Pet Goats & Pap Smears →

I am happy to announce my forthcoming book, Pet Goats & Pap Smears: 101 Medical Adventures to Open Your Heart & Mind.   

Many people have commented (both positive and negative) on the cover. Unlike advertisements that objectify women or dominate animals, this book cover celebrates and honors both women and animals. Ads often use women to sell products. Think of a sexy woman lying on a sports car or a young woman wrapped around a bottle of liquor. Selling alcohol and cars has nothing to do with nearly naked women, but performing Pap smears is about naked women. I’m a doctor. My patients are mostly women and I spend much of my day listening to women and examining their bodies.

The cover model is a medical student and she is not naked. The goat–Charity– is a therapy goat. Both enjoyed the photo shoot. In fact, Charity choreographed the shoot by getting into some very funny positions and sometimes offering us hilarious facial expressions. The woman and the goat are not cheap gimmicks. They are both congruent with the profound message of Pet Goats & Pap Smears.

Why pet goats? Many people know that I have been leading town halls nationwide to help citizens design their own ideal clinics and hospitals.  As I met with people across America, pet goats were an unexpected theme in citizen testimony. And to my surprise, pet goats keep popping up in my life. The healing potential of animals is underutilized in medicine. To serve my patients, I’m willing to integrate most of their ideas into my medical practice–even if their requests seem odd to me.

Why Pap smears? A Pap smear is a screening test for cervical cancer, in which a smear of cervical cells is taken from inside a woman’s vagina. The cervix is the doorway to the womb, the birthplace of all humanity. When I’m in between my patients’ thighs looking deep inside the places where nobody has looked before, patients often tell me things that they’ve never shared with anybody. This sacred relationship between a doctor and patient is the foundation of health care.

Pet Goats & Pap Smears is more than a collection of stories. It’s a book of 101 medical adventures that have been retrieved from the deepest places inside people I have cared for. Sometimes, I’m so deep inside patients that I believe I have touched their souls. I know they have touched mine.

Pet Goats & Pap Smears

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The Endless War on Pubic Hair →

 

Over the years I’ve noticed a lot of hairless pits and pubes during paps. Some women apologize for the stubble, for not having freshly-shaven legs.

But I live in Oregon now where people celebrate pubic hair. And I prefer the natural look. I love smiling women with hairy pits who never apologize to me for not shaving their legs.

Why apologize for hair?

Hair insulates and offers a buffer to chaffing and abrasions. And shaving inflames follicles leaving microscopic cuts that act as a breeding ground for nasty bacteria like staph, herpes, and other STDs. Plus there’s the risk of abscesses, boils, and deeper infections that necessitate surgery on one’s scrotum, labia, penis, or inner thighs.

Some claim shaving their pubes increases sexual sensitivity.  My plea: Just a trim, not a clear cut.

 

 

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Medical Mystery Shoppers →

Obama says primary care is a top priority for the administration, but 36% of physicians lose money every time they see a Medicare patient.  Now Medicare will cut reimbursement by 30%.

Government-hired mystery shoppers were to spy on doctors to figure out what’s really going wrong. Thankfully, public outcry at this $350,000 taxpayer-funded program led to its demise.

Want to fix primary care? Ain’t no mystery. Pay docs enough to keep their doors open or get out of the way. More and more physicians are boycotting abusive third parties and establishing direct relationships with patients who value their services.

Your thoughts?

 

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Want the Clinic of Your Dreams? Ask Your Community →

Tired of assembly-line medicine? Don’t wait for politician-saviors. Convene with your neighbors.

Americans typically rely on elected officials to uphold the will of the people, but decades of partisan struggle have stalled meaningful health-care reform. Now physicians are leaving exam rooms to take direct action.

In 2004 I had my epiphany: “Why wait for legislation? I’m a board-certified physician. What’s stopping me from serving the public?”

From living rooms to Main Street cafes, I held town hall meetings where I invited citizens to design their ideal clinic. Bus drivers and businessmen, housewives and hippies, teachers, and kids of all ages joined together to design a new model, a template for the nation.

So What’s an Ideal Clinic?

Mimi, a mother of two, shared: “An ideal clinic is a sanctuary, a safe place, a place of wisdom where we learn to live harmlessly, listen with empathy, observe without judgement. It’s a place where a revolution starts, where we rediscover our priorities.”

Lynette, a Chinese woman, added, “No front counters separating people from people, complimentary massage while waiting, fun surgical gowns!”

Jacob, a soft-spoken young man with dreadlocks, imagined “intriguing magazines” and a “pet cat that greets people at the door.”

A shy East-Indian student, Anjali, summarized, “Most importantly, the doctor would be someone with a big heart and a great love for people and service, someone whose presence itself is enough to cheer a patient. . .”

From nine town hall meetings over six weeks, I collected one hundred pages of written testimony, adopted 90% of feedback, and opened the community clinic one month later. For the first time my job description was written by my patients, not administrators.

The Patient’s Prescription

What do Americans really want in an ideal health-care system?

1. Authentic relationships: People prefer doctors who are fully present–emotionally, spiritually, and physically.

2. Integrative healing: All medical professionals work in concert. On-site complementary therapies such as massage, yoga, and acupuncture are accessible.

3. Physician role models: Happy, healthy doctors inspire patients to live happy, healthy lives.

4. Patient-centered care: One citizen’s advice: “Abolish cookie cutter medicine—everybody does not need the same thing.”

5. Flexible financing: Offer payment options: Monthly stipends, sliding scale discounts, bartering, and accept insurance when possible.

Health Care of, by, and for the People

Tucked in a wooded residential area a few miles from my home, is a sanctuary with yoga, massage, acupuncture, and a solar-heated, wheelchair-accessible indoor pool and hot tub. Follow a covered walkway to a clinic with overstuffed chairs and fun flannel gowns where patients enjoy thirty to sixty minute appointments; those who walk or bicycle to the office are rewarded with a selection of local handmade soaps and lotions.

The community clinic operates with no grants or outside funding. Malpractice premiums are discounted 50% as I work part time. Low overhead allows this one-physician, no-staff model to pass savings onto patients. Most insurance is accepted; uninsured receive 30% off with barter options available. Claims are processed through a free online clearinghouse. Administrative tasks and non-urgent calls are handled in my home business office at my leisure.

Is this a spa specializing in the worried well? Quite the contrary. Founding this community clinic has been the most personally and academically-fulfilling adventure of my career.

Case in point: Jacob–a thin, uninsured 25 year-old male whom I met at a town hall meeting–presented for a check up on opening day with a blood pressure of 220/120. My first diagnosis of renal artery stenosis. I accompanied him to angioplasty and that evening celebrated his new blood pressure–118/80–by sneaking Jacob and his family into the radiology suite to demonstrate his life-saving procedure with his very own catheters, wires and film images which I provided as souvenirs.

Physician, Heal Thy Profession

The care Americans want and deserve can’t be legislated by bureacrats. The time is now for physicians to bypass partisan discord and enact real change. Need help? Contact me at IdealMedicalCare.org

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Should Physicians Pay Patients for Waiting? →

Meet Elaine.

 

We lost touch for a while, but caught up with each other recently.

 

Like most girlfriends, we shared adventures of love, travel, and work. I told Elaine that I left assembly-line medicine. Now I  host town hall meetings–inspiring citizens nationwide to design ideal clinics and hospitals.

 

Elaine shared: “If I’m kept waiting, I bill the doctor. At the twenty minute mark, I politely tell the receptionist that the doctor has missed my appointment and, at the thirty minute mark, I will start billing at $47/hour.”

 

Wow! I had to hear more.


Elaine scheduled her physical as the first appointment slot of the day.  She waited thirty-five minutes in a paper gown before getting dressed, retrieving her copay, and informing the receptionist to expect a bill. The doctor pulled up just as Elaine was leaving.

 

Prior to her initial visit, Elaine signed the standard agreement outlining no-show and late fees. On follow up, Elaine knocked on the door and discovered her therapist with another client. He apologized for his scheduling error. Elaine sent a bill; check arrived the following week.

 

Elaine values herself and her time.

 

When the Comcast guy told her to wait at home between 3:00-6:00 pm, she said, “Expect a $141.00 bill. Is that okay with your boss?” A compromise: The driver agreed to call fifteen minutes ahead of arrival.

 

I was intrigued. Who pays for waiting?

 

Cab drivers charge hourly for waiting.  Restaurants may provide a discounted meal for the inconvenience.  Airlines cover hotel rooms for undue delays. Some physicians apologize. I offer a gift.

 

Central to medicine is a sacred covenant built on mutual trust, respect, and integrity. What happens when physicians fall into self-interest or self-pity?  Or when physicians are so emotionally, physically or financially distraught by their profession?

 

Patients suffer. And their wait times increase.

 

So what’s a doc to do?

 

1)  Remember: Respect is reciprocal. If physicians are on time, patients will be on time. If physicians don’t cancel appointments with little notice, patients won’t either. Doctors should stop charging fees they are unwilling to pay themselves.

 

2) Functional clinics attract functional patients. Patients fall to the level of dysfuntion within a clinic. A chaotic, disorganized clinic attracts chaotic, disorganized patients. Take care of yourself; uphold high standards and healthy boundaries.


3) Don’t wait. Doctors should apologize for delays. And if presented with an invoice for excessive waiting, doctors should gladly pay the fee. Fortunately, most patients don’t bill at the doctor’s hourly rate.

 

My opinion. Share yours:

 

 


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