Innovation in Medicine

I am becoming more and more convinced that the greatest opportunity to impact patient behavior and lifestyle choices (the single greatest contributor to one’s health) begin in the community and the idea that a clinic is the catalyst for change or hub of health promotion is obsolete.

What if instead of placing more value (square feet) in “innovative” buildings where doctors exist, we placed value (money) in innovative solutions centered in our communities, where the circumstances that beget health disparities exist? What if some* health issues are really social justices issues – shared problems that are contingent upon resources, access, education, and literacy? If that is true, as I believe it is, then doctors don’t have all the answers and clinics aren’t the only cure.

So the question becomes:

How can our institutions of health bend toward the need and stay relevant in the spaces where people live, work, and play?

I have one idea.

Social media – or the technology and web-based tools used to connect people, resources, and ideas – offers an incredible opportunity for physicians to meet patients where they are, and the data suggests, patients are online. Advancing community engagement initiatives in medicine demands new solutions to complex and challenging problems. Future success relies on how well medicine, as a field, takes advantage of the technology to broadly disseminate credible health information in a space where patients set the agenda. Moreover, using social media to create partnerships between key stakeholders in community health, including community advocates and local and state government, can revolutionize our current models of care and add civic engagement to a physician’s repertoire of treatment modalities.

Admittedly, social media is not the entire solution. But, embracing new technologies to eliminate traditional barriers that prevent the medical system from responding to healthcare needs in holistic and systemic ways, is an important start. Future work must address the potential health disparities that may be created when access to health information is contingent upon access to the internet. However, much is being done to advance mobile health solutions to ensure that everyone benefits from the sharing of information and pooling of resources likely to mark the new age of social media in medicine.

Exploring the uses of social media in medicine is a growing interest of mine and I am fortunate to be connected to a few leaders in the field who are really blazing the trail including Wendy Sue Swanson, MD, Bryan Vartabedian, MD, Ricky Choi, MD, and Heidi Roman, MD. Click on their name and follow them on twitter!

What do you think about social media in medicine?

Footnote: * Some medical problems clearly require medical care that can best be provided in a hospital and/or clinic setting and patients with such ailments rightfully deserve the benefits new technology and innovative medical strategies may bring to bear on their treatment course. This statement is only meant to highlight the growing number of patients who rely on our healthcare system because of problems that currently lie outside the purview of “physician” responsibilities. This illustrates the need for partnerships between physicians, patients, community advocates, and local government to collectively address the needs in our communities that beget major health problems and significant health disparities.


Equality and the Future of Medicine

Today, President Obama issued “our generation’s task” – to make the values our forefathers fought to uphold, real. To make equality real. On the day our nation remembers Martin Luther King Jr. and his breathtaking view of a new America, we would be remiss to ignore the similarities between the American future Obama espoused and the American Dream of our beloved visionary Dr. King. At a time in need of national healing, both men stood on the Washington Mall and called our nation’s attention to one presiding creed, “We hold these truths to be self-evident, that all men are created equal.”

Equal. What does that mean today? (and why does it matter?)

As a pediatrician invested in the young lives who will lead the future of our nation, equality means health. Let me explain.

In medicine, we understand that health is related to a number of factors that affect a person’s life, including the sociocultural environment in which a person lives, works, and plays. The CDC refers to the pieces that make up a sociocultural environment as “social determinants of health.” That means, where you live, work, and play matters. And that’s not all. Where your parents and parent’s parents lived, worked, and played matters too. It turns out, one can predict a number of medical problems a given population is at increased risk to have based on that population’s access to housing, education, healthy food, safe spaces for play, proximity to medical services, and a host of other local factors – factors that may be unique to some communities but are not entirely out of our control, as individuals or as a society. President Obama’s Accountable Care Act was an important start to creating equity in medical service provisions in the United States, but there is so much more to be done. It is clear that for a number of preventable illnesses (obesity, type II diabetes, and in some cases asthma), safe housing heals and healthy food prevents disease. The future health of our nation relies on us as individuals, collectively demanding that we as a society invest in comprehensive strategies to address the inequity that exists in our communities.

The point is, our forefathers had it right. As President Obama so aptly stated, “fidelity to our founding principles requires new responses to new challenges.” The challenge in medicine today is to foster and sustain partnerships to collectively address the issues of inequity that exist in our communities.

From the ballot box to your neighborhood, what are you doing to make America a more equal place?

Here’s to a future that shines bright for all of us!

Pearls of 2012


This is a pic I took on a trail near Stinson beach.

And I’m back! After a short holiday hiatus – I went home for Christmas (first time in the last 3 years!) and had a lovely jaunt of Q2 NICU call to ring in the new year (that’s every other day, 26 hour shifts in the neonatal intensive care unit) – I’m back and looking forward to new beginnings in 2013, for me and my blog!

For me, moving into a new year isn’t so much about resolutions as it is about lessons learned. Here are 3 things I will carry with me from 2012.

3. The Power of Partnerships. In 2011, one of my research interests dovetailed with a colleague of mine who is now a chief resident here at UCSF. We are both excited about the opportunities to use social media in medicine and our collective energy pushed our projects forward in 2012. Here’s what I learned:

  • Collaboration, at its best, builds on the strengths and augments the weaknesses of everyone involved. This maximizes productivity and personal satisfaction in shared projects.
  • Healthy working relationships are based on mutual respect and trust.
  • Clearly delegate responsibilities and assign credit for each portion of a project before you start. In writing is best because you can refer to it if/when confusion about roles/responsibilities arise.

Together, we have written a paper (that is waiting to be published), started a website (to launch in the new year!), submitted an abstract to an academic conference (that was accepted!), and developed teaching tools around our areas of interest (including a new curriculum we are hoping to use in our residency program). The future of medicine is about aligning our collective interests and building something that is bigger than the sum of our individual parts. We will continue to do that in 2013!

2. Change Starts with Me. I have long felt physicians have a responsibility to be vocal members of our body politic. If our nation’s healthcare spending makes up close to 20% of the GDP (one and a half times more than any other country, by the way) and we now know our population’s health is intimately linked to issues of housing, income, education, and local environment, then physicians should be talking about these things, and they need to be speaking publicly. I am starting with myself. This blog is my effort to foster and join national conversations about health in the context of our daily life, work, and play. No topic is off limits. Join me in 2013 as I put my mouth where our nation’s money is and take on the major issues facing medicine and pediatrics today!

1. Life is a Beautiful Mess. My perfectionist tendency has always been to tidy up loose ends and clean my stress away. But I am starting to realize that some parts of life are best left alone – unplanned, unadjusted, un-judged. As the countdown at the bottom of this page reveals, I am graduating soon (really soon) and completing a long stretch (24 years long) of the planning and preparation that traditionally defines higher education. Now it’s time to get off the ride and start a ride of my own. I don’t know what lies ahead for a young pediatrician who’s passionate about finding meaning in clinical medicine and addressing the major social issues facing my field today. But I have a feeling, the ride is going to be exhilarating and exhausting and full of the dips and turns that are worth getting a little messy for.

This is the end of that trail...a new beginning...

This is the end of that trail…a new beginning…

What pearls are you taking from 2012?

Here’s to new beginnings in 2013!