We need a new model

It’s common language now to say that we have one of the best health care systems in the world, but some of the worst access to care. In my mind this is true, but it’s missing the point. In thinking about healthcare as a business saying that we have poor access to care is basically saying we have a great product, but our potential customers due to various reasons can’t figure out how to use it. We take a passive approach when we start placing the burden of our failing system on access to care alone. Our model is complacent with the concept that the patient will come to us. We commonly accept the idea that our patient’s will negotiate their own insurance, co-pays, and the myriad of other complexities involved in acquiring and utilizing healthcare. In short, we have the potential to offer a brilliant product, but we over rely on our customer to do all of the work to reach what we are selling, and often through a web of tangled bureaucracy.  Our access to care is indeed terrible, but poor delivery is equal to blame. What are we doing as a medical community to offer new innovative ways that would allow our patients not only quicker and more efficient care, but a delivery mechanism that takes the burden of procuring healthcare off patient and more on the infrastructure?  Read more

May your skies be blue, and your wingman be true!

We all know or in one way remember the buddy system. When you were a kid at camp you had a buddy that you had to go everywhere with, or as an adult if you’re walking home at night maybe it’s good idea to take a buddy. Generally we know this concept as a safety in numbers kind of philosophy. The Air Force however has a different approach on the buddy system, it’s called the “wingman concept”, and it’s not just about walking home alone at night from a bar, it’s a philosophy that they want to permeate into every aspect of everyone’s life. It goes beyond being safe in a dark alley, it goes into suicide prevention, co-dependance on your other airman, and in my opinion and many others a very distorted maladaptive way of building what the Air Force considers personal resilience.  Read more

Contractor Conundrum

The most terrifying thing possible for a young physician without any considerable post graduate training is to be alone in the middle of Africa with an overweight, hypertensive, diabetic, middle aged male that starts complaining of the tell-tale crushing substernal chest pain. Oh yeah, and without any real cardiac drugs. Spend enough time in one place and the worst case scenario will eventually happen, and it eventually happened to me.  Read more

No Tiki No Laundry

No Tiki No Laundry

I haven’t talked about it in a while, but Gisele’s school in Burkina Faso is doing well, and I thought I would write a post about how it’s grown and some of the grassroots lessons I’ve learned about the hope-filled, but often hopeless act of giving aid.

When I got involved the school had about forty kids, three teachers, and part time cook, and one part time security guard all operating under the same small building which they partitioned into two classrooms. The picture below is the school today. They have six teachers, there are roughly one hundred and thirty kids enrolled, they have 24/7 security, a new playground, a new building for new classrooms, desks, and even uniforms.  Read more

First time’s a charm

event date: Nov 2011

The day, or I should say night started like any other night in the plywood palace that was our clinic in Afghanistan. Constituted eggs for breakfast, followed by sick call, or as it should have been known, ambien call. Followed again by constituted eggs for lunch. Somewhere in the monotony the phone rang, and the night got more interesting. A CASEVAC in the SOF world seems to typically be initiated by some guy at a desk that we don’t know, calling some guy at a desk that we do know about some guy in the field that got shot that nobody knows. This was that kind of phone call. The medical planner asked us if we could be ready to go with all of our gear in 15min to respond to a casualty at an out station. Little information was given, he didn’t really know that much just that it was a solider with a gun shot wound to the head that was critical, but stabilized. There would be a plane ready to take off in about 20min. Read more

Too Close For Comfort

One of the ultimate hypocrisies I’ve noticed in the military is the obsession with preaching safety when at home. Driving 15mph on base, wearing a reflective belt in inclement weather, not running with earbuds in, the list goes on. On the surface you might think, this is great, they really care about keeping people safe and mitigating our risk, and would never put us in harms way. Then you get to a combat zone and you have this realization that there is not a reflective belt in the world that will protect you from an incoming mortar, a stray bullet, or some crazy ass Afghan solider that decides one day to point his rifle at the wrong team. If they had the same obsession with safety downrange that they do at home maybe they wouldn’t make me live in a plywood box with no reinforcement, but I’m starting to think that is about as likely as them issuing me a giant metallic hamster ball that I can roll around in fully protected from all forms of flying metal objects. Read more

Golden Mortars

The first time I heard the loud speaker shout out “INCOMING INCOMING” I nearly fell off the couch in the clinic where at least I thought I was enjoying a fairly peaceful meal.  This was my first IDF attack in Afghanistan. IDF stands for Indirect Fire, basically bad guys run around in villages outside of the base and indiscriminately launch mortar rounds towards all the shiny lights without much care for aim. Unfortunately they are a fairly common occurrence, but this was my first. Read more