If Owen Tripp can achieve intelligent integrated care for large numbers he will be doing a great service. It is still more than a bit puzzling as to why he had such difficulty finding care for his acoustic neuroma. His choice of access to care using urgent care clinics was poor. A good primary care doctor would have tried a simple thing or two and sent him to an ENT, who should have easily made the diagnosis. Every major medical center has neurosurgical teams versed in this surgery. But more importantly than a single individual is the evolution of care for the majority. There are so many factors responsible for the difficulty in accessing care that there is no easy fix. The corporatization of medicine for profit is a disaster and the complexity of todays knowledge base is overwhelming, but until adjunctive help from AI proves valuable the best model is still access to the medical system through a knowledgeable and unhurried primary care captain of the ship. Medicine is still an art as well as a science, with the need to integrate many disparate factors into a unified concept. As a retired surgeon I am amazed how hard it has been to find high level care for my family. It has several times taken all 50 years of my experience to achieve close to the desired result. I'm extremely empathetic with those who have to undertake these tasks without medical training. Jerold Lancourt, M.D.
As a retired pediatrician I find the same challenging problems for myself and others seeking excellent care. I notice very few MDs do physical exams any more. Disproportionate reliance on imaging and labs to the exclusion instead as complementary tools to the basic listening history and exam we were taught in our training. Very fragmented care without continuity even in one emergency room or urgent care visit despite the common ownership of urgent care and emergency care by one of the amoeba like expansions of hospitals/medical centers. To get a PCP who can coordinate one’s care with a network of specialists one must pay for a concierge doc. Very few people can afford that or navigate the system without it. Hiring of more categories of MDs on contracts and private equity contribute in some areas like nursing homes and emergency rooms. Some years ago I noticed a sign in an emergency room at a prominent hospital in Atlanta GA stating that most of the providers in that ER were not employees of the hospital and the hospital took no responsibility for their care. At least it was honest. One more issue I can’t help but bring up is the intensive promotion of Medicare advantage. They call and advertise on buses offering vision nd hearing , but also cash and groceries etc. It’s a tremendous shift of public healthcare money into private insurance and often or ultimately limited and delayed care. And one needs an out of network specialist for a particular surgery or medical problem that may be out of luck. Kaiser gone bad. But very seductive to the uninformed.
As I listened to this inspiring conversation I found myself wondering whether an individual could be covered by Included Care. It sounds like one must be an employee of a large company that contracts with Included Care. Is that correct?
Thanks very much for sharing this conversation on GT. Much appreciated .
Everything you say strikes at the core. Medicare Advantage is one of the biggest ripoffs in the history of American Medicine. Included Care, whether it really works or not (of which I am skeptical) is apparently based on employer based insurance. That model is so flawed. It's almost laughable that the CEO of a 'forward-looking' company would be so uninformed to go to a 'doc-in-the-box for his care.
Anecdotes can prove a point. When my office manager got brain cancer, our insurance company (a major one) decided that since she couldn't work any more she should be kicked off the insurance. I kept her employed to try to avoid that, then they demanded payroll records. I fought it but eventually lost. As you said, the fragmented, disconnected care is a nightmare. Greed among a subset of doctors has always been an issue, but it's nothing compared to the corporate and private equity interests that are ripping the heart out of medicine.
Thanks for alerting us to what appears to be a terrific resource on the foundational question of how to identify the right doctor. I am sure everyone reading this will know of examples where this was far more difficult than it should have been. Let us hope this catches on!
While ruminating on AI ability to clarifying diagnostic issues, I thought of the old SOAP way of hidpstory taking, and the role of the history. I believe I listened where Mato and another was aggregating patients past medical history some things will be elusive if no “ history” available.
Medical records in my region seem absent. Not needed, for instance, I had acute upper left qyadrant pain, doubling. I was ordered x rat. Ok, the double contradybct scan. Normal. Next day, my internist said let’s look. A raduiligust ran screen at high speed. “Wait!” Sacid my late friend. “ that is s where pain!” An intussusception of jejunum. pting. Prior radiologists put in teaching files, but refused to ebter update. I was heading to vacation, carried copy of CT scan. As I knew if I told ER doc I had an intussusception,might hear laughter. Etiology? Long term ocassiinalmcrsmping.
I don’t see the evidence for this model - and it will deliver what Owen promises it will. It’s what other new integrated health care models are supposedly offering. The user feedback on his model is quite negative. This was a surprisingly disappointing conversation.
Thanks for checking user reviews. Perhaps I was too quick/superficial in response because I wish for something like this. The devil may be in the extensive logistics details. One Medical is also a nice model but has lots of turnover of providers and mostly physician extenders so the specialist networks they refer to and the individual providers skills and experience are critical.
I'm sorry to hear that the user feedback is negative. I was willing to give him the benefit of the doubt. But as noted above the primary care pay scale is totally insufficient to support a practice. When I look at my EOBs after my wife and i go to the doctor the arithmetic is obvious. If the doctor spends 30 min with you and gets 50 to 100 dollars for the visit, that doesn't pay for the overhead to run an office (from personal experience) Private practice in primary care is staggering. Whatever ones views on private practice, with all its negatives, it still was the backbone that made American medicine the envy of the world for many decades.
Unfortunately, the commentary presented in this interview is all too common. For over 19 years, I've performed reconstructive surgery for head and neck cancer, breast cancer, and sarcomas. Recently, an old neighbor of ours passed away from a sarcoma. It had been misdiagnosed as a hematoma from a testosterone pellet placement for several months until the patient had an MRI, and it showed a lesion very consistent with a sarcoma. And this patient knew us, both myself and my wife personally. He knew I was a plastic surgeon, knew I did oncologic reconstruction, but still did not reach out to me. And then once I saw the MRI, I knew the patient would need a hemipelvectomy, but ultimately, they would pass away from widely metastatic disease because large, high-grade, undifferentiated sarcomas have a terrible prognosis. And ultimately, the patient did pass away. So just like Owen's story, these rare conditions, these harder-to-diagnose conditions are often difficult, and I don't envy any primary care doctor trying to understand or figure out these signs and symptoms. I, too, like Dr. Topol and Dr. Lancourt, often get asked questions about what's the right doctor to go see? Who do you recommend? Where I trained at Indiana University medical center, I knew every person to send someone and where I taught for seven years at the Medical College of Wisconsin, I knew who to send everybody to as well. When I moved into private practice in Austin, Texas, it became very difficult because I did not train in that community, and I had not lived in that community before, and it was essentially a private community. So then it became very difficult to figure out where to send somebody. But I continued to do cancer reconstruction and cancer care, and multidisciplinary care is the best for patients. But it became more and more complex in that environment and I stopped performing microvascular and other forms of reconstructive surgery in 2020. I was not familiar with Owen's company, but I will look at it because I always want to provide the best options for my team members. So I really enjoyed the conversation today with Dr. Topol and Owen.
If Owen Tripp can achieve intelligent integrated care for large numbers he will be doing a great service. It is still more than a bit puzzling as to why he had such difficulty finding care for his acoustic neuroma. His choice of access to care using urgent care clinics was poor. A good primary care doctor would have tried a simple thing or two and sent him to an ENT, who should have easily made the diagnosis. Every major medical center has neurosurgical teams versed in this surgery. But more importantly than a single individual is the evolution of care for the majority. There are so many factors responsible for the difficulty in accessing care that there is no easy fix. The corporatization of medicine for profit is a disaster and the complexity of todays knowledge base is overwhelming, but until adjunctive help from AI proves valuable the best model is still access to the medical system through a knowledgeable and unhurried primary care captain of the ship. Medicine is still an art as well as a science, with the need to integrate many disparate factors into a unified concept. As a retired surgeon I am amazed how hard it has been to find high level care for my family. It has several times taken all 50 years of my experience to achieve close to the desired result. I'm extremely empathetic with those who have to undertake these tasks without medical training. Jerold Lancourt, M.D.
As a retired pediatrician I find the same challenging problems for myself and others seeking excellent care. I notice very few MDs do physical exams any more. Disproportionate reliance on imaging and labs to the exclusion instead as complementary tools to the basic listening history and exam we were taught in our training. Very fragmented care without continuity even in one emergency room or urgent care visit despite the common ownership of urgent care and emergency care by one of the amoeba like expansions of hospitals/medical centers. To get a PCP who can coordinate one’s care with a network of specialists one must pay for a concierge doc. Very few people can afford that or navigate the system without it. Hiring of more categories of MDs on contracts and private equity contribute in some areas like nursing homes and emergency rooms. Some years ago I noticed a sign in an emergency room at a prominent hospital in Atlanta GA stating that most of the providers in that ER were not employees of the hospital and the hospital took no responsibility for their care. At least it was honest. One more issue I can’t help but bring up is the intensive promotion of Medicare advantage. They call and advertise on buses offering vision nd hearing , but also cash and groceries etc. It’s a tremendous shift of public healthcare money into private insurance and often or ultimately limited and delayed care. And one needs an out of network specialist for a particular surgery or medical problem that may be out of luck. Kaiser gone bad. But very seductive to the uninformed.
As I listened to this inspiring conversation I found myself wondering whether an individual could be covered by Included Care. It sounds like one must be an employee of a large company that contracts with Included Care. Is that correct?
Thanks very much for sharing this conversation on GT. Much appreciated .
Everything you say strikes at the core. Medicare Advantage is one of the biggest ripoffs in the history of American Medicine. Included Care, whether it really works or not (of which I am skeptical) is apparently based on employer based insurance. That model is so flawed. It's almost laughable that the CEO of a 'forward-looking' company would be so uninformed to go to a 'doc-in-the-box for his care.
Anecdotes can prove a point. When my office manager got brain cancer, our insurance company (a major one) decided that since she couldn't work any more she should be kicked off the insurance. I kept her employed to try to avoid that, then they demanded payroll records. I fought it but eventually lost. As you said, the fragmented, disconnected care is a nightmare. Greed among a subset of doctors has always been an issue, but it's nothing compared to the corporate and private equity interests that are ripping the heart out of medicine.
Well said. I needed to proofread!
Wow!
I am appalled by the experience of the poor person with scabies.
Diagnosis should proceed from the easiest to treat explanation towards the more difficult.
Owen Tripp's hearing loss proved to be scarily complex, but starting from: "Is the ear canal blocked by wax?" worked for my husband.
Thanks for alerting us to what appears to be a terrific resource on the foundational question of how to identify the right doctor. I am sure everyone reading this will know of examples where this was far more difficult than it should have been. Let us hope this catches on!
I took a look at primary care pay scale. Not competitive. Not even close. That’s why you can’t find a doctor worth his/her salt!
While ruminating on AI ability to clarifying diagnostic issues, I thought of the old SOAP way of hidpstory taking, and the role of the history. I believe I listened where Mato and another was aggregating patients past medical history some things will be elusive if no “ history” available.
Medical records in my region seem absent. Not needed, for instance, I had acute upper left qyadrant pain, doubling. I was ordered x rat. Ok, the double contradybct scan. Normal. Next day, my internist said let’s look. A raduiligust ran screen at high speed. “Wait!” Sacid my late friend. “ that is s where pain!” An intussusception of jejunum. pting. Prior radiologists put in teaching files, but refused to ebter update. I was heading to vacation, carried copy of CT scan. As I knew if I told ER doc I had an intussusception,might hear laughter. Etiology? Long term ocassiinalmcrsmping.
I don’t see the evidence for this model - and it will deliver what Owen promises it will. It’s what other new integrated health care models are supposedly offering. The user feedback on his model is quite negative. This was a surprisingly disappointing conversation.
Thanks for checking user reviews. Perhaps I was too quick/superficial in response because I wish for something like this. The devil may be in the extensive logistics details. One Medical is also a nice model but has lots of turnover of providers and mostly physician extenders so the specialist networks they refer to and the individual providers skills and experience are critical.
I'm sorry to hear that the user feedback is negative. I was willing to give him the benefit of the doubt. But as noted above the primary care pay scale is totally insufficient to support a practice. When I look at my EOBs after my wife and i go to the doctor the arithmetic is obvious. If the doctor spends 30 min with you and gets 50 to 100 dollars for the visit, that doesn't pay for the overhead to run an office (from personal experience) Private practice in primary care is staggering. Whatever ones views on private practice, with all its negatives, it still was the backbone that made American medicine the envy of the world for many decades.
Unfortunately, the commentary presented in this interview is all too common. For over 19 years, I've performed reconstructive surgery for head and neck cancer, breast cancer, and sarcomas. Recently, an old neighbor of ours passed away from a sarcoma. It had been misdiagnosed as a hematoma from a testosterone pellet placement for several months until the patient had an MRI, and it showed a lesion very consistent with a sarcoma. And this patient knew us, both myself and my wife personally. He knew I was a plastic surgeon, knew I did oncologic reconstruction, but still did not reach out to me. And then once I saw the MRI, I knew the patient would need a hemipelvectomy, but ultimately, they would pass away from widely metastatic disease because large, high-grade, undifferentiated sarcomas have a terrible prognosis. And ultimately, the patient did pass away. So just like Owen's story, these rare conditions, these harder-to-diagnose conditions are often difficult, and I don't envy any primary care doctor trying to understand or figure out these signs and symptoms. I, too, like Dr. Topol and Dr. Lancourt, often get asked questions about what's the right doctor to go see? Who do you recommend? Where I trained at Indiana University medical center, I knew every person to send someone and where I taught for seven years at the Medical College of Wisconsin, I knew who to send everybody to as well. When I moved into private practice in Austin, Texas, it became very difficult because I did not train in that community, and I had not lived in that community before, and it was essentially a private community. So then it became very difficult to figure out where to send somebody. But I continued to do cancer reconstruction and cancer care, and multidisciplinary care is the best for patients. But it became more and more complex in that environment and I stopped performing microvascular and other forms of reconstructive surgery in 2020. I was not familiar with Owen's company, but I will look at it because I always want to provide the best options for my team members. So I really enjoyed the conversation today with Dr. Topol and Owen.
https://www.cidrap.umn.edu/covid-19/new-surveillance-tool-can-predict-covid-variants-concern
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