Dartmouth and Iora Health, Partners in Innovation
Aug30

Dartmouth and Iora Health, Partners in Innovation

I recently accompanied Dr. Rushika Fernandopulle on a visit to the Iora practice site in Hanover, New Hampshire which was created in partnership with Dartmouth College, King Arthur Flour (an employee owned company) , and the New England Carpenters Health Benefits Fund. The Hanover site opened in March 2012, a little over a year after the New Yorker article by Atul Gawande that introduced so many of us to Dr. Fernandopulle. I have been...

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Concierge Medicine: Still Not a Good Idea
Mar04

Concierge Medicine: Still Not a Good Idea

A few physicians in my community began to try concierge medicine in the mid nineties. My first reaction was, “Harley Street has come to Beacon Street”. If you watch Downton Abbey, Lady Mary Crawley probably took her maid, Anna Bates, to Harley Street when they went to London to get the help of a gynecologist because of Anna’s recurrent miscarriages. Harley Street is synonymous with expensive private care. The English who want to avoid...

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Looking Forward with the Triple Aim
Feb25

Looking Forward with the Triple Aim

It is surprising that we have no good metrics to track our progress toward the Triple Aim. We have lagging numbers on what we spend as a nation and debatable public health indicators of gross population metrics. No one knows how many healthcare organizations have incorporated the Triple Aim into their strategic plans. We have very little to help us judge what organizations are accomplishing and no way of comparing their results to...

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Where Healthcare Should Focus in 2016
Jan20

Where Healthcare Should Focus in 2016

I have been looking forward to 2016 and asking myself where healthcare should focus in the year ahead. In this connection, Don Berwick’s speech at the 27th Annual IHI Forum had a profound effect on me. You can watch it on YouTube. I appreciated his insightful and historically astute descriptions of Era 1 and Era 2 of healthcare. The first era goes all the way back to Hippocrates and Galen and was dominated by clinical autonomy and...

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The Digital Doctor, 2016
Dec31

The Digital Doctor, 2016

One of the many lists forecasting what will happen in the New Year predicted that in 2016 many patients will begin  consulting a Digital Doctor by using a health app for the first time. The article also predicted a big rise in the use of video visits and video consultations with medical providers. Perhaps to some this sounds like news but my response is, “It’s about time!” The widespread use of computers in medicine has been a long...

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The Older Americans Act
Aug14

The Older Americans Act

Recently the New England Journal of Medicine published a great article in the “Perspective” section, “The Older Americans Act at 50”.  Unfortunately the article is available online only to those who are subscribers, so I will try to give a very brief overview of its thoughtful content. I find that many physicians are totally unaware of the OAA program or–if they are aware–they do not know how to maximize its benefit for...

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Health Disparities and the Triple Aim
Jul03

Health Disparities and the Triple Aim

Last Saturday morning I was thinking about health disparities as I prepared to give a keynote speech at the Whittier Street Clinic’s Men’s Health Summit and Grand Opening Ceremony.  I have recently joined their Health and Wellness Foundation Board and the CEO, Frederica Williams, has wasted no time putting me to work. For those of you who do not know the Whittier Street Clinic, it is a historic neighborhood practice in the...

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The Moral Injury of Avoidable Death
Jun25

The Moral Injury of Avoidable Death

Last week I passed on a story my friend Dr. Doug Beers told me about a case of avoidable death as a result of medical “overkill.” It was a distressing story, but Doug recently told me another story that disturbed me more. We were sitting on the dock at my place on Little Lake Sunapee, chatting with my neighbor who had just given us a tour of the lake on his boat. The conversation turned to my long-term friendship with Doug, and to the...

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