Burnout Causes Problems

Just came across an article in the NY Times: Basically, its simply saying out loud something that most of us in healthcare see and know and do every day. MOST…. but not all.

Sequoia MD is built on now working this way. We are focused on not exploiting patients, or doctors, or nurses, but instead working in a way that is focused on excellent care, and should work for the long haul.

Progress Not Perfection

All day, I talk to patients about the idea of making progress, even if not arriving at perfection. Well, today in the office, we ran out of mailer bags, the bags we put medicine in when we ship it to patients.

We are all creatures of habit, and tend to continue with whatever we are doing. But I wondered, was there a better way to ship medications? Turns out, you can buy these mailers from 100% recycled plastic. Well, why not?

You might this is a small thing (it is!), you might think this is a silly thing to write about (and it is!), but I also think it’s an important reflection on making small changes, one at a time, to make the world a better place. So, from here on out, we will be using recycled plastic mailers. One small improvement, every day, adds up to big change over time. Its another way we practice what we preach.

New Faces

I am excited to announce that I am hiring a nurse practitioner to join me at Sequoia MD. Kristen brings energy, passion for great care, experience, and kindness to the team, and will be a wonderful addition to the office. 

Kristen’s hire strengthens the core pillars of what this practice is about— a long term relationship with your doctor, availability when you need it, a caring place to come when things are not going well, and a place to get your needs met. 

For the first few weeks she is in the office, she will be spending a lot of time spending time with me during appointments, and learning the ins- and outs- of how the office works. Since the practice has opened, I have been frustrated that I have no one available in the office on the days I am out. That will no longer be the case. 

Lastly, a word or reassurance. I know in a lot of offices, nurse practitioners are hired to make it more difficult to see the doctor. I want to be very explicit that her hire represents a great addition to the team taking care of you, not a gatekeeper to prevent you from seeing me. You can never have too many people on your side, and I hope that with time, she will be as helpful to you as I am.

As always, should you have any questions or concerns, please get in touch.

Election Day

Today is Election Day, which means I hope you going out to cast your vote.

One of the challenges we face (and which is reflected in our politics) is a lack of community. The importance of having community I have brought up with many of my patients, and it is particularly relevant today. While we all have our opinions (sometimes the same, sometimes different, sometimes strongly held, sometimes not), we all share a need for human connection.

There is an ongoing study out of Harvard that examines the effect of community on our health. One of the most important findings from it is how loneliness (the lack of community), is directly detrimental to our health. In the words of the study’s lead investigator, “Loneliness is Lethal.” You can see a great talk on it here.

So, when you vote today, say hello to the people who are also waiting in line. When you get home, chat with the neighbor. Community is not created overnight, but perhaps today is a good day to start.

A Doctor in the Family

Being a doctor, family members often ask me medical questions. “Should I take this medicine at night or in the morning?” or “Is there anything else I can do for my arthritis?” While I don’t mind helping out with these kinds of things, really, it be nice if everyone had a doctor in the family— so something close to it.

That idea is a big part of what Sequoia MD specifically, an direct primary care more broadly, is all about. The entire premise of the practice is that is is built around a relationship. It used to be the norm that your doctor knew you, knew who you are. While that still exists some places now, it is, unfortunately, the exception. I want to bring it back.

I like the fact that sometimes, I see my patients at the park, or at the grocery store. I like the fact that my patients are a part of my community. I think its important to be there when things come up, they can call me— even if its just a small question, or something that you forgot to mention at an appointment.

Its not for everyone. Some people like big institutions. Some people prefer complex systems of care. Me? I prefer relationships with my patients, and I feel incredibly lucky that I get to have that, that I get to the be doctor in not just my own family, but in many families.

Its the individual...

This article hits the nail on the head around a lot of the current issues around chronic pain and addiction. It also is another example of another huge challenge in healthcare.

 One of the biggest challenges I see in medicine is the idea that "someone else" knows better. For any individual patient, that patient, and the doctor taking care of him or her, are going to make the best decision. It won't always be right, but it will certainly be a better decision than one make for 2.000 miles away.  Politicians, insurance company administrators, bureaucrats, "policy makers." and a long list of other people are going to know less about any given situation than the patient and the doctor. And yet, they often have as much (if not MORE) influence, in how an individual patient gets treated. 

This is true with managing pain. For a long time, doctors were very concerned about the dangers of prescribing opiates. Then a whole host of other people got involved, and basically told doctors they were not doing a good job, because we weren't controlling patients pain, not prescribing enough. Now, those very same people, are coming back and telling us we are not doing a good job because they are being prescribed too much. 

How about we let doctors work with patients to come up with the best treatment for that individual person? Complicated? No. Revolutionary? Maybe...


As many of you know, I spend a good amount of time each summer at Bearskin Meadow Camp, in Kings Canyon/Sequoia National Park. Its beautiful up in the mountains, and a tremendous amount of fun. The camp is for children and families who live with type 1 diabetes. My first summer there was over 20 years ago. 

There are many amazing things about camp, but one of the things that I took away most strongly from this summer is the community that camp offers. People living with diabetes often feel tremendously isolated. Many of the campers and staff that come to camp feel that most of the year, no one “gets it.” In contrast, while they are at camp, everyone “gets it.” There are a whole host of issues that living with diabetes comes with, and spending time with people who have shared those experiences, is profoundly healing. Why? I think, because it dispels the notion of “I am alone.” 

I like to say that the antidote for isolation is community. 

The challenge is that the feelings of isolation that go with living with a chronic illness are not isolated to diabetes. In fact, many of the patients I see daily struggle with this feeling. The irony is that this difficulty connecting with others is universal human experience. Everyone feels it, to a greater or lessor extent. 

So, for people who are lucky enough to be able to go to camp, come to Bearskin. But, everyone and anyone can practice creating community. If you are feeling nervous about striking a conversation with someone— a neighbor, a friend, someone in the checkout line— know that they are probably just as nervous as you are. And know that both of you will be richer, less lonely, and less isolated, with a bit more human connection. Whether at camp or at home, practice building community.