Clinician Creative

Finally reading Peter Attia ‘s Outlive.. loving the chapter on Centenarians… completely agree with his characterization of 100+ year olds as surprisingly healthy and vibrant relative to our expectations all of my 100+ year old patients (and I’ve been lucky to have quite a few), are more likely to be at home vs nursing home, still walking v Bedbound/wheelchair bound, and are almost universally cognitively intact compared to other “high risk” 65+ patients I’ve cared for. One very striking common factor in the 100+ group is they all seem to have extremely good senses of humor. I never left the home of a 100+ year old patient without hearing a genuinely funny joke One secret to a long life… Laugh more

What sort of innovation in medical practice design would enable more doctors to transition to lifestyle focused care? ??

After being asked by a 70 year old patient ,in far better shape than my 34 yr old self, What was I doing for my health? I made a serious health change. Step one I went to the trusty Cochrane Database Searched “diet and mortality” Found this well done systematic review With this very telling graphic And let the data lead my diet https://lnkd.in/dPFMDDqg

“What do you do for your health doctor?” When I ran my first direct primary care practice about 8 years ago I had a patient, a woman in her 70s, who came to me because a cardiologist had told her due to her lipid panel and cardiac calcium score she needed statins And she was hoping I would tell her something different I recommended the statins She got very upset with me, pointing out that she exercised an hour a day, ate a clean diet, never smoked or drank, had a rich social life, and slept well At the time, I was 40 years younger than her, slept terribly doing hospital night shifts to cover what my practice didn’t, lived off the Wendy’s near the hospital and coke, never exercised, and had no friends outside work “What do you do for your health doctor?” ,She asked. It was a wake up call. I changed everything about my health and lifestyle after that moment

After an online debate on how primary care should relate to emergency departments and hospital services, we think we may have found a new slogan for our primary care focused healthcare innovation services “Make primary care primary again” ?? hat tip to J. Michael Connors MD for a slightly different variation on that concept in a LinkedIn thread recently

Beautiful story of a brave boy With an ultra #raredisease Manifesting as the not so rare cluster of symptoms more commonly called #cerebralpalsy Whose story has now landed in a time capsule on the surface of the moon. There is good data to support that much of what we call severe cerebral palsy today is actually just a manifestation of identifiable genetic disorders And thus potentially curable with #genetherapy. This may sound like a moonshot, and that’s exactly the point. If we can return to the surface of the moon, we can cure what for all of human history have been incurable complex chronic conditions. ?? Now we in the medical, scientific, policy, business, and patient advocacy communities need to work together to help people get access to these miraculous therapies. Unlike the real moon landing, It shouldn’t take 50 years for people like Raiden to land of the surface of the metaphorical moon landing happening in gene therapy FDA approvals, right now. I haven’t been this excited about the possibilities of medicine and science since I was in Mr.Gillam’s high school biology class learning about the completion of the human genome project in 1996. ?? We in science and medicine are the new astronauts. Avoidable human suffering is the metaphorical Soviets. We need to get people like Raiden and his family to surface of this new moon We need to get all who qualify access to gene therapies This is new space race. ?? We must win We will win Raiden can’t wait 50 years this time. The time is now! Bravo to Tommy Pham ?? and everyone in the rare disease community that made this happen. This is a beautiful manifestation of a fathers love Now all my fellow scientists, doctors, entrepreneurs, and policy wonks… Time for us to get to work!

Jamming vs full production performance Aka what the heck does Taylor Swift have to do with #healthcareinnovation ? I have a 9 year old daughter Therefore I know far more about Taylor Saift than I’d otherwise admit ?? I also played guitar in a number of garage bands in high school ?? So I’ve participated in more than my fair share of random one off jam sessions with random musicians in friends’ garages Mentoring at the Yale CBIT (Center for Biomedical Innovation and Technology) this past weekend got me thinking about the spectrum of clinical innovation in healthcare and #healthtech There are jam sessions with friends in a garage ( hackathons, weekend innovation events, etc) And there are full on Eras tours ( well funded VC backed startups, corporate and large health system innovation departments) And a whole bunch of stuff in between ( the majority of people working to change things systematically in healthcare) The essential skills to perform well at the hackathon/garage jam session and the fully funded VC backed startup/Eras Tour are the same: - work well in fast moving , dynamic, diverse teams with imperfect information - willingness to quickly change course and ideas based on iterative experiments and data collection - a deep focus on clearly understanding the problem rather than becoming too attached to any one particular solution But the infrastructure ( and the stakes ) needed to succeed in each of these settings are wildly different. What do you all think about this analogy? Is it useful in helping frame your relationship and understanding of #innovation in #healthcare ? What’s the same about jam sessions and Eras tour? What’s different? What’s needed for success at Eras tour level that may not be evident at jam session level? **** Hi, if my posts are new to your feed, let me introduce myself. I'm Michael. I practice as a med-peds doctor, help build beautiful new health systems as a physician entrepreneur, startup mentor, and angel investor. I also write a newsletter. Subscribe today: cliniciancreative.substack (.) com Let me know your thoughts about this post in the comments below ??

This is a big deal….?????? Outcomes Based Agreements to price cell and gene therapy in such a way as to improve equitable access to potentially curative gene therapy ?? For people covered by Medicaid affected by sickle cell disease. “Under the model, CMS will negotiate an OBA with participating manufacturers, which will tie pricing for SCD treatments to whether the therapy improves health outcomes for people with Medicaid. Negotiations will also include additional pricing rebates and a standardized access policy. Participating states will then decide whether to enter into an agreement with manufacturers based on the negotiated terms and offer the agreed-upon standard access policy in exchange for rebates as negotiated by CMS. As part of the CGT Access Model, CMS will negotiate financial and clinical outcome measures with drug manufacturers and then reconcile data, monitor results, and evaluate outcomes. The CGT Access Model will begin in January 2025, and states may choose to begin participation at a time of their choosing between January 2025 and January 2026.” #genetherapy #sicklecell #raredisease #healthequity #heakthcareinnovation

I've been privileged to learn from many incredible mentors in my career One of my mentors at Caremore was Dr Jennie Byrne, MD, PhD She's continued to be an inspiration, mentor, and friend in the years since. Recently, she interviewed me for an upcoming book on Moral Injury in healthcare and clinical frontline teams. This is an insanely important topic that everyone building in healthcare, leading clinical teams, or working at any level with clinicians must understand and act to diminish if we are going to right this healthcare system ship... Please check Dr. Byrne's important work (including her previous book on Remote Work and the changing nature of the work place). #healthcareinnovation #healthcare #physicianleadership #burnout #moralinjury #healthtech

Physicians are uniquely trained to… …. Design and test healthcare system and care delivery innovations. I know I know Why waste valuable physician time on anything other than diagnosing and treating patients? Don’t we project managers and designers and consultants for all that healthcare systems innovation stuff? Well yes… and these people are incredibly valuable to innovation in healthcare delivery settings… But, physicians who already know the “system” intimately (and feel the pain in working within its dysfunction every day) Are also rigorously trained in the very skills that make for a good rigorous modern system designer They are practiced in the mental models of hypothesis testing and quick iterative data collection and decision-making informed by the scientific method in uncertain settings In medical school with formalize this into an assessment and plan (which when done right is a differential diagnosis… untested assumptions… and an obtainable, rigorous series of iterative tests to test these assumptions against real world data… diagnostic testing) This is the exact system of iterative design forward thinking designer/project manager/innovators like my friend Samuel Liberty advocates in system / project/ game design All of you who’ve spent time on internal medicine rounds will be very familiar with Ockham’s Razor … cited in this article focused on game design We need more frontline clinicians involved in healthcare delivery innovation We physicians should recognize the parrellels of our unique training to modern design thinking And set the example and pace in our institutions. ——- Follow me for posts on #healthcareinnovation #physicianleadership and #healthtech design I’m Michael R. O’Brien, MD Healthcare Executive, Physician Innovator, Advisor, and Angel Investor Founder of Clinician Creative