Author Archives | Richard

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Trump’s Super Sperm

December 18, 2017


Dr. Jen

Ah-hah. That title grabbed you! Then you will definitely find this post amusing, if not informative. Seems Ivana claims that the Donald got her pregnant three times with an IUD in place. This announcement caused our old friend Jen Gunter, Twitter’s unofficial Ob/Gyn, to express some humorous disbelief based on the science of IUD’s. Could one fail?  Possibly! Three failures? Go Figure!

Bottom Line. Jen’s punchline here is a hoot. While Putin is riding around on a horse shirtless, lifting weights and wrestling bears to prove his manhood, Trump is out-sperming IUD’s.

 The mind boggles!

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Listen to Letters About Physician Suicide

December 15, 2017


Dr. Wible

Yup. You read that title correctly. Go to this link, and you can hear Dr. Pamela Wible read from her own book that gives an inside view of her own perspective on physician suicide. A perspective that has grown out of her own experiences and the self-inflicted deaths of many physicians close to her.

We’ve talked about her work before. BUT. Actually listening to her talk about it brings us up close and personal to the message she works so hard to convey.

Bottom Line. Damn it!  I’ve written about this once too often to not do anything about it. I just wrote to Pamela, volunteering my services in any way she thinks someone with my background can help her cause. I suggested, for example, that we work together to craft a training class for Pharmaceutical Sales Representatives. As I am conceiving of it, the class would sensitize PSR’s to the risk of physician burnout and suicide. At the least, it would train them to avoid making matters worse through their actions. At best, Reps could become part of the solution, through providing access to resources like Pamela’s book, webinars, retreats, etc. 

Update. Within moments, Dr. Wible took me up on my offer. Now I want you to jump in and let me know how you and your company can help here.  ’ve never asked any of my followers to do anything but follow. BUT. This is really important! Drop me a line at and let me know what you can bring to this effort. For example, we are looking for opportunities and sponsorship for the screening of

Thanks in advance!

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Facebook Looks for Potential Suicides

December 14, 2017



Check this out. What you will see is a Reuters article that describes how Facebook is further ramping up its use of artificial intelligence to recognize suicide risks in the verbiage of member posts. Importantly, Facebook not only has the ability to recognize such threats, they also have developed the ability to intervene, in multiple languages, 7/24/365. Good stuff!

Are there privacy and other issues here? Sure. But it strikes me that the benefits far outweigh the downsides.

Bottom Line. The potential uses of artificial intelligence to glean information and intervention triggers from social media posts are almost limitless. 

Let your imagination run wild for a moment. What do you see as the most interesting/important applications of this technology?

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Physician Burnout-No Simple Solution!

December 13, 2017



Here is an article that cuts right to the chase. “Physician Burnout,” a term previously heard seldom if ever, is claimed by this article to be the direct result of medicine morphing from a clinical focus to a business focus. Quite simply, business is not what most doctors signed up for, and is not something for which they are especially well trained. I think that is correct!

AND. The article offers an interesting solution. Get those physicians who occupy administrative roles to spend at least some (20%) of their time interacting with patients. That one I am not so sure about.  More specifically, I don’t see how redirecting a small percentage of administrators’ time will solve burnout issues across the broader physician population.

Bottom Line. As have so many other articles dealing with this issue, this piece claims that burnout is a significant  problem with a majority of practicing physicians. This leads me to two conclusions. First, as an industry we should do absolutely nothing to exacerbate this problem. And second, we should give serious consideration to seeing if we can contribute to a solution to physician burnout. 

Whatever the solution may be!

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What Does A “Hospital” Do?

December 12, 2017



Check out this Forbes article. What you will see is the revelation that hospitals, major hospitals, are losing money. The situation is bad now, and likely to get worse. Why?

Simple. Years ago, hospitals were places where people went to die. The costs of maintaining the beds necessary for this role were fairly low. Scroll forward, and hospitals became the places where people went for treatments that couldn’t be handled by their physicians. Increasingly, these treatments involved lots of expensive professionals and equipment to serve relatively few cases. As multiple hospitals in an area all hired these professionals and purchased this equipment, case per hospital got fewer and fewer, and revenues vs. costs got way out of whack.

The key paragraph in the article reads like this:

“Hospitals have contributed to the cost hike in recent decades by: (1) purchasing redundant, expensive medical equipment and generating excess demand, (2) hiring highly paid specialists to perform ever-more complex procedures with diminishing value, rather than right-sizing their work forces, and (3) tolerating massive inefficiencies in care delivery (see “the weekend effect”).”

So. Costs continued to rise as a percentage of revenues. Salaries and huge investments in things like EHR caused financial strains, with government and insurers limiting payments making things even worse.

What next?

Bottom Line. As is spelled out so clearly in this article, the future financial health of hospitals cannot be achieved by tweaking. New answers to questions like what do hospitals do and how can they do it most efficiently need to be brought forth. What will all of that look like?

Good question!

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Healers vs. Pencil Pushers

December 11, 2017

1 Comment


Check out this post from the physician/author pictured above. Interesting at a couple of different levels. First, Suneel’s point is clearly that the number of medical administrators in the U.S. is growing much faster than the number of physicians. I’m guessing that this is correct. BUT. I did a double take, and noticed that the ordinate (Y axis) here is in percentages, not in raw numbers. SO. If back in the 1970’s there were very few administrators compared to physicians, OF COURSE their percentage growth will be much higher as both professions grow over the decades.

Bottom Line. I often think that in many discussions that matter, percentages are specifically designed to screw with our minds. Tricks like taking a percentage of a percentage. For example, 10% of the population has condition X. That is 10 out of every hundred people. Smoking causes 1 more person in that group of 100 to have that condition. Is that a 1% increase or a 10% increase. The latter interpretation requires you to take a percentage of a percentage. Such thinking can lead us to jump to many bad conclusions.

Politicians do things like that all the time!

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I Am Not Quite Sure Why …

December 8, 2017



But I think you should go here and look around. What you will see are the musings of a physician who takes relating to patients to a new level. He spends significant amounts of time meditating “on the mat,” attempting to get better connected to himself so that he can get better connected to patients. Why does he meditate? Because, he argues, “I don’t have the time not to.”

I tried to pick one of his posts to focus on exclusively here. I failed.  Like I said, look around. You need to contemplate an array of the posts to “get it.” This doc is not just about diseases and prevention. His mission statement is:

“…to help people improve their health and lead meaningful fulfilling lives.”

Bottom Line. I like it!!! This approach is not for all doctors, and not for all patients. BUT. I think this is really powerful. 

And one thing I think I know for sure. This Doctor is NOT going to “burn out.” He is just going to keep getting more and more connected. To himself and to his patients. 

Good stuff!

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Navigating the Healthcare System

December 7, 2017



As Dr. Linda, a clear-thinking PCP observes in this piece, many patients need help in negotiating the complexities of the “Healthcare System.”  Translated, this means that getting procedures, medications, etc. authorized for payment can be a real challenge. She goes on to point out, however, that there are principles for patients to follow in getting this accomplished. Educating patients on these principles, motivating them to stay in the fight and to ask for help if necessary are all important pieces of this puzzle.

Bottom Line. I keep thinking that if we turned this navigation challenge over to Amazon to solve, they could readily develop a painless way for patients to work the healthcare system to get what they need. 

 Some out-of-the-box thinking is clearly required here!

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It Should Start Early

December 6, 2017


Direct Care West

We’ve talked a lot about physician burnout. We have often referred you to the works of Pamela Wible, a physician who runs retreats and mounts other interventions in an effort to minimize the number of cases in which physician burnout results in suicide.

BUT. While these efforts are meaningful and important, maybe they are just a Band-Aid. Maybe the long-term fix lies in training physicians early on in their careers to take control of their own destinies. Getting them to study “business.” Not Accounting 101, but the kind of business studies necessary to manage a career in medicine. More specifically, a career for Primary Care Physicians in a Direct Patient Care (DPC) practice. Retail medicine without the intervention of insurers, corporations, etc.

Check this out. What you will see is Direct Care West, a student led organization dedicated to teaching medical students and residents how to set up and run a DPC practice.

Bottom Line. While DPC works for some PCP’s serving some patients, it doesn’t work for all of primary care, and certainly doesn’t work for the other specialties. BUT. The principle of teaching doctors to enter a world in which they are in control is a generalizable notion that deserves further consideration.

 Can we help?

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Layoffs at WebMD

December 5, 2017



What is WebMD? I remember when it was a startup, aimed at communicating with/advertising to physicians. It has morphed many times in the ensuing years, and as the recent 10% staff cut indicates, is in the process of morphing again.

Bottom Line. Healthcare communications aimed at physicians and patients is a very crowded space. Given the WebMD core competencies and the future opportunities in the marketplace, ponder the direction in which you would take the company if you were in charge.

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