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submitted by Zipdox to copypasta

[Table] I am a doctor, rapper, and video maker who's trying to revolutionize healthcare and stuff. AMA!

Verified? (This bot cannot verify AMAs just yet)
Date: 2013-11-24
Link to submission (Has self-text)
Questions Answers
You want to revolutionize CARE. What is the biggest issue in the current CARE model and how do you plan on reforming it? Reimbursement model (this directly influences the care model). Current fee-for-service incentivizes us to do things TO people, not FOR them. Change it to a flat membership fee (for primary care) and a fee-for-outcome for most everything else.
Team Based Care: we talk about patient-centered medical homes but it's just talk, and when implemented it's pretty much polishing the existing turd. We need to rebuild our care model around a collaborative, non-hierarchical culture. Interdisciplinary, core-value driven. That's why we use health coaches, docs, nurses, nurse practitioners, and social workers together. They huddle every morning to talk about all the patients that are coming in, as well as patients that we haven't seen that we're worried about.
The days of one doc-one patient should end. Humans are complex systems deserving of a robust team approach.
Also, we need to respect the mind-body interface (heck, how do you think the placebo effect, one of the strongest healing phenomena we know, works?) and allow for TIME in visits to talk, develop relationships, tease out the underlying drivers of "disease". It's health care, not just sick care.
The placebo is a very interesting effect but is it true that it works wonder only for a short time? If it is a chronic problem, the problem will come back after some duration of time. It's very complicated. There are short term and long term effects, but one thing is clear: what we describe as "the placebo effect" is simply some influence that our conscious and subconscious mind has on our physiology. I think it goes beyond hormone release and has a deeper effect (I'm not talking metaphysics or magic here though). We need to understand it better in order to harness it. I think it's also what drives much of so-called "alternative medicine": highly effective because they harness the mind (but are they more effective than another placebo? Hmmm...)
Nothing you're promoting will revolutionize anything... You're simply going to try to have the government mandate more things and you're going to simply further increase the overhead cost of medical care. Sorry? I think you have me confused with a communist. Our care model has NOTHING to do with government mandates and everything to do with providers developing their own culture and protocols. Removing fee-for-service FREES us from interference and allows us to do our jobs. A nightmarish system? Take a look around. That's what exists NOW. Government funding insurance for people who can't afford it is NOT government control of physicians. PS I do appreciate your viewpoint and question though, it triggers important discussions.
Alternative medicine incorporates a more holistic approach when treating diseases. Maybe this is just my perception but doctors, scientists and science in general do not take that seriously due to the lack of experimentation and peer-reviewed studies being carried out in the field of alternative medicine. How do you plan on investigating the reliability of alternative medicine and changing the viewpoint that a holistic approach is less of a witch-doctor practice and more of a healthy way to treat patients? I agree. Alternative medicine is well-received because it isn't reductionist like much of Western medicine, and there is touch and relationship driving the interactions. The problem is that the studies that have been done (of any reasonable quality) haven't shown alternative medicine to be more effective than placebo (which again gets at how damn effective placebos are). Also, much of alternative medicine is couched in pseudoscientific language and a degree of religious-like magical thinking.
Connect with the heart as well as the mind.
See the big picture.
Better understand the role of nutrition and social factors in health.
Better understand the influence of the mind on the body.
Here's an interesting take: do you think fee for service is more of the issue, or do you profit for service is more of the issue? I don't think reasonable service fees in medicine are necessarily a bad thing, I think you only run into unnecessary procedures/tests getting performed when they are profitable. What is your take on perhaps a system where the profit is instead built into the flat membership fee, and additional services performed are billed at cost? Haha, your proposal is in fact our model! We build in a slim profit into the membership fees, and anything else we do (vaccinations, medications, etc) is billed at cost (no administration fee). The profit happens when people are healthy and happy, because they sign up again (or their employer renews with us, or their insurer continues to pay our membership fees knowing they are saving money in downstream averted costs).
It necessarily is not a free market solution if you accept any money from the government. That isn't an opinion. Disagree. BTW, we don't/can't accept medicare or medicaid. I don't care how the care is funded, as long as we can practice our model (which we think works best for patients/providers/and employers)
You're going the right way if you are trying to move away from the present model of churn patients through to charge them to medicare/aid as quickly as possible; I see that, I get it. But without radically removing the government from your system, you're not revolutionizing anything.
I see your married. What on earth does your S/O think about all of this? Haha! She's a radiologist and views me with a kind of odd clinical detachment that allows her to soldier on in the face of my absurdity ;-)
What is your most interesting/shocking patient story? Also can you please make a rap about it. Oh man, there's a million of them. One of my favorites was a young woman with psychiatric illness who kept eating random inedible things. We had to remove EVERYTHING from her room because she would eat them if we didn't. The gastroenterologist passed a scope into her stomach and found a bunch of buried treasure, most fascinatingly his own scope! See, she'd swallowed fragments of her room mirror, and the GI doc was seeing his scope reflected back at him.
Oh wow. I don't even. I can't comprehend how consuming inedible things could become an idea for someone let alone an obsession. Thank you for your reply, very interesting. The world is a strange and wondrous place for sure! Thanks for your question!
"DO-odd-deNUM" or "DUO-dee-NUM?" WOW. Best question yet!
Prior to medical school, I was a DO-odd-deNUM guy. Then UCSF forced me to call it DUO-dee-NUM.
But I still refuse to say "SANT-i-meter"
I hate "SANT-i-meter" - so arrogant ad uppity. I don't get it either. I don't have a dollar and 50 "sants."
It just makes no sants to me at all.
Hiring any clinical social workers? We just hired an AMAZING one, but we are always building our pipeline so definitely hit up Link to iorahealth.com and submit your resume. Or email us at [email protected] -- thanks!
I just wanted to ask how your care model differs from the capitation models of the 90's, which weren't very successful. Are your membership fees risk-adjusted? If so, don't you end up charging poorer (who are often sicker) patients higher fees? Doesn't that discourage the very same patients you're hoping to capture from signing up? If your membership fees aren't risk-adjusted, then what incentives are there for the clinic to take sicker patients? Sorry for all the questions, but I'm VERY interested in seeing how population-based and interdisciplinary models of care can be economically feasible (so they can be disseminated far and wide). I feel like some of the big ACOs like Kaiser and Geisinger are starting to make real progress in this direction, and they don't have a capitation model. How do you feel about ACOs? Re: 90's capitation, the difference then: insurance companies (HMOs) were imposing capitation and it was treated as a zero-sum game: if you avoid treating a patient, you SAVE money, and they go somewhere else that will absorb the cost of your under treatment (like a hospital, ER, or another medical group). Incentive then is to do LESS without regard to outcomes. BAD. In addition, HMOs restricted patient choice. BAD. BAD. BAD. You go elsewhere and cancel your membership with us. Your employer sees data showing that you are getting care in expensive outside locations, that you are unhappy, and that your outcomes (HTN control, BMI, smoking, etc) are crappy. Then THEY take their employees elsewhere. We NEVER restrict patient choice. They can go to any specialist (they may have to pay higher copays, etc) and they can leave us any time. However, we build relationships with them so that our opinions on specialists, care coordination, etc and more likely to be heard and trusted. That's our model. Empower patients by helping them to be a level on a 2.8 trillion dollar juggernaut.
I believe the hidden curriculum in med school burns students out to become passionless and boring, which sounds like the problem you had until you started funny videos. My question is - how to prevent this phenomenon at the med school level? My second (related) question is - is this problem best solved at the med school level? resident training level? etc. Thanks. BLAM. You hit it on the head. Med school is designed to MAKE US SUCK. Really, this is not hyperbole. To stay yourself throughout med school is a Herculean task with everything arrayed against you.
Here's the thing though: as much as I love to bash Millennials, I think they are going to slowly shift the culture of medical training. They're spoiled enough not to put up with that old skool BS anymore.
I think you have to start even BEFORE med school, in the pre med world. Currently it's swarming with a-holes each trying to out a-hole one another. We need to change the admissions process to value traits we want in docs, and that will by extension change the premed process. Forget numbers and focus more on emotional IQ and other factors. There will always be a place in healthcare for folks without high emotional intelligence/empathy (research, surgery, radiology ;-) ) but we need to skew the numbers in the direction of people who get along with people well.
That will then create an environment in medical school where there will be a bottom-up shift in the culture, especially as the old attendings perpetuating this sad culture die off and are replaced.
OK, I'm starting to rant now. takes valium ahhh. That's better. Peace and love yo!
Awesome. Keep up the GREAT work!! Also, I don't know if you've seen this already, but I thought you might appreciate it. Link to www.youtube.com. WOW. That video was hilarious! Sharing everywhere I can, thanks.
Psych resident here. Can't describe how much I had to unlearn about what I was taught in med school to be able to do my job better. Sounds like a Yoda quote, but it's certainly true...
Which of your named jobs do you like doing most? Why?? Making videos takes the proverbial cake. It's an amazing feeling to create something, especially with friends, and see it broadcast to the world via social media and feel the feedback (for better or for worse).
My 4th grade yearbook has a bunch of kids signing in the back things like "good luck with your pop star career." Luckily, I got to feel like a pop star doing this WITHOUT having any of the required talent!
As a filmmaker, I totally agree! That's awesome man, keep doing what you're doing! Sweet!
Have you ever seen that rap video that CERN scientists created about the Higgs Boson? What do you think about making one for healthcare? Seen it and love it. Attempts by others have been made.
We're thinking about an overall "fix healthcare" rap...
With your new project in NV what would you say has been the most surprising aspect of the new endeavor? Haha, you are perfect for us! check out Link to iorahealth.com
What new abilities in yourself have you found by taking on this project? Surprising aspect? That there is such a groundswell of popular community support for what we're doing. It's really a moving thing to experience.
How and through what methods are you going to use to keep the momentum for keeping the culture of your clinic steered in the way you desire it to go? New abilities? haha, pretty much everything I've had to do is new for me! I'm constantly pushed, challenged, scared, and amazed.
Now qhat type of workers do you need out there in Nevada? We are working with Iora Health and we are together working to scale their amazing culture. It's about people in the end, and the right people with the right core values make it work.
Did I mention I have an art degree? We are constantly needing to recruit as we grow, so spread the word!
I am so happy to see you challenging the insurance/ primary care paradigm. Cutting insurance out of the upkeep and maintenance of the human body. For those of us with chronic conditions- like crohn's, MS, and type one diabetes- otherwise hard working and functional members of society- yet also considered a drain to the healthcare payment system as it stands now (even with the remarkable ACA updates to the insurance game "read- still not much of a help for the chronically ill"). What initiatives/ changes can help deal with the cost of chronically ill people? Thanks for the question! Actually, our highly collaborative flat fee primary care model is ideally suited for chronic disease management. See this article in the New Yorker on our partner Dr. Fernandopulle's pilot clinic in Atlantic City using the health coach model we'll be employing: Link to www.newyorker.com
No more fee-for-service management of chronic conditions. Instead, open access to your care team, mental health support on site, and group classes on managing chronic illness that create mutual accountability.
Best 5 rappers of all time? And how do you see the rap game today? In no particular order: E40, Jay-Z, early Kanye, Tupac, and I also like Bay Area underground rapper Saafir.
The rap game today? Hope mixed with despair, son.
Early kanye? Yeezus will give you industrial beats and you will like them. Opinions on Kendrick Lamar? Kendrick Lamar is a genius.
The Later Ye Saint tho, I can't listen to it since he dissed my boy Tony Hsieh ;-)
As someone who was recently accepted to medical school, I've seen your commentary on the state of healthcare and the burdens it places upon the practicing physician - what are your biggest points of advice to an entering medical student today? I truly believe that things are only going to get better for up and coming physicians in the future. I actually think it's the most exciting time in history to be a medical student. As we shift from the old system to what invariably will be better (how can it not be?) we will see advances in care models, technology, and even fundamental changes in how we train med students. Most importantly, we'll see a shift in the culture of medicine and I think this will be driven by our millennial generation.
So get fired up! By the time you graduation and finish your training, you'll get to work in a system that deserves you.
Who would you want to collaborate with? Alive, dead or not even born. Weird Al.
Dr. William Osler.
The band Men at Work.
General Zod from Superman II.
Oh my Zod! Kneel before ZOD!!
Dr. Osler? Your medical nerdiness is showing. Can't help it. I'm a massive dork.
What's your single greatest failure? Not recognizing how unsustainably miserable our current healthcare system was...earlier.
What would you have done if you did realize this earlier? I would have unplugged from the matrix earlier and started our clinic so we might have influenced the Obamacare discussion before it turned into all this.
Would you still have pursued a career in medicine though? Yes. Absolutely. I couldn't do what I do and be who I think I was supposed to be without having gone through this. I'd absolutely do it again.
That's reassuring because so many people are advising against pursuing medicine. Don't listen. There will always be something for you, a niche, in healthcare, if you keep your eyes clear and don't settle.
Ever think about becoming involved with organized medicine? What would be your advice to them about how to engage with doctors and get buy in on visionary improvements to the system? This is a tough question. I've personally never been found of organized anything, let alone organized medicine. The organizations are calcific, tradition-bound, and often vested with interests that counter the interests of patients. Good people in bad systems I feel.
I know that there is a lot of resistance to utilizing Placebos as a legitimate treatment option due to the ethical consideration of lying to patients. But more modern research is starting to showing effectiveness even when the patient knows it's a placebo. Do you think they have a place for legitimate treatment option? If so how do you go about fixing the pbranding problem? I LOVE this question! I've been thinking about it a lot. There's NO reason we can't give someone a pill, tell them that it is mostly sugar but that many patients have found tremendous relief from it. That's not lying, and as you mention the placebo effect works EVEN WHEN WE KNOW IT'S A PLACEBO!
We don't understand the mind-body connection at all. But let's harness what we can until we do!
Do you sit, with a team and brainstorm lyrics or do you just right them yourself? (Or do you have a ghostwriter gasp?) It's a mix. The best lyrics come from collaborating with others (mainly one Dr. Harry). We then bounce stuff off each other and see what sticks. Inevitably poo gets mixed into all our lyrics. Not sure why. Wait a sec, yeah, I'm pretty sure why.
When will you team up with Dr. Ron Paul to revolutionize health care? As soon as I can construct a tinfoil helmet thick enough to prevent the government radio waves from entering my skull and forcing me to believe that sometimes government can be helpful.
What do you see happening in the field of psychiatry with all of these changes taking place in healthcare? I'm a current 3rd year medical student considering going into this field, and would appreciate your opinion. Also, I love your stuff! My mom's a psychiatrist of the old skool with a couch and notepad and s**t. I'm thinking more and more we're transitioning to an era where technology is leveraged to ENHANCE the human relationship, not replace it.
So telepsych is certainly coming.
Current reimbursement models favor visits focused on psychopharmacology as opposed to a more holistic approach. I think as we shift to fee for outcome this will change as well. We understand the mind-body connection poorly but as we get better we can harness therapies that don't rely as heavily on medications.
Now I'm rambling.
Tips for getting through med school? Really hard staying motivated with the studying. Smoke a LOT of weed!
Just kidding. Or am I?
Seriously, it helps to remember WHY you are doing this. Why did you go to medical school? Reconnect with that feeling, meditate on it, remember it. Much of what you're slaving over now you will incorporate subconsciously as a practicing doc, so think of it as building the deep fabric of who you will be.
In the end IT IS TOTALLY WORTH IT!! The world is your oyster when you finish (that sounds lame, but it's true).
Which would you rather fight: one horse-sized duck, or 100 duck-sized horses? This is where it gets real. What weapons do I have?
Your bare hands and your razor sharp wit. Ducks, as we know, imprint on the first thing they see when born. They then pretty much think "Mommy."
I would make sure this Horse-Duck imprinted on me and therefore would be unable to harm me. Now presuming it wasn't just spawned for this battle, the window for imprinting might have passed, so on to plan B.
Force feed it grass nearby until it dies of acute fatty liver. Then it's FOIE GRAS TIME B*TCHES!!
What kind of stuff do you rap about? Who is your favorite rapper? How does one go about making a video with one camera? Can I have a link to your album? Link to www.youtube.com
Favorite rapper = several (E40, Jay Z, et. al)
No album yet, just a bunch of YouTube videos.
One camera's all you need with some clever editing and a tripod and most especially a green screen. That way you can put yourself in any scene/ any backdrop.
This is some funny stuff. As a doctor, how do you feel about the medicinal use of mj? Would you recommend it to your patients for pain, etc if you were in a state that allows it? I think marijuana should be legal. Period. Forget about medicinal use, it should just be legal. We have toxic compounds that are currently legal and regulated (tobacco, alcohol) and yet we ban this substance and incarcerate it's users. Madness.
How certain are you that it will be financially sustainable? It seems like you're able to offer a lot for a low price. Can you share with us any numbers on how many times you expect an average patient to access various services or anything like that? They have no specific requirements beyond a high emotional intelligence and empathy and an ability to listen and connect. They are trained on the medical stuff and the health coaching. Many have vaguely medical backgrounds such as being an EMT, etc. Experience with prior pilot clinics has been that patients come for the docs, but stay for the relationship they've built with their health coaches. In pilot clinics, average touch points with patients are around 6 times/year in healthy populations, 11X in very sick populations, and our staffing is designed appropriately for the population.
Also, as medical students,w e are repeatedly advised to make minimal contact with social media. We sign professionalism agreements to ensure we dont "embarrass ourselves, our institutions and patients trust in us" Great question. Social media is the future of how healthcare information will be disseminated and how we as providers can become more human, more accessible, and more engaged. We should be ENCOURAGING medical students to engage via social media while teaching them appropriate boundaries and professionalism (much of which is common sense, and some of which isn't...like HIPAA). Dr. Kevin Pho (aka KevinMD) is great example of how to harness social media to do great things in healthcare.
What do you think will be the most significant outcome of the human genome project? Individualized therapies (drugs etc) that take into account personal responses.
Better understanding of risk (DM, CAD, etc) by understanding someone's genetic profiles. 23 & Me is a great example (I've done it, learned A LOT).
The end to "one size fits all" medicine and the beginning of clinical trials tailored to and subdivided by genetic profiles.
It seems like you were an attending at that point? Yes, I was an attending but thanks to work hour limits for residents our call days SUCKED.
Do you feel your personality aligns with the Zappos culture? I feel that Zappos is WAY too cool for me. I strive to be more like them and to incorporate elements of their culture into what I do. But every time I watch one of their all-hands meetings, I'm blown away by how smart, funny, and awesome their culture is.
I watched Hard Doc's Life. Which doctors, if any, aren't earning a living wage or have to buy shoes at Payless? I'm in Canada, but all the doctors I've met up here, including GPs who work now and then at walk-in clinics when they feel like it, are earning lots of money. $200K of debt after 7 years minimum of post graduate education during which you are making zilch, then as a primary care doc you might make $150K/yr (sometimes more, sometimes less) minus malpractice etc...you ain't buying Bruno Magli's.
Hard Doc's Life was hyperbole, but illustrates the point that non-specialist physicians in the states are paid and treated as second class citizens relative to specialists...which is exactly backwards from a public health standpoint.
How do you feel about the most recent changes to the healthcare system? Insurance reform isn't care reform. We need both to be successful! We're working on the care reform part, and we're partner with folks that are acing the insurance reform part (Nevada Health CO-OP).
I whole heartedly agree! You built a demo kitchen? That is awesome! Damn, I wish I lived in Vegas and could be part of your team! Best of luck and if you ever decide to bring Turntable Health to San Diego I will be the first to sign up as a midlevel!! Sweeet!
I know it's late, but do you think that insurance reform (and/or single payer) will eventually lead to care reform? I think they need to happen concurrently to have the greatest chance of success. For example, I think Obamacare is doomed to fail if we can't bend the cost curve, and that will never happen with fee-for-service focus on sick care. So if we have models focused on wellness and chronic disease prevention/management, if we address end of life care properly, and we have docs who are now inspired to go into primary care because it no longer sucks to take care of people, then we bend the cost curve, and the govt can afford to help more people get coverage, and health improves while costs decrease (a virtuous cycle). A long way to go, but we'll get there.
Hey Zdogg, I love your videos and parodies. (Dr. Harry cracks me up) I feel like I can really relate to you, because I have a good sense of humor and I love to joke around while also having a sense of seriousness. You have inspired me to persevere as a pre-med, and I hope one day I can be as good of a doctor as you are one day. My question: I am starting medical school next year; any words of advice to a newbie? Thanks!! CONGRATULATIONS! See my answer to the other medical student. You are in for an amazing ride if you keep your bearings on who you are and why you did this in the first place.
I'm going to have to buy health insurance, I'm 24, have a very serious back injury from 6 years ago, and make less than $30,000 a year. Is it more prudent to buy the cheapest plan possible because I'm young or should I try and squeeze a better more expensive plan in to my budget? I guess really my question is how screwed could i be going for a cheap insurance plan? At 24 you qualify for the cheaper "catastrophic" plans, and some of these spring for some minimum preventative care visits as well. But if you look at some richer plans, given your income, you may qualify for federal subsidies that will help make them more affordable.
In Vegas, we are working with Nevada Health CO-OP (Link to Nevadahealthcoop.org to offer Neighborhood VIP plans that wrap health insurance around full access to our primary care clinic. Best of both worlds, but not the cheapest option. Still, our clinic can help keep you out of trouble that might otherwise force you into situations where you spend out of pocket deductible money (like ER, etc).
Do you feel like there is a giant dismissal of rap music within the Liberal community and within websites like Reddit? In other words, do you think a lot of intellectuals don't listen to rap because of the lyrics and meanings of most rap songs? I think massive wisdom, social commentary, and intellect is woven within much of rap music.
Not so much with some rappers, but definitely with many.
Contrast with country music, which is so concrete sometimes as to be parody of itself. Or alternative music, which is so abstract and "poetic" as to leave many scratching their heads.
In Hip Hop we find hyperbolized reality that is much akin to holding one of those magnifying mirrors you see in department stores up to all of society.
Do you ever start rapping during surgeries? Rappin' in the OR is a punishable offense where I trained. Unless the attending surgeon liked the beat...
Also, you mention "intellect is woven within much of rap music". Do you dismiss rap that is not intellectual. Being completely honest, if I like how it sounds I listen to it, and because of that my music taste is often put to shame by many online communities. Nope, sometimes I just love a great beat and dope flow. That in itself is "intellect" of a different kind. Haters gonna hate, listen to what moves you!
Do you make rap music while performing surgery? Luckily, I don't perform surgery! (I'm an internist).
But if I did, I believe beatboxing in the OR...while technically legal...may not be entirely sterile given the flying spit...
How do you have the time to balance your work life and personal life? How often do you get a break to just be with your friends? These things definitely blend with one another. As I type this, my two daughters are climbing on me and we're sitting at the breakfast table. It can be tough because my current work has no set hours or physical boundaries, so I just try to meld the two as best as I can.
Weekends are a bit more protected, and I'm lucky to work with people I consider to be friends as well.
How best do you see Physician Assistanst working with hospitalist teams? Do you feel PAs are a good attribute to the health care system? YES. I'm a firm believer in the role of PAs. I think they add tremendously to the team, and they allow docs to do more doc-type stuff (like golf, and checking their stocks). haha, just kidding. Well, a little bit kidding. No I'm kidding.
I think PAs can and will serve a crucial role moving forward.
Are you Doctor Dre? OK, let's do some quick calculus to answer your question.
I am a doctor, yes. Plus, my last name is Damania. Which sometimes can be spelled Da Mania. Which means I'm crazy. Which means I could have problems with memory. Which means I MIGHT have "forgot about Dre." Which means having forgotten, I could well BE Dre.
Last updated: 2013-11-28 12:09 UTC
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