We stand at a crossroads in healthcare.

Behind us lies a long-lost, nostalgia-tinged world of unfettered physician autonomy, sacred doctor-patient relationships, and a laser-like focus on the art and humanity of medicine. This was the world of my father, an immigrant and Primary Care physician in rural California. The world of Health 1.0.

While many still pine for these “good old days” of medicine, we shouldn’t forget that those days weren’t really all that good. With unfettered autonomy came high costs and spotty quality. Evidence-based medicine didn’t exist; it was consensus and intuition. Volume-based fee-for-service payments incentivized doing things to people, instead of for people. And although the relationship was sacred, the doctor often played the role of captain of the ship, with the rest of the healthcare team and the patients subordinate.

So in response to these shortcomings we now have Health 2.0. The era of Big Medicine. Large corporate groups buying practices and hospitals, managed care and Obamacare, randomized controlled trials and evidence-based guidelines, EMRs, PQRS, HCAHPS, MACRA, Press Ganey, Lean, Six-Sigma. It is the era of Medicine As Machine…of Medicine As Assembly Line. And we—clinicians and patients—are the cogs in the machinery. Instead of ceding authority to physicians, we cede authority to government, administrators, and faceless algorithms. We more often treat a computer screen than a patient. And the doc isn’t the boss, but neither is the rest of the healthcare team—nor the patient. We are ALL treated as commodities…raw materials in the factory of Health 2.0.

And so the calling that brought us into medicine is itself in crisis. 60% of physicians wouldn’t recommend their career to their children, while our nurses are marching on Washington in protest. Why? Because although many of the principles of quality, efficiency, and systems-thinking espoused by Health 2.0 are crucial to moving us forward into the 21st century, we’ve lost the heart and soul of medicine along the way. That distinctly analog human relationship that shifted medicine from career to calling. And nowhere is this more obvious than in Primary Care, ground zero. Thirty-plus patients a day, regulations and paperwork everywhere, dysfunctional EHRs, and patients turning to Dr. Google in despair…is it any wonder that Health 2.0 is breaking the foundation of our healthcare pyramid? My dad could never practice in this dystopia…so he retired.

And yet here I am presenting a music video where I sing, “I hope my children follow Daddy into medicine.”

Why?

Because Health 3.0 is here. In places like Turntable Health, Iora Health, and many others around the country a new emergent path is manifesting…starting with Primary Care. Taking the best aspects of Health 1.0 (deep sacred relationships, physician autonomy) and the key pieces of Health 2.0 (technology, evidence, teams, systems thinking), Health 3.0 restores the human relationship at the heart of healing while bolstering it with a team that revolves around the patient while supporting each other as fellow caregivers. What emerges is vastly greater than the sum of the parts.

Caregivers and patients have the time and space and support to develop deep relationships. Providers hold patients accountable for their health, while empowered patients hold us accountable to be their guides and to know them—and treat them—as unique human beings. Our EHRs bind us and support us, rather than obstruct us. The promise of Big Data is translated to the unique patient in front of us. Our team provides the lift so everything doesn’t fall on one set of shoulders anymore (health coaches, nurses, social workers, lab techs, EVERYONE together). We are evidence-empowered but not evidence-enslaved. We are paid to keep people healthy, not to click boxes while trying to chase an ever-shrinking piece of the healthcare pie. Our administrators seek to grow the entire pie instead, for the benefit of ALL stakeholders…

And so when the family physicians at Health Is Primary asked me if I would be willing to make a video to help the next generation get passionate about the future of Primary Care, I made this. I wanted folks to know that I could honestly tell my daughters that there is no higher calling than every day being with people when they are most vulnerable; getting to know them and their families; preventing illness and alleviating suffering. It is a gift, to get to do what we do every day.

So this is for all of you students out there who are thinking about choosing the family medicine or primary care path.  It’s also for all my primary care colleagues who are working hard to make our system better. And it’s for ALL of us in healthcare…we should be proud and inspired as we together forge our way to Health 3.0.

 

Based on the brilliant original song 7 Years by Lukas Graham. Written and performed by ZDoggMD. Audio engineering by Devin Moore. Directed by Tom Hinueber. Cinematography by Logan Stewart and Variables of Light. Special thanks to Dr. Venu Julapalli for giving us the framework of Health 3.0.

Cast:

  • Allison Andersen APRN
  • Melat Demeke
  • Dave Hart MD
  • Stephanie Lapid BSN, RN
  • Ken Wong RN
  • The ZPupps (my daughters Nina 8 and Maia almost 5)
  • Mrs. DoggMD (see if you can spot her!)

Crew:

  • Duane Wik
  • Steven Z. Smith
  • Lindsey Dimick

Join the Health 3.0 movement and watch our daily live Z-Casts on Facebook!

And get me to come perform this LIVE!

 

7 Years

Once I was 7 years old

My daddy showed me

The path to be a doctor can be lonely

Once I was 7 years old

 

It was a long tough road, but we thought we were tougher

Pushing each other out the way, as premeds we would suffer

By senior year I bought a suit for interviews, my mother

Was so confused because her son had turned into a gunner

 

Once I was 20 years old, my daddy told me

“Don’t be a PCP like me, do derm please”

Once I was 20 years old

 

I always had that dream, like my daddy before me

Be a healer, take the time to know my patients’ story

That subspecialty glory, just always seemed to bore me

To make health primary, that passion always seemed to draw me

 

Soon I was 30 years old, trapped in a system that sucked souls

Insurance, EHR, Press Ganey owned me

Soon I feel 80 years old

 

I only see one goal, Health 2.0’s a failure

But I know with all our voices we can make it greater

I got my team with me, our time is now, not later

We love our patients, hate the system, let’s unbreak it major

 

Once I was 40 years old, our story unfolds

I was finally shown Health 3.0 before me

Once I was 40 years old

 

Soon I’ll be 50 years old, our practice full grown

We’ve touched thousands of lives but we’re still learning

Soon I’ll be 50 years old

 

I still marvel at this life

My wife and children awe me

So now I tell them how I’m touched by all my patients’ stories

I got my colleagues with me, we relive that med school glory

And those we lost along the way

My brothers, I’m still sorry

 

Soon I’ll be sixty years old, my Daddy’d be proud of his son

Remember why we live this life: to make a better one

I made a man so happy when I saved his little son

I hope my children follow daddy into medicine

 

Soon I’ll be sixty years old, will I look back on the road

And see a job I did, hell no, I’ll see a calling

Soon I’ll be sixty years old

Soon I’ll be sixty years old, will I look back on the road

And see a job I had, hell no, I’ll see a calling

Soon I’ll be sixty years old

 

Once I was 7 years old

My daddy showed me

The path to be a doctor can be lonely

Once I was 7 years old

22 Responses to “7 Years (A Life In Medicine)”

  1. Abbey Banister

    You are awesome. And I don’t say that with gusto or bravado, but with heart and awe. I’m a RN in a Nursing Home facility. Half of our facility is assisted living, but my floor is for those who need extensive/high level care. We do not have an on-site MD, but a handful of ones that do rounds, or send their PA or FNP to do rounds for them. Some those providers are great. They have not become Healthcare Zombies. Other’s, well lets just say they see it as a career, not a calling. How I wish more doctors had the views that you have, and were willing to take a stand, start a movement, go against the status-quo and BE HEARD! This is a calling! And we should be here to make others lives better! You give me hope. keep up the good fight. I’ll do what I can, share your message, in my little part of the world. Miles City, Montana, Nurse Abbey 🙂

    Reply
  2. Timothy Fitzgerald

    Thank you for your efforts. “Ain’t the way to die.” was my intro to your work. Technology is wonderful as a tool. One can make a good honest living in healthcare. That takes care of the economic needs of a person. Interaction with our patients is a substantial portion of the compensation for our work and addresses the spiritual needs we have. You plainly get it and my hat is off to you.

    Reply
  3. Michele Lonzo

    Awesome! As I expected it to be… thank you for what you do to make it a better place to practice! Saw beautiful Mrs.ZDogg (or rather Dr. Mrs.ZDOGG @ 3:18… ??

    Reply
  4. DocBeau

    As always excellent. I wish I had your courage ZDogg… To walk away and start a new.

    Reply
  5. Bonita Westhafer

    Your best yet! It shows the sacrifices you have to make to be a physician. It is definitely a calling like nursing is for me. Thank you for all you do to promote improvement in healthcare! In my 22 years of practice I have seen so many changes and the current system discourages both physicians and nurses from continuing in their practice.

    Reply
  6. Treshia Soluvinmyilife

    Profit before patients. I can’t. wait till that change. Thanks for a the truth and being our voice. Y\n

    Reply
  7. Daniel Saurborn

    Powerful stuff, Zubin. Great emotion here. Thanks for sharing your talent and insights with the world.

    Reply
  8. Dave Chase (@chasedave)

    Amazing video. Even better was meeting IRL this week. I’ll be your opening act any time. Seriously. I know I’ll be promoting you to be the “headliner” for the various talks I give.

    Reply
    • ZDoggMD

      Dude, I think the headliner gradient flows the other direction 😉

      Reply
  9. Mary Kate DiTursi

    This made me cry. I have so much I to write … About loneliness, loss, the changes I saw in myself during the past 10 years. About how some people have a vocation instead of “just” a job but the fulfillment from following your calling is supposed to help the work-life balance. \n\nThat, damnit, it IS worth it, I can see the shape of it, but it is like trying to find a piece of white soap you dropped in the white shower without your glasses blood pooling into your head with hot water pounding on you and why is it so hard when the soap is right there?\n\nHow many times was I told to not go into primary care? First people, and there were some, even dear loved friends, who told me not to do medicine. During med school and residency so many people questioned why I wanted primary care. Surely I was too “smart”. Surely I should go into fellowship.\n\nWhy was I being so thorough? Why was I taking so long? Why did the flaws in the system, the resources, the residency program, the very human doctors who were my teachers, the availability of evidence, everything bring out my stubborn streak and my eternally-a-problem temper? Why did I beat myself so damn HARD against all of this; why didn’t I bend? \n\nWhy did I take the pain out on myself, the one already fragile and so very human tool who is needed to find the soap? \n\nAnd why did this shiny new MD-PhD with a history in protein research and a genuine love of the lung truly shine with honest joy in the continuity clinic? Even as she struggled with the documentation.\n\nWhy do I insist on owning my own practice? Why don’t I cap my Medicaid census at 30% and take only families with private insurance for the rest? That’s more than my share. Why not use a collection agency? Why do I pay my staff a living wage and give everyone health insurance at 100%? Obviously my practice doesn’t have that kind of money; why do I pay myself so little? \n\nHow much can I ask my husband to take? How much before I lose me, the woman he married? There is a price to be paid for refusing to bend, and that price isn’t paid only, even mostly, by me.\n\nSpeaking of price, do I continue to take advantage of income-based repayment and pay $1700 a month for 30 years on my student loans? Do I convert the practice from a PC to a not-for-profit so as to take advantage of public service loan forgiveness so it only takes 10? If I do that, I lose it all – it’s not mine and I can’t ever get it back. And there are bills in Congress right now to cap the public service loan forgiveness at a sixth of my total med school debt.\n\nBut my $1700 a month barely touches the principal. I have been making payments for 7 years (I didn’t defer during residency because I am older) and in another 23 the principal will be 80% of what it is now. Then, under IBR, the loan will be forgiven. I hope. If nothing goes wrong. Just another rich doctor gaming the system to make more than $200,000 disappear, is what they’ll say when they tank the program. And when they calculate my son’s student loan eligibility in only nine more years, it will be on my income. Not on my income less my monthly loan payment.\n\nSo do I turn away the parent who showed up for a sick visit with an 18 month old with a fever and discovered at check-in that she let her child’s Medicaid expire? The computer validates insurance for all upcoming appointments a few days before but that doesn’t help the same-day sick visits? Or do I let mom fill out our “I promise I’ll fix it” form and see the child? (As long as her Medicaid recerts in 30 days the program will backdate to cover the claim.). She won’t pay even a token fee because the ED will see her for “free”.\n\nBut they won’t notice that we referred this child to ENT six months ago and the child hasn’t been. Meanwhile none of our contact information from Mom six months ago is valid; she moved and her phone # changed. Oh and she is overdue for her 15 month and 18 month visits. Do I convert the visit? The child needs it but … no insurance. But opportunities like this are HOW we catch our more vulnerable children and that Hib vaccine she’s due for will reduce the risk of that next ear infection turning into meningitis.\n\n(Otitis doesn’t become meningitis, you say? You’re right. Since about 1993. When Hib got introduced.)\n\nAt most other practices this family doesn’t get past check in. Unless they are partners the doctor probably never even knows tgey tried to see them. They will eventually be discharged from the practice for failure to pay noshow fees or failure to keep up with well child checks. They’ll have patchwork coverage and a relationship with multiple local PCPs over the course of the child’s life which will cover the minimum of shots, though certainly not on the optimal timing to provide optimal protection. They’ll get physicals at school that do the bare minimum with no analysis of growth chart trends, and no one to note that hey, last year we talked about some counseling for that depression; how’s that going?\n\nSure if the BMI is out of percentile the school might mail a letter home, but it will go to the same invalid address from six months ago that the Medicaid recertification paperwork went to.\n\nOr do I force and forge a relationship with families so they know that I AM their PCP, that they SHOULD call me when grandpa just went to jail and grandma lost the apartment so now mom is struggling to find a place while staying with a friend. Homeless? No, of course they aren’t homeless!\n\nThere are programs with ACE screening, PAM screening, help from DSRIP, integrated social work and even payment for some of these services. But the documentation requirements are insane – I know, we are doing them. Albany Med’s DSRIP office has a whole paid staff sitting in cubicles on Broadway dealing with it. I and my staff of 11 do Excel spreadsheets and submit things on the day they are due in between patients, callbacks, and charting.\n\nThe cost of care is much lower in small practices and physician job satisfaction is much higher. But primary care doctors are leaving it in droves. \n\n Before heading into med school, physicians as a group have no increased risk factors for suicidality. It has been studied-it is not that emotionally unstable people are drawn to medicine at higher rates. In the US, 400 doctors take their own lives each year – that’s a graduating class of physicians each year, and nearly three times the national suicide rate.\n\nI am lucky. I conquered the worst of my demons, though there are scars, worse on those who walked through the fire with me.\n\nThe soap is RIGHT THERE, damnit.\n\nMy son sometimes says he wants to be a doctor.\n\nThis video made me cry.

    Reply
  10. Simon Carley

    Such a great video. Thanks for the work that you do and for inspiring the next generation of primary care physicians on this side of the Atlantic as well as in the US.\n\nAlthough I’m an ER doc and so not strictly in primary care world I think we share many of the challenges and values that you so wonderfully put forward.\n\nThank you.\n\nStay fabulous.\n\nS\n\nSimon Carley\nProfessor of Emergency Medicine\nManchester\nEngland

    Reply
    • ZDoggMD

      Thanks Simon, I was hoping some of the themes we presented would be universal across geographies and specialities…glad I didn’t alienate EVERYONE 😉 Thanks for taking the time to write!

      Reply
  11. Lisa Abdul-Quddus

    I think this one has knocked Readmission out of my number one slot. Very inspiring. BTW ZPupp1’s expressions are priceless.

    Reply
    • ZDoggMD

      Insert Nicolas Cage voice: “That’s high praise…”

      Reply
  12. PerrineAnderson

    You made all of us at “house Call Doctors ” cry with this one, Doctor. Thank you from a primary care NP

    Reply
  13. Patrick Erickson

    As the son of a Family Practice Doc and a second year Osteopathic Medical Student this one really resonated with me. Watching your videos over the past few years leaves one big question…. How are you not a DO?

    Reply
  14. Beth

    I love this video. My daughter an ER nurse was the person to show me ZDogg on YouTube. In this video I see her when you sing about it being a calling.

    Reply
  15. Kassandra Lea Rodriguez

    This song really made me cry and it touched my soul. My dad is an RN and I’m a CNA working on my LVN. Working in the medical field is extremely difficult, but it is also very rewarding. I remember all of my patients stories, even though some passed years ago, and I just hope that I was able to make their last days as comforting as possible. It really worries me that the further I progress in Healthcare, that I’m not going to be able to have a one on one relationship with my patients. We need progress combined with personalized care!

    Reply
  16. Angela Bonin

    Thank you ZDoggmd for this video. Registered Nurse here and beyond burnt out. Anytime I need to get pumped up for a shift I watch this video and it reminds me why I do this. Thanks for the reminder and for all you do to un-break healthcare!

    Reply

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