for a healthy new start.

Welcome, Friends

There are a handful of folks I have invited to the early, “beta” version of my new blog.  I would appreciate any feedback and thoughts you might give.  I hope to use this site to discuss change, both personal and professional, and to link those discussions to things my readers may have some interest in from their own experiences.

Thanks in advance to those who agree to jump in.  I will let you help me decide when this is ready for a “public” audience.


The Accountable Care Act Turns Two! Thoughts on an Anniversary

As a preventive medicine, public health and health policy-trained family physician from a rural community, who has worked with underserved folks for nearly 25 (yes, really!!) years, I have to share this infographic. The Accountable Care Act is not perfect, but it moves us toward more equitable distribution of health care, provides for cost reductions, quality improvement, increased access and maintains our capacity as a nation to lead the world in health care innovation.

The fundamental problem is that we are no longer able as a society to pay for all the things we can DO in medicine, and we are struggling to come to terms with that.

If the ACA goes away, all the things in this graphic will go away. If the mandate goes away, the whole thing falls apart, because the insurance companies won’t play.

For those who are NOT celebrating the two-year anniversary of the ACA, I would issue a polite, but firm, challenge: Design a program, using public policies you can agree with, that would achieve these things. I have seen no other such proposal anywhere; absent one, I will support the ACA, and yes, celebrate it!

INFOGRAPHIC: The Affordable Care Act Turns Two


Today, I posted this, my most political post ever, to Facebook. With some trepidation. I know those who follow me on Facebook are made up of a number of folks who probably disagree with the premise; I know some of them will respond negatively. But I firmly believe that our current “status quo” in health care is not a “health care system,” but a “disease care industry.” I also firmly believe that the moral decision that over 50 million human beings who live in the richest country on the planet should be excluded from access to the most basic of health care is a hideous and unethical choice we have made for over 30 years. I believe these things to be unacceptable to me as a human being.

The political winds blow in many directions, and a lot gets lost in the crosswinds. The bottom line is, more people have more access, and costs are going down, and quality is going up (yes, physicians are being held accountable for the health of the populations they serve, and so are hospitals, health systems, educational institutions, and perhaps even politicians). This law has many things that need to be tweaked, and if it survives the Supreme Court challenge that begins week, many of those issues will be addressed, hopefully in a bipartisan fashion. But the ACA provides forward motion that leads to more people being able to afford basic health care, improvement in the quality of that health care, and more concern for the experience of patients, who are, in fact, a primary reason the industry exists – all of this is good.

Two years ago last week, I was in Washington, DC on the day the law was signed. I found myself in Washington again over the weekend, and was glad to be there for the second anniversary.