Dad's Eulogy


It’s been a few months that I’ve been writing this. Well, not quite writing it. Crafting would be more like it. In my head.  Over and over.  Today I needed to write it.

The waves of sadness we have felt the past few days are calmed by an undercurrent of peace.

We know that dad was ready to go. He had talked about it for weeks. He wanted his life to be rich and full and warm and happy right up until the instant he departed. And it was.

I’ve wanted to capture the message. The message that dad sent me for fifty two years, and which I hope can be heard by you - those of you here sharing this time with us - and especially his grandchildren: Molly, Sam, Charlotte, Rosie, Max and Zoe. Listen up - I’m translating Pete here for you, kids. It’s good stuff.

His message was always implicit. It’s not what was said - it’s what was unsaid. And didn’t need to be said. It’s what was done - without fanfare or any quest for recognition - because he loved doing it. Whatever it was.

Today you will hear the vignettes from our family: the funny episodes, the touching courtship of my mother, the track & field success, the rich and beneficent psychiatry career. These are the papier mache.

So I’ll offer some chicken wire, and I’ve even got a mnemonic for you. I’m a fan of Sesame Street - as was dad - so we’ll start with the letter “E” - the first letter of his rarely used middle name. Right there in your program - if you want to follow along.  Elliott.


E - Engaged. In his wonderful book, Graceful, Seth Godin contrasts the “tourist” from the “traveler.”  

“It’s not the cameras or the colored shirts.  It’s the eyes - that dart back and forth - alert for threats, clearly closed to anything that might cause change. It’s OK to notice, but if you [live life] as a tourist - you’ll return as you went - unchanged  ... The engaged one, the graceful actor in an unfolding play, will open themselves to the world they’ve bought a ticket to, knowing full well that they will be changed.”

Engagement.  Dad was always engaged. He sought not to change others to meet some arbitrary model. He engaged with people, science, language, comedy, literature and music - not to influence - but to be influenced.  Like dad, I seek to be a traveler rather than a tourist.  To be changed, rather than to change.  Thank you dad.

L- Listen. Dad knew how to really listen. Listen in a way that validated without judgment, reflected without direction, and motivated without urgency. A few weeks ago, I told dad an affirming story about this wonderful skill he had passed on to me. I was teaching residents and medical students in the hospital in 1998 or so. We were in the emergency department, called there to admit a patient to the hospital who "refused to go home." We found a 40ish woman, lying on her side in the room. The medical workup was entirely normal. A family member had recently been admitted to the hospital for appendicitis. She was scared that she might have appendicitis as well. After we listened to her story, I asked her what else was going on in her life, how she was feeling, what troubled her the most about her situation, and how she was handling it all. I asked her if she would like to go home, and she eagerly agreed that this was the best course of action. On our way out of the ER, the doc exclaimed: "How did you do that!?" "I was in there talking to her for 30 minutes!" “Well,”  I replied,  “I listened."  Dad taught me that. Thank you dad.

L - Love. This one’s hard. I’ll make it short. Love the people, love the places, love the music, the nature, the color of the sky at that special moment, the waves as they crash into the beach. Dad loved so many things and so many people. Most of all, Dad loved mom. Courted away from a football player in high school (or so goes the story I choose to remember), lured 3000 miles to Cambridge for marriage, mom and dad shared and traded the pilot/co-pilot seats for fifty-seven incredible years from Boston to San Francisco to Cambridge to Newton, and annual ventures to Italy and finally back to San Francisco. The growing children always felt unwavering love and support from our parents - even through the hurdles of adolescence and young adulthood that try the patience of all parents. I never had even an inkling that dad disapproved of me. Never. Ever. I think that’s part of what love is. Thank you dad.

L - Learn. (The silent third L in "Elliot.") Dad loved to learn. He was always - up to and including the very last day of his life - learning more about people, the physical world, music, spirituality, and of course - by extension - himself. No opportunity to learn would be missed. The process, more than the content or the result, was exciting to him. He didn’t learn in order to achieve a pinnacle of knowledge - so that he could leverage it in some way to “win” over others. Learning - for the sake of learning - was his passion.

A few weeks ago, he found a copy of a book called The Canon by Natalie Angier. He consumed it with such energy and excitement! I learned from him about the trilobites - 17,000 species of extinct arthropods that are fossilized and have taught us so much about our past. Trilobites died 250 million years ago - yet they're still teaching us.

He was also fascinated by the story of the Sea Squirt. Here's what he read aloud to me:

“The sea squirt is a mobile hunter in its larval stage and thus has a little brain to help it find prey. But on reaching maturity and attaching itself permanently to a safe niche from which it can filter-feed on whatever passes by, the sea squirt jettisons the brain it no longer requires. Brains are great consumers of energy, and it is a good idea to get rid of your brain when you discover you have no further need of it.”

He LOVED the sea squirt! He loved LEARNING about the sea squirt! So fascinating. "good idea to get rid of your brain when you discover you have no further need of it.” So cool. So funny. He adored the sea squirt.   Me too! Thank you dad.

I - Introversion. Albert Einstein wrote: “I am a horse for a single harness, not cut out for tandem or teamwork.”

Like Einstein, dad was an introvert. As am I. My siblings inherited the "extrovert" gene from mom. (Lucky them - High school is so much easier for extroverts!) Dad's introversion always calmed me - reminded me that I had permission to want to be alone - to need to enjoy things quietly and by myself or with a very small number of others. Dad's introversion reminded me that there was nothing wrong with seeking solitude. Thank you dad.

O - Observation. Dad observed everything. Always watching, seeing things others didn’t notice - in a book, in music, in people, in a landscape, in art. He saw the virtue, the achievements, the unique goodness that makes everything and everyone important.  Thank you dad.

T - Tenacity. Dad was focused, tenacious, and determined to do what must be done. We see this in his track and field successes at Lowell High and Harvard and beyond. We see it in his long, successful professional career - and of course we see it in his graceful, Engaged, Listening, Loving, Learning, Introverted, Tenacious final push across the finish line. Dad was, in his final weeks - his true self in every way. He died as he lived - without struggle or anger, without judgement, without fear.  

T - Tender. 

Elliott - dad's middle name:



Love (Learn)






Even before dad’s illness, I would start my speaking engagements with a picture of an apple near the base of a tree.    H36r47Sc_400x400

I would describe the careers of my father - and his father: psychiatrists whose work was focused on helping others succeed.

No - I'm not a psychiatrist. I'm a family physician, health IT nerd, former federal servant - but my goal is identical to that of my dad - and his dad before him .. and perhaps .. it's YOUR goal too: without judgment, assumption, bias or personal agenda, help others be their best.

And it’s amazing how a set of simple principles can cause humans to be so influential. Without trying to be influential at all.

Thank you, dad. Thank you. Thank you. I will miss you every day, and I am grateful for what you have given - to carry with me forever.

From my run this morning.  We humans love the beach.  The end of land.  The beginning of ocean.   


My Dad

Dad's traverse is complete.  He did it his own way.  Of course. 

To be published in various newspapers .. 


Arthur Elliot (Pete) Reider, MD


Arthur Elliot (Pete) Reider, MD, died peacefully at home in San Francisco of lymphoma on Thursday August 13th 2015.  Janet Sampson Reider, his wife of 57 years, and all three of his children were by his side.  Dr. Reider and Janet divided their time for the last few years between their family home in Newton Massachusetts, a home in Vermont and San Francisco where they grew up.

A graduate of Harvard Medical School, Pete married Janet, his high school sweetheart, in the spring of 1958 after graduating from Harvard College. Janet and Pete met when they were 13 years-old, and Janet recalls how he *chased* her up the path at a Sunday school picnic, thus initiating the courtship.  They began their married life in Cambridge, as Pete entered medical school.

A retired psychiatrist, Pete had a rich and rewarding professional life, earning the respect and gratitude of hundreds of patients, as an intern at Mt. Zion Hospital, as chief resident at Mass Mental Health Center, and in private practice in Cambridge and Newton.

Pete was a lifelong runner and fan of track and field. At Harvard, he ran cross country and was the captain of the Men’s Track and Field Team. He was a record holder in the mile run with time of 4:11,  the 2 mile with a time of 9:21.8, and cross country.  He was voted to the Harvard Athletic Hall of Fame and named a member Men’s All-Time First Team All-Ivy League Cross Country Team for both the 1957 and 1958 seasons. Coach Bill McCurdy said that Pete “was one of the toughest little men he has ever known, and that he fought fatigue like a mortal enemy.”  Among Pete’s greatest joys was cheering on sons Jacob and Matthew, and grandchildren Sampson, Molly, and Charlotte as they continued the great Reider running tradition.

Pete was the son of Dr. Norman Reider, a renowned psychoanalyst, and Mrs. Louise Reider.  Born in Topeka Kansas, he spent his early childhood in New York City, before moving to San Francisco, where he attended Lowell High School with Janet.  With Janet at his side, Pete enjoyed travel, music, books, science, Red Sox games, the New Yorker magazine, and sharing his quick wit and love of learning with his grandchildren.  Pete enjoyed a tradition of taking grandchildren on trips to Venice and never missed a graduation, play, concert, track meet, soccer game or birthday celebration. He was the best Grandpa on the planet.

Always curious, Pete took to writing short stories and poetry in recent years.  Stepping Stones, a book of his poetry and fiction, notable for its quirky humor and characters, was published in 2014.  Sharing his love of knowledge with others, Pete taught courses in the blues, humor in literature, and creative writing at BOLLI, the Osher Lifelong Learning Institute at Brandeis University.

Pete leaves behind his beloved wife Janet; his children Jacob Reider and his wife Alicia Ouellette, Suzie Reider and her husband Brian Smith, Matthew Reider and his wife Alison Cohen; grandchildren Molly Reider, Sampson Reider, Charlotte Reider-Smith, Rosie Reider-Smith, Max Reider, and Zoe Reider; his brother Jonathan Reider, brother-in-law John Sampson and his wife Sharon Litsky; sisters-in-law Deborah Green, Louise Sampson and Leah Reider, as well as dozens of beloved in-laws, cousins, and friends.

Avoid ICD-10! Yes you can!

Lots of news/talk about ICD-10 these days.  Most organizations are spending time and money training care providers on it.  Software developers are busy implementing it - often by changing diagnosis selection search menus from ICD-9 to ICD-10.

They're missing a fantastic opportunity.

ICD-9-CM and ICD-10-CM are administrative coding systems.  They're used to code diagnoses. Clinicians have (unfortunately) been forced to learn many ICD-9 codes and are being told that we need to shift to ICD-10.  Some of our colleagues are hoping that they can just use ICD-9 and "someone else" will convert ICD-9 to ICD-10 but of course this can't happen.  ICD-10 is much more granular, and often requires additional information.  It's like the vet requiring one to specify your animal's breed:  ICD-9 allowed for "dog, cat, aardvark."  ICD-10 requires:  "Golden Retriever, Persian, O. a. lademanni ."  Nobody can translate to the more precise term if you hadn't recorded sufficient information in the first place.

"But how can we avoid ICD-10?  That's the title of your blog post!"  You say.  "How?  Why?"  ICD-10 (and ICD-9) are administrative coding systems, weren't designed by or for clinicians.  We don't think that way.  There are (much) better alternatives.  When ONC made SNOMED-CT required for recording diagnoses in certified EHRs in 2012 (effective for the 2014 certification criteria) I thought it would be obvious that the combination of SNOMED-CT for recording of diagnosis - combined with the free ICD-10 to SNOMED CT mapping tools that NLM published at the same time would meet the needs of organizations to RECORD SNOMED-CT and yet DELIVER ICD-10 to those who required it - primarily CMS and other payers.  Why capture SNOMED-CT and then (again) capture the same information in ICD-10?  I was sure that everyone would "get" the hint.  Commercial solutions like IMO and HLI offer even more elegant methods of capturing interface terms (terms that are customized to the user) and then mapping to the proper code:  SNOMED-CT for clinical data recording and transmission, and ICD-for administrative transactions.

It wasn't obvious.  Many (but not all) health IT developers ignored the opportunity to insulate clinicians once and for all from administrative codes.  Hospitals and other care delivery organizations spent millions on consultants to develop and implement training and "go-live" strategies to teach clinicians ICD-10.  I implored folks in both communities to think past the veneer of the federal regulations, read the preamble of the ONC Certification criteria (where we explained much of this) and think outside of the box.  Innovation?  Nope.  Folks have read only the veneer of federal regulations from both CMS and ONC, avoided creative thinking, and implemented solutions that check the regulatory box, blame the feds for it, and impose massive pain on a generation of clinicians.

It could have been avoided.  

Naysayers will insist .. "but what about the extra information that ICD-10 requires such as laterality?"  And my answer is that this information can and should be captured without ever exposing a clinician to an ICD-10 code.  Some organizations are already doing this.  Some EHR developers are already doing this.  If yours isn't, then you should ask them why not.  

The requirement is that ICD-10 be delivered.  There is no requirement that ICD-10 be entered into the computer (or paper) by the clinician.  When I order a diagnostic test such as imaging or blood work, those doing the testing will likely require ICD-10 so that they can pass it along to those who will pay them for the service (I say "may" because again - the requirements of them are to pass along ICD-10 to those who will pay.  But they have passed on this burden to the clinician without careful thought:  they, too could insulate the clinician from the burden and perform the translation from a clinical question ("why is this test being ordered?") to a billing transaction ("what is the ICD-10 code for which this test was ordered?")  Technology should capture the diagnosis in a terminology that I understand - MY language (HLI, IMO or SNOMED-CT) and if additional data is required - I should always be prompted for it - in the most elegant manner possible.  The information that I capture can/should then be stored in the patient's problem list if it's not already there (and of course if it IS already there - it should be offered as an initial selection to avoid replicating work that was already done!) and then translated in the background into the administrative code.  This should be opaque to the user.  Accessible?  Yes - sure.  Just as I can "view source" in my browser to see the HTML.  But really - who wants to do that?  Not me (most of the time).  Not you.  Nor will I need to see the ICD-10 code 99% of the time.

Don't burden your clinicians with ICD-10!  Avoid it.  Yes you can.  And you should.  Anything less is irresponsible.  Yes - some Who have been "educated" by high-priced consultants will ask for it.  But you shouldn't give them a faster horse.  Give them what they need.


Is it Disruptive?

It’s hard to hear a pitch, listen to a speech, or read blogs without hearing/seeing a claim that some cool new thing is distruptive. Most innovations are sustaining innovations. Here’s a good checklist for whether something is a disruptive innovation (via this post in HBR):

  • Does the product either target overserved customers (by offering lower performance at a lower price) or create a new market (by targeting customers who couldn’t use or afford the existing product)?
  • Does it create “asymmetric motivation,” meaning that while the disrupter is motivated to enter higher performance segments over time, existing players aren’t motivated to fight it?
  • Can it improve performance fast enough to keep pace with customers’ expectations while retaining its low cost structure?
  • Does it create new value networks, including sales channels?
  • Does it disrupt all incumbents, or can an existing player exploit the opportunity?
  • Does it disrupt all incumbents, or can an existing player exploit the opportunity?

3rd Platform for Health IT

For the low-low price of $4500 (that's $500 per page) you can buy this 9 page report on how the athenahealth-BIDMC alignment is evidence that cloud-based information technology will form the basis of tomorrow's health IT solutions.  Obviously, I've not read the report.  It's not clear if Bernie Monegan has either, but she's written an article about it, which has generated some buzz on the Internet in recent days.  (One wonders about a relationship between HIMSS - which owns Healthcare IT News - and ICD - but I don't recall that there is one) .. 

Let me save you $4500.  

Where the data lives doesn't make this new.   SMS (which became Siemens and of course is now Cerner) hosted hospitals' data in their data center in Malvern 25 years ago.  Call that a "cloud" in 2015 parlance, but a hosting facility is a hosting facility.  

Yes - there are some differences.  Traditional hosting is single-tenant.  The server(s) are dedicated to a given facility, and they're mirrored to a redundant facility for disaster preparedness.  The server looks, acts and feels like is in the hospital basement rather than in some data center in a secret mountain in Colorado - and there is a (virtual) dedicated wire that goes from the hospital to the data center.  The CIO can tour the data center and the guy with a pocket protector can point to "your" servers - and there they are - lights blinking away, fans whirring.  

And "cloud" these days invokes a multi-tenant model.  One big data bucket, and one big application layer, with a technical architecture that separates patients and providers in a way that privacy and security are managed well, but that eliminates redundant hardware and software.  The data and the software services are distributed logically and often physically.  There isn't one server where "your" data lives.  It's everywhere - inherently redundant.  athenahealth and PracticeFusion are obvious models of this in the ambulatory domain, while RazorInsights and iCare are examples of acute care products like this. 

This isn't the interesting part of "3rd platform" for health IT.  Yes - it's self-evident that distributed computing, mobile endpoints, and "loosely coupled" services will be part of the future health IT infrastructure.  Ho-hum.  The rest of the world has been there already for a half-decade.  Hosting your own Microsoft Exchange server in 2016 will be akin to driving a Chevy Nova.  Health care will catch up.  Slowly.  We'll see initial progress in the value based primary care settings:  Iora Health, Chen Med, Oak Street Health, and Qliance are already adopting entirely new care models - with entirely novel health IT platforms to support these models. 

After value based primary care, we'll see innovation in the LTPAC space. They are relative non-consumers of health IT, and therefore represent a unique breeding ground for innovation and creative applications of technology.  

The unique feature here isn't that the tools will "live in the cloud."  What's unique is that the tools will be centered around the goals of the individual rather than the goals of the care delivery organization.

We chose careers in health care because we wanted to have impact.  To help.  To make the world a better place.  Atul Gawande’s wonderful book, Being Mortal, reminds us that the profession of medicine has failed miserably at doing what is in fact most important:  understanding the goals of individuals, and helping us navigate that path. Together.  The book isn’t about death.  I had actually avoided it initially - worried that it was.  It’s about our pervasive and persistent inability to do what’s right in health care, and tells a handful of stories about some amazing people who are breaking with tradition and doing what’s right - with impressive results.

As I read the book - I pressed “replay” on vignettes from my career as a family physician, a parent, a software developer, a federal servant, and a son.   I ask myself how I fared in this context.  When I supported a patient’s decision to decline a medication that I thought would help them feel better, was I helping or hurting?  If I “took a strong position” on immunizing children, was I alienating parents from the care delivery system altogether, or “holding firm” on a “scientific fact?”  When I helped to create regulations that explicitly expressed certification requirements for health IT systems, was I protecting the public interest, or stifling innovation?  The answers, of course, are foggy.  What was the “right” answer for one individual may be different from what is right for another.  What's "essential guidance" for one software company may be "prescriptive regulation" to another.  One size does not fit all.

What's the 3rd platform?  It's the individual.  Designing our systems (not just our IT systems) in a way that helps us discover the priorities of each individual, and then adapt to support them. Driverless cars?  Of course.  Just tell me where you want to go.  Technology is an essential component of the solution.  But humans define where we are going.

The High Cost of Free Checkups | The Health Care Blog

Vik and Al's post on THCB was e-mailed to me this AM with a request for a comment.  My reply:

I completely agree.  And I completely disagree.  
I agree with Zeke (and the research he cites) that the "physical exam" is useless.  Indeed, when I was a full-time family physician, I would refuse to discuss/schedule an "annual physical."
But Al and Vik have conflated the "annual physical" with a proactive interaction between a care provider and an individual.  Notice that I didn't say "physician" (it need not be a physician) and notice that I didn't say "patient" as we need not think of ourselves - all of us - as flawed or "in need of care" in some way.  We're individuals and not patients.
But planning our health, just as planning our finances, or planning our home/car/helicopter maintenance schedules sometimes requires the assistance of a person who has more training or expertise than the individual.  
Appropriately managed, this is a regular event, which adds value as the foundation of a trusting collaborative relationship between an individual and a member of a care delivery team.  
Just as we needn't gather evidence that parachutes save the lives of humans who fall out of airplanes, we needn't gather evidence that this relationship is important.  Yes - text messages, e-mails, activity trackers, wifi scales and video chats are all appropriate adjuncts for the (ideally rare) face-to-face interaction.  But they're adjuncts.  Not substitutes.  We do need time together because we're humans.  A physical exam?  No.  of course not.  A "check-in" every year or three?  Absolutely.

It's time to stop calling them EHRs

It’s time to stop calling them EHRs.  Yes - we also need to stop calling them EMRs.  In 2011, ONC discussed the difference between the two terms, but I think that conversation missed the point:  whethere it’s “medical” or “health” that is the focus, these aren’t (shouldn’t be) RECORD systems at all.  We need to expand our expectations from CRUD to something that we really need: smart tools that help us collaborate toward improving health for individuals.   In November, when I floated this concept, I was teased (corrected?) for focusing on terminology and missing the point that we need EHRs to do more than just store data.

But it’s more than just terminology.  Our words mean a lot. A “record” system is for storage of records.  It saves information.  Our expectations will always focus on storing and retrieving information.  That’s the core of the design.  But in other industries - we’ve seen migration from information store/retrieve to intelligent platforms that anticipate our needs.  Does storage occur?  of course it does.  But storage of information is the byproduct of collaboration and not the goal.  

Let’s call it health IT - or even better - "IT for health.”  

Patient Centered IT

In my spam

This appeared in my e-mail today.  It’s an ad for some article that was supposed to prompt us to think about IT from a different perspective.  Should IT be delivered from a clinician-centric approach? How is that new?  I suppose it’s better than a “CFO-centered approach,”  but we deserve even better.  As an industry, we've lost focus on our priorities.  The needs of the individual are getting lost in a maze of fee-for-service motivated check-boxes and auto-generated drivel.  What's the foundation of IT that's best for a patient?  THAT’s what should be delivered.

AMA's letter to ONC

The AMA and 33 other organizations sent a letter to National Coordinator Karen DeSalvo last week.  The letter has seven requests of ONC:


  1. Decouple EHR certification from the Meaningful Use program;
  2. Re-consider alternative software testing methods;
  3. Establish greater transparency and uniformity on UCD testing and process results;
  4. Incorporate exception handling into EHR certification;
  5. Develop C-CDA guidance and tests to support exchange;
  6. Seek further stakeholder feedback; and
  7. Increase education on EHR implementation.


Let’s take them one-by-one … 


Decoupling EHR certification from the EHR incentive programs.  One could argue that this is already happening, and we can expect it to continue to happen.  Check.


Re-consider alternative software testing methods.  I’m not sure that “re-consider” is what’s in order here.  The letter asks ONC to re-consider the stance on scenario based testing.  But ONC’s stance is (and always has been) that scenario based testing is a great idea.  Is the goal of the letter to express enthusiasm for this model?  ONC will share the enthusiasm.  The harder part will be to create a framework that builds and maintains scenario-based test procedures.  This is a shared responsibility.  Shared by government (ONC and NIST) and industry (health IT developers) and - yes - the AMA and the 33 other organizations who sent the letter.  ONC has invited everyone to participate (here’s the open test development site).  So far - I don’t see much (any?)  engagement from the AMA or the others who signed the letter.  It’s relatively easy to write a letter saying someone else is responsible for solving problems.  Time to step up to the plate and participate in the solutions, folks!

Establish greater transparency on UCD testing.  Yep.  I agree.  ACBs need to enforce this, and ONC needs to get serious with those who don’t comply. UCD testing results not posted on the CHPL?  Give them 60 days warning (more than enough!) and de-list the product.  

Incorporate exception handling & C-CDA guidance and tests.  These requests expresses AMA’s ambition for ONC (and NIST?) to do full interoperability testing.  But as defined by congress in ONC’s authority - the certification program does conformance testing.  That means the products conform to the standards.  It doesn’t mean they have been tested with full end-to-end interoperability tests.  If we want ONC and NIST to do that - there will need to be an expansion of ONC’s authority and budget.  Asking ONC to do this is barking up the wrong tree.  AMA should lobby Congress on this one, not ONC. Yes - there is some low-hanging fruit here with the C-CDA. ONC could offer more explicit guidance to limit some of the optionality that exists in the HL7 standards.  I agree on this point.

Seek stakeholder feedback.  I think they do a pretty good job with this.  ONC’s FACAs are open to the public, transcribed, and always invite public comments.  

Increase EHR implementation eductaion. Well, ARRA funds are depleted.  While I agree that there is work to continue here - but ONC and the RECs and the developer community - I’m not sure that this can be increased in context of the current fiscal situation.  


I’ll enable comments on this post - as I’m interested in how others view this letter.

Writer's Block ..

Or maybe I should call it "Reider's block?" ..

Despite 15 years of blogging - this time, I've written and re-written a post so many times I can't count them.  So here's one to get me started.   

I had dinner last night with a former colleague who has had a long track record of success in government, health care, and education.  He’s getting close to retirement, and we talked about what has driven him – what he sees in himself as a leader, and why some people seem to find success so consistently, while others do not.

His goal after retirement is to teach in community colleges.  A community college grad himself – he reflected that these schools are special places that help others succeed.  Period.  The faculty are not arm-wrestling for status or grandeur. Students often have had other careers, or had less-than-stellar high school performance.  

He is a noble guy – with altruistic goals – and I think that this demeanor is what’s helped him succeed throughout is career.  I observed that his interest in teaching community college students aligns perfectly with how he’s approached every other job:  to help others succeed.  It’s not about himself or his own personal achievements.

This demeanor is uncommon.  But it’s certainly aligned with how I’ve tried to be throughout my career as well.  Success as a physician wasn’t ever measured by my income, or the number of patients I saw in a day – it was measured by my patients' success.  I served them.  Period.  To help them reach their own personal goals of health and happiness.

And then – at some point fairly late in my career – I realized that this approach – helping others succeed without judgment – without invoking MY agenda - was the same set of attributes that would align with success in other domains.

Fast forward to January 2015.  My dad has been in the hospital and I’ve once again witnessed the dysfunction of our care delivery system from the other side of the stethoscope.  It’s a sobering reminder.  The culture of health care that I witnessed in Boston (at the “best “ hospital in the world)  remains disconnected, distracted, and aligned on the wrong incentives:  

  • Revenue.  Fee-for-service models push care providers to maximize charges rather than care quality, patient experience, or best outcomes.
  • Recognition.  Smart, assertive heroes who do more, and write more papers and get more national or international recognition are perceived to be "better" physicians than folks who listen, share decisions with patients, and really focus on the right stuff.

Despite many efforts to change the way we pay for care, educate our physicians, or create stage 4 cultures - so far, it's not working.

But we can't stop trying.

And so my next chapter will be focused on a few guiding principles:

  • Work with great people who want to do what's best for others - to really add value to the world in a way that will empower others to find health and happiness.
  • Facilitate new cultural norms in health care that focus on shared decisions, collaboration, transparency, and compassion.
  • Avoid people and organizations who want to be "rock stars" and succeed for the sake of success - either in status or revenue or power.