Thursday, September 26, 2013

45th Reunion West Point Class of 1968: "OLD Souls" in "Old Bodies"

I was deeply touched by our 45th class reunion at the Marriott in Tarreytown, NY with daily outings to West Point.  In 1964 we started the adventure.  700 + graduated on June 5, 1968.  Now 39 are deceased, 20 of them in Vietnam.  Many alums and/or spouses have ailing bodies with arthritis, cancer, heart disease, kidney disease, prostate disease, etc.

BUT, we still are instilled with the "Old Souls" put into our once young bodies as cadets.  Our "old bodies" match the souls now.  The hearts are big, as are many of our understandings about life and the meaning of our West Point experiences.  The music of the sixties goads us on through CD's provided by Dick Steiner to tell the stories.  The Sugar Bowl story and the Stealing of the Navy Goat story stimulate the telling of many other stories of life in another era.  It was good, once we graduated.  Then we missed part of West Point.

Which part?  The reliable part?  The honorable part?  The friendship part?

Here they are- friends, brothers.  They understand part of us that no one else can.  Every five years or so we refresh that feeling of being understood and get a sense of West Point Wholeness.  Through the relationships and the connections to each other.

A glimpse of The Plain, A Cadet Parade, The Cadet Chapel, Trophy Point, The Hudson River, Thayer Monument, The Hotel Thayer, The Park Restaurant (I love it), Constitution Island, etc. may last for five to ten years as an anchor test.  Yes, I graduated from West Point in 1968.  That is very satisfying.  BUT, much less meaningful without the friends and brothers.

Thank you, Brothers.  Of the Class of 1968.  NO TASK TOO GREAT!

I reviewed our 45th Reunion Weekend on my Dr Synonymous Show:  Click Here

Wednesday, September 18, 2013

Erika Bliss, MD "Changing the System" with Direct Primary Care- Interview

The President and CEO of Qliance, a Direct Primary Care network in Washington state, Erika Bliss, MD tells the story of Qliance and her desire to "change the system".  "We work for our patients" has been a key factor in health care delivery by Qliance physicians since founder, Garrison Bliss, MD started the first practice.

Dr Bliss expounds on some aspects of "The System" that may be corrected by Direct Primary Care.  She reviews the vision of Qliance from founding to the present.  To grow the movement, Qliance hopes to network with other practices and networks to keep it expanding to serve the whole nation.

Listen as she speaks of individual and population based care via the DPC business model and practice strategies.  From caring to measuring outcomes and responding to patient and employer needs, she sees DPC as having a workable, (flexible) answer.

Interview w/ Dr Bliss 9/17/13 by Dr Synonymous

Dr Bliss interview starts at 14:30 on the show.  Skip ahead to that spot and get some great information.

She will be a presenter at Direct Primary Care National Summit

Monday, September 16, 2013

Direct Primary Care: Interview with Erika Bliss, MD President Qliance

The Dr Synonymous Show 9/17/2013  The interview starts at 14:30 into the show.

Listen on September 17 at 9 PM ET on blog talk Radio (internet) as Dr Synonymous interviews Erika Bliss, MD about her experience with Direct Primary Care as a Family Physician and as President of Qliance in the Seattle area. Qliance

Questions will include:

How did you get into Direct Primary Care?
What do you like about it?
Where is it headed as a movement in Washington and nationally?

Tell us about your career in Family Medicine?

How about your relationship with Qliance?  Then let's look at the home page for Qliance and chat a bit about it.  (click on Qliance link above)

Why was it started?  By Whom?

What are the benefits of having a network of several practices?  Drawbacks?

Who can be a Qliance physician?

What is the policy scene doing with DPC?  How does it relate to the Affordable Care Act?

Who are friends of DPC?  Enemies?

What else is important about DPC?

What do you expect from the DPC National Summit in St Louis October 11-12?
Direct Primary Care National Summit

Wednesday, September 11, 2013

Direct Primary Care: Expanding the Conversation From NC to DC and Beyond

DPC PIONEER:  Dr Brian Forrest discussed his history with and approach to DPC, including the training of physicians in multiple specialties in Direct Pay practice on my BTR Dr Synonymous Show.  His heart for open access for all showed through in this 50 minute interview with Dr Synonymous (aka, A. Patrick Jonas, MD) on Blog Talk Radio.  Listen as he describes his mission, passion and success with DPC in Apex, NC and beyond.

DPC Interview w/Dr Brian Forrest on Dr Synonymous Show 9/10/2013

Dr Forrest (and Dr Synonymous/Jonas) will be presenting information about DPC at:

Direct Primary Care National Summit

How about DPC and the poor?  Read the two part guest post on Common Sense Family Doctor written by Dr MargueriteDuane.

Common Sense Family Doctor Guest Post Part One on DPC by Marguerite Duane, MD

DPC for the Poor- Part Two by Dr Duane

Direct Primary Care is jumping, folks.  It isn't for everyone, but it's an important model for the present and future.  What do you think?

Tuesday, September 10, 2013

The Dr Synonymous Show: Interview with Brian Forrest, MD about Direct Primary Care

Dr Brian Forrest, Medical Director and Founder of Access Healthcare (and current Board Chair or the North Carolina AFP), is the special guest of Dr Jonas (aka, Dr Synonymous) tonight speaking about Direct Primary Care.

Access Healthcare

The general questions we'll cover in the interview include:                  

                     What is Direct Primary Care?  How did you get into it?

                      What do you like about it?

                      How many ways can it be done?  How about rural settings?

                       How does a "pure" DPC practice differ from a hybrid?

                       What about the poor?  Do they use DPC, too?

                         What about the rich?  Do they have access, too?

                       What kind of physicians practice DPC?
                        How does your practice work in North Carolina?

                         How do you train other physicians to do DPC?
                         What kind of demand is there for  DPC?

                          Is this just a way to make more money?
                          Does every state allow DPC?

                          Are DPC companies competing to buy up practices?
                           How does DPC affect the course of the healthcare transformation?

                            What about the DPC Summit in St Louis on October 11-12?

Direct Primary Care National Summit

Join us for another episode of Dr Synonymous live from 9-10 PM on Blog Talk Radio    The Dr Synonymous Show September 10, 2013 

Wednesday, September 4, 2013

Direct Primary Care: It's Not Just the Money

When we didn't receive Medicare payments for five of seven months between October 2012 and April, it hit my practice hard financially.  We were close to a disaster (like closing) until the OSMA (Ohio state Medical Association) helped us get connected with a human who could get our claims paid.

The non-payment was caused by new computer registrations we had to make for the Affordable Care Act (ObamaCare, aka, RomneyCare).  They made data entry errors in all three of the major changes, not easily detectable by the first four representatives we spoke with as the problem worsened from December through April.  After we had assurances in May that it would be fixed, we heard nothing at all for 30 days.

That experience was an eye opener.  Our survival as a practice is threatened by the massive system changes.We have no assurances that we'll have any patients after January 1, 2014.  We're small and vulnerable.  How do we continue?

I love being a Family Physician.  There is a sacred aspect to each of us that should be honored in our human endeavors.  As a Family Physician, I get to witness and experience that sacredness in my patients and myself.  The patient-physician relationship is the sacred core of the practice of medicine that I believe to still be worthy of honoring and protecting.  The relationship is a human connection that gives each patient and physician glimpses of the sacred nature of the other.  People are amazing and I'm blessed to get to help them with their health, illness and, eventually, their demise.  But, OUR demise as a practice is a surprising possibility.  How do we stabilize and increase our chance for survival?  We need to find an Island of Hope in the Heart of Darkness.

I'm starting to see that Direct Primary Care (DPC) might be that island.  It's a business model that gets us away from insurance companies, misaligned quality initiatives, and the quicksand of the Affordable Care Act.  (The ACA has some strengths and weaknesses, one of which is that we may disappear or drown in a sea of well-intended initiatives).

My practice has started Direct Family Medicine (DFM), the practice part of the DPC business model.  All new patients to the practice can only enter via DPC into our DFM.  I've posted about it before.  A good introduction to the concept can be found at  It's not just about the money.  It's also about serving others as a Family Physician as well as I am able.

I'm a member of the planning committee for the Direct Primary Care National Summit in St Louis October 11-12 at the Airport Marriott.  It will be an exciting opportunity to explore the "Island of Hope" and get some great information about how to proceed with Direct Primary Care.  Physicians and practices from pure DPC, hybrid (traditional/ DPC practices) and transitioning practices will all be represented as well as a few networks of DPC practices.  Click on the link below for more information.  More conferences of a similar nature will start to pop up as thousands of physicians seek to leave The Heart of Darkness and continue to practice.

Direct Primary Care National Summit

Monday, September 2, 2013

In Search of A Principled Heart in Health Care

"A Principled Heart, that's what we needed.  Just someone with a principled heart."  I could hear the anger through clenched teeth as someone described a dehumanizing experience in a hospital with a dying relative in severe pain as they reflect on "the cartel that used to call itself a hospital."

A FAMILY PHYSICIAN in the best sense is called to have a principled heart.  We care.  We serve.  We'll protect our patients from unnecessary suffering.  We'll preserve their humanity when they crawl through the muck of sickness and ill health and impending demise.

Or will we?  Are we there?  Or are we communicating in real time with the admitting hospitalist, cardiologist, intensivist, oncologist, etc. if we're no longer admitting to hospitals?  Would they let us know if our patient is stuck and in need of a translator or decision maker who is a broad based generalist, able to dance across the confusion of our non-system of health care?  (Like us).

I know we have principled hearts.  BUT, are they connected where they are needed?

What do you think?