My TED talk given 2/3/18


My new practice is an attempt to go back to where health care should be: between doctor* and patient.  Instead of me being paid by insurance companies or government bureaucracies, I work for my patients, because you work for the person paying you.  Being paid by third parties meant that they were the one I had to make happy, not the patient.  This is why customer service is nonexistent in health care.

I think people should expect more from their doctors.  People expect to have to wait when they shouldn't.  They expect to have to come in to have questions answered, even if they are simple questions.  They expect for care to be complicated when it could be simple.  They expect the doctor to be the center of the health care universe, when they, the patients, should be in that position.  

My practice operates on 4 main principles: 

1.  Focus on health instead of sickness.

People shouldn't view health care as something they need to use.  Ideally, people would stay away from doctors, off of drugs, and out of hospitals.  The problem is that the whole system we have is aimed at the opposite.  My practice is different, taking the time to do the things necessary to keep people well. 

My patients spend most of their time on the couch across from me.  Not in the exam or waiting rooms!

My patients spend most of their time on the couch across from me.  Not in the exam or waiting rooms!

2.  Listening is more important than doing things.

I answer the phone.  I communicate electronically with my patients.  I take the time to get to know them.  This is a whole lot better than ordering a bunch of tests, and it's quite a bit cheaper.  Unfortunately, communication is penalized by the U.S. system.  Fortunately for me, my patients are amazed at the difference they see from a doctor who actually listens. 

3.  Less medical care is often better than more

Health care has been turned into a transaction: find problems, treat them with procedures, and get paid for the number of procedures done (the bigger the better).  This has yielded the expected outcome: more care than is needed; lots more.  Unfortunately, the focus on treating problems gets in the way with the highest goal of medicine: preventing disease in the first place.  My focus is far more on risk reduction and quality of life than on finding disease and doing a treatment (often for diseases that aren't high risk and treatments that are).

4.  Patient records belong to patients

If my bank told me that the only way I could get my bank records was to pay for them, I'd fire them and get another bank.  This is what doctors tell patients all the time.  Why?  Because records are not for care, they are for showing the problems and procedures necessary to get paid.  I think records should be entirely focused on patient care, not on billing.  I think patients are best served to have access to all of their records, especially in this age of mobile computing.M

If you want to see more about my practice, go to my practice website:

*Obviously, this includes nurses, PA's, NP's, social workers, dietitians, physical therapists, and all of the other members of the health care team.  I write the orders as a physician, but care is best done with a good team.