Two years in review (one in stealth): a career transition

I had intended to post this around New Year’s day along with others who were sharing their reflections of the year past. And while an unexpected event delayed this posting to the point that it no longer seemed relevant, it has become clear to me that some of my readers have not been kept abreast of my career transition. I’d like to share the details of a whirlwind 2 years but it would be the length of a short novel, so here I take a brief look back and share a key point related to being a doctor in a startup in healthcare. 

At the end of 2017, there was little I could say about what I was up to. A year prior to that point in time, I had fully transitioned from practicing full-time primary care to eating, drinking and breathing start-up life. It was a crash course in product development and machine learning at a company that was in stealth mode. My family and peers had know idea what I was working on, but they were curious about the transition.

The first question people ask when I say I closed my practice to work at a startup is “Are you glad you’re working less hours?”

Let’s rewind. I was a young female Internal Medicine doctor working full-time in a large multi-specialty physician-owned Seattle practice, on call for my own patients every night except for weekends, when call was rotated. (I became more and more aware of this being a rarity when the jaws of those I relayed this to – primary care doctors themselves – would gape in shock.) I had good access, a fairly streamlined flow, and a great group of office staff (every doctor knows how critical and valuable this is). My physician-owned multi-specialty group gave the top floor of a beautiful new building in Seattle to the Internal Medicine Department. We Internists felt valued.

No doubt, the work was hard. The paperwork and messages were never-ending. I worked at least an hour and a half almost every night. But I knew what else was out there and how doctors in other health systems worked. I also explored concierge practice and felt the model didn’t align with my values or primary goals at the time. Direct Primary Care (DPC) was a strong consideration. Still, despite moments here and there of wondering what else was out there, I felt I truly had a pretty good thing going and appreciated the organization for which I worked.

It was, thus, serendipity that I came across a job description for a primary care doctor needed for a Seattle startup early in 2016, when I was neither burnt out nor actively searching for something else.

No, it was not about the hours.

 

 

 

Making the leap

Being observant of technology that came out of Silicon Valley, and mostly disenchanted with the leadership in the area at the time and the apparent values – I had been following the Theranos story closely –  I was skeptical but curious. Would a healthcare startup based in Seattle have a better culture? Would it last? 

In residency, one of my attendings had said that it took about 15 years of practice for doctors to really feel they’ve got it down, hit their stride. 15 years. Imagine hearing that now. By the time I answered this unusual start-up job description, I was already at 10.5 years of full-time work (and roughly twice the experience of colleagues working 0.5 FTE). Taking this new job was a risky move. Yet, I was always drawn to the tech side of things, particularly how it relates to usability in multiple areas. I had been dismayed by the way product after product was being developed in ways that kept missing the mark on being actually useful in the healthcare ecosystem or being short-sighted to the point that primary care doctors have to pick up the pieces.

So, after multiple talks with the CEO of the startup and verifying that both of us had an aligned vision, I went from running codes in the hospital to running code….or so I like to say fully tongue-in-cheek ever since a couple of our engineers showed me how to do a little of that.

 

Not breaking things

I learned firsthand what “moving fast” really looked and felt like, and more importantly, when to quickly hit the brakes on a plan and what to anticipate. Moving fast thoughtfully without breaking things is paramount to changing any system that touches people so intimately. This absolutely applies to healthcare, but not solely healthcare.

Failure is the best option….for learning

Though we are careful not to “break things” as a company, one of the most valuable parts of my experience thus far is learning how to fail. It turns out, trying not to fail 100% of the time is time and resource-intensive and unproductively aspirational, particularly when the path to doing something new has not been paved yet. I was forced to keep the risk-averse side (ubiquitous among doctors) in check. There are many articles and books that emphasize the importance of failure. Nowhere has the learning curve around this been as steep for me as in a startup. 

Looking forward

We’ve made big strides since we were a small company of 17. I am looking forward to what lies ahead in 2019 and beyond. No doubt it will include some uncertainty and some failures, but it will be mission-driven and exciting all the way.

The Hashtag That Resonates Reverberates

Over the past week, the #WorkMeHomeMe hashtag has been making some rounds on Twitter. 

It started with a couple tweets, an opinion, and then a call to action.

The Work-Me-Home-Me hashtag has awoken the self-deprecating side of MedTwitter. Unlike the oft carefully crafted and curated world of Facebook (as I remember it), Twitterites are juxtaposing their strong professional capabilities right alongside their…well… less stellar sides. Most – but not all – are MDs and women. Others want to play. 

And they should.

They should because the candid and public sharing of a seemingly contradictory combination behaviors demonstrates awareness that life can sometimes seem dichotomous. It helps us verbalize that we do not “keep our sh*t together” 100% of the time. More importantly, it demonstrates that we accept this as part of reality. Enough so, at least, that we can admit it to each other.

It can be validating just to read through these tweets. 

And apparently useful in educating one’s spouse of the Work-Me-Home-Me phenomenon:

The humor has the potential to lighten your mood:

And it can be sobering:

#WorkMeHomeMe tweets represent the honest reality of the work-life conversation, the work-life balance/juggle/symmetry/dichotomy/contradiction/harmony/whatever-else-we-may-call-it. Getting these raw glimpses into the lives of healthcare workers (and other professions) may be particularly valuable for so many who are starting their careers and already feeling stressed about how to be successful and perfect in all facets of life.

As empowering as #ILookLikeASurgeon – one of my favorite Twitter hashtags – is, #WorkMeHomeMe is the flipside, saying #IAlsoLookLikeThisAndItsOK.

And that can be empowering in a very different way.  

 

 

Google’s new mental health tool is a good idea. But there’s more work to do.

Google has just come out with a mental health tool for those who query “depression” on its site. The Patient Health Questionnaire 9 (PHQ-9) is a series of nine questions that help assess depression symptoms. Doctors use it when screening for depression and use the results in conjunction with additional history from the patient to make (or not make) a diagnosis of Major Depression. Now anyone can access this same questionnaire on Google but is preemptively “encouraged to  talk to a care provider or doctor about what your score may mean for your overall health.” A link to the National Suicide Prevention Lifeline is also provided.

Depression, recently reported to be the world’s most widespread illness, has far-reaching implications when left untreated: from strain on personal relationships to disability and worsening of chronic conditions to an economic cost to society. As an internist, I saw many patients who were never diagnosed but wondered if they had depression. Some sought help even when their spouses or parents didn’t “believe” in depression and told them to “think positive” or “get over it.” I am thankful for those in the public sphere who bravely share their mental health struggles and help remove the stigma of mental health issues. And I applaud Google for designing a way to bring additional awareness to its users.

Google’s PHQ-9 feature is just a first step, however. Those who search the term “depression” likely represent a population who suspect or have been told they might have this diagnosis. But bringing awareness to the completely unaware is where the greatest impact can be made. I can’t count the number of times that patients have said – after diagnosis and when their depression is better controlled – that in retrospect, they likely had depression for many years and just didn’t realize it.  With platforms like Google, Facebook, Twitter and Instagram plus advancements in AI, we just might see that awareness occur sooner.

 

Kids get it.

Children never cease to amaze me.

During the holidays in our office, we had on our checkout desk a simple white Christmas tree the size of an 8oz paper coffee cup. It lit up and was a small part of our festive décor. As one of my patients checked out after an appointment, her daughter went right up to it, took in an audible and pleasantly surprised-sounding breath, and couldn’t help but exclaim, “Oh. It’s so beautiful!” A medical assistant and I just looked at each other and exchanged touched glances at the purity of the emotion.

Children are surprisingly forgiving, too. One minute they are upset about something a friend did, and the next, they can quickly find a way to look past it and be playful again. They are more resilient than we give them credit for. They want to be happy and they want others not to be sad.

Which is why I was both touched – yet not that surprised – at how some 1^st graders in Minnesota supported the Viking kicker who missed what should have been a winning field goal in the last few seconds of last week’s football game against the Seahawks. I was happy for my Seattle team, but couldn’t help but feel for Brian Walsh. Anyone who’s ever worked in any field (medicine or otherwise) that involves making and executing critical decisions in an instant understands that type of weight. And like medicine, though football is considered a team sport with many players, in the end, it can be one person who ends up shouldering (or feeling responsible) for a bad outcome. Even the understandably upset Vikings coach, who should lead his team as an example of sportsmanship, made an unsupportive, frustrated quip to the media after the game. Since then, he has provided a better perspective to his team’s loss of the game. And, of course, may people used social media as a platform for malicious commentary without consequence.

As someone who lived and breathed Bulls basketball in Chicago years ago, and now is exposed to some of the real tough challenges in peoples’ lives,  I can truly say that, in the end, “it’s only a game.” And we are – each one of us – human.

Those first-graders know that. Kids know how to bounce back. They know how to rally and support. We should all learn from them in this very real and important game of life.

#DearPatient, just thought you should know

#DearPatient

It’s midnight.

I’m still up…

…documenting

and reviewing your chart.

Trying to find out what ails you.

Just thought you should know.

I am not Marcus Welby.

But I am your primary care doctor.

Yours.

……Truly.

Useful links on Measles and vaccination (supplementing Seattle Times column)

My column on measles and vaccination appeared in this past Sunday’s Seattle Times.

Here are some informative links to articles to help continue to inform/educate the reader on this important topic:

CDC information on measles

Benjamin Franklin’s story

Infographic

5 GIFs That Show Why Herd Immunity Is So Important

Measles Outbreak with a Baby at Home

Can a Food Delivery Service’s Business Model be a Solution to Food Deserts?

This post expands on the topic discussed in my latest (July 2014) column in The Seattle Times: “In a dietary rut? Here’s how to escape it.“

Food conversations occur multiple times a day for me. I talk to patients frequently about dietary changes. I enjoy various cuisines and am fortunate to live in a city with an abundance of locally sourced food and a booming restaurant scene. However, as is the case for many people, figuring out weeknight meals while working full time is always a challenge.  Long clinic days don’t allow for much time pouring over a recipe or spending much time in the kitchen. An easy solution is to order food for delivery. But, even in Seattle, what’s quick is not always healthy. Besides, I happen to rather enjoy cooking. With time just as scarce on the weekend, what’s a healthy, fresh food seeker to do?

I discovered and signed up for a meal delivery service called Blue Apron at the beginning of the year. Blue Apron sends you a box of the ingredients you need to cook a meal for two (or 4 or 6, etc) three nights a week, along with instructions that fit one side of a glossy, 8×11 inch recipe card. You provide your own cooking oil (usually olive), salt, pepper, and water. Most items are premeasured, but you do have to do some prep work (chopping, slicing, dicing etc). It prices out to $10 per person per meal. While this is cost-prohibitive for some people (I can certainly whip up less expensive meals myself), it is unlikely I can have a set of recipes as varied as what Blue Apron provides. Discovering new vegetables, herbs, grains, and foods from other regions is invaluable. You learn to make things like salad dressings and pickles from scratch (with much fewer ingredients and preservatives!). It never feels boring to eat these meals. I can control the oil and sodium content of the food.  And since I grocery shop much less, I spend less on overall by not picking up extraneous items. I also don’t waste bulk ingredients for a specific type of cuisine that I might only make once. This service also eliminates my personal pet peeve, which is the “oops, I forgot to pick up an ingredient” emergency in the middle of cooking.

Can a system like this – at a lower price point – be an answer to food deserts across America? Food deserts are areas where people have limited access to fresh produce due to financial and/or geographical reasons. There has been a push (as part of First Lady Michelle Obama’s Let’s Move! Campaign) to try to engage Americans in healthier eating, with grocery stores being set up in such food deserts to make healthier items more accessible to residents in these areas. The results, however, have been disappointing. Reports state that the people living in those communities were more aware of the new store, but they never actually changed their purchasing or eating habits. Seattle, where I live, is the complete opposite of a food desert, yet some of my patients [and myself when I was younger and much less aware] seem to virtually live in one.  It might be due to cost, ethnic/familial culture, lack of time, or habit. I recently went to a cooking class where everyone in the group other than myself did not cook much. Though they had been to a few cooking classes, they never reproduced the dishes they learned. Perhaps a food delivery service like Blue Apron might provide the missing piece for healthy eating in food deserts and elsewhere by bringing the produce and the instructions to the individual.

Another plus with Blue Apron: you can engage your kids in healthy eating, too. The glossy handout with bright pictures is a great way to have kids go on a “treasure hunt” for different ingredients. They are naturally drawn to the little packages and surprise treasures in the box. They will learn about different foods along with you, and, if you include them in the process, you can draw them into eating foods they have never seen before, starting them on a lifetime of food exploration and awareness and less food anxiety than we have been experiencing in our current generation.

—————

A few notes: 

While there are more food delivery services (like Plated), I haven’t tried them, so I have limited this piece to my experience with Blue Apron.

Be aware that if you have dietary restrictions or preferences, food delivery services may accommodate some but not all restrictions. If your doctor has placed you on a specific kind of diet, this type of service may not be right for you.

If you do want to try your hand at using Blue Apron, there is a fair amount of chopping and peeling involved. Taking a knife skills class can help you be safer and more efficient in the kitchen.

Also, I found that I prefer to eat more vegetables in a meal than what is provided with Blue Apron, so I occasionally supplement with vegetables procured from my local farmers market (a great thing to do in the summer). I could also sign up for vegetarian meals on the service, as a solution.  

 

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You’ve Come a Long Way, Baby

Yesterday marked the 50^th anniversary of the landmark Surgeon General’s report on smoking and health. It really wasn’t that long ago that smoking was a way of life. As the author points out in this piece on why people smoke, even doctors had cigarettes in their mouth while examining patients back then. The Surgeon General himself, Dr. Luther Terry, was a smoker until a few months before he made his speech in 1964. And for something so deeply ingrained into the culture, so addictive, and a major part of the economy – the report was given on a Saturday in fear of a negative stock market response – we really have seen a remarkable decline in smoking.

The antismoking campaign is a major public health success with few parallels in the history of public health. It is being accomplished despite the addictive nature of tobacco and the powerful economic forces promoting its use.

–          CDC

We now have a better understanding how diffusely tobacco affects the body. People who smoke are at higher risk of everything we worry about getting: cancer, heart attack, stroke, vascular problems leading to leg amputation, and looking older. I see many adult children of smokers who have never smoked, deterred by their parents’ habit. But many children and young adults continue to experiment with smoking, often thinking that they can quit anytime. Unfortunately, smoking continues to be glorified in other settings. Hollywood practically gives them away, somewhat reminiscent of cigarettes being provided to US soldiers in the past.

We’ve come a long way, but we’ve got more work to do.

It was a quiet year….

Two Thousand Thirteen was a quiet year for my blog. But it was a busy year of doctoring with 10-12 hours in clinic most days, an additional 2-3 at night, plus a few hours on most weekends. [We can analyze why over a drink sometime]. Of many sacrifices a full-time primary care practice necessitates, blogging was one of them. Also falling victim to the work schedule were guitar lessons, dinners with friends, and medical conferences I had planned to attend. Reading? Shopping? All of those seemed like luxuries. I missed writing on this blog, which was a nice way for me to reflect on this complex world of medicine.

However, in 2013, I did continue to work out regularly (for my own sanity, and – yes – I think of this as an achievement considering my schedule) and I wrote regularly for the Seattle Times as a columnist for the On Health section of the paper. I continued my position as a committee member with the Women in Medicine group of the Washington Chapter of American College of Physicians, and we hosted various increasingly successful events during the year. I continued to serve as an advisory board member for an IT company, learning more about the complexities of IT systems, networking, and EHRs. I mostly listened on Twitter, often inspired to write posts, but lacked the time and energy to put my best work into it. However, it was wonderful to keep up with some of writing of some of the colleagues I admire. And the best part of 2013 was that I had the honor of having one of my pieces published in a book (more on that in a future post).

We are fully into 2014 and New Years’ Day already feels like it was long ago. My schedule has not changed, but there is one thing I know for sure – this year won’t be so quiet for my blog.