Some Total Transparency

My hubby just sent me the TED talk by Dr. Leana Wen about the importance of physicians being totally transparent.  Transparent about our educations.  Transparent about how we get paid, not just whether we get bonuses for being shills for pharmaceutical companies but also if we make more money doing a procedure than we do to just talk to someone. Transparent about about where we live.  Transparent about our practice philosophy.

When I was in training, I remember being told to guard my personal life closely.  Do not talk about myself.  Definitely not about my family.  Or about my own experiences.  No family photos.  I even met some physicians who removed their wedding bands at work in order to present a completely blank persona, as if a doctor is nothing but a doctor.  It reminds me of the classic childhood belief that the teacher lives at school.

What surprised me was not Dr. Wen’s insistence that physicians tell the truth about themselves but the extreme negative reaction from other doctors.  Really?  It’s so scary to have someone suggest voluntary disclosure that you must threaten or try to destroy the career of the woman who suggests it?

Louisa May Alcott (of Little Women fame) wrote a charming book called Eight Cousins and its sequel Rose in Bloom that are essentially a palatable version of her father, Bronson Alcott’s views on education.  At one point Rose, the protagonist, is caught reading a French novel (shocking!)  She tries to hide it but then argues that what she’s doing isn’t wrong.  After some discussion, she realizes that she knows inside that what she’s doing is wrong because she had that instinct to hide it.

Perhaps the doctors who aren’t comfortable with being transparent should take some time away from JAMA to read Rose in Bloom.  If they are so embarrassed about what they are doing that they need to hide it from view, perhaps they actually know that they shouldn’t be doing it.


So, in the interest of complete transparency, here’s the dirt on me:

I am board certified in Family Medicine and belong to the American Academy of Family Physicians (AAFP).  I went to University of Denver for undergrad (on scholarship so all my student loans are from medical school) and University of Colorado for medical school.  I completed my three year family medicine residency in Pueblo at St. Mary-Corwin.

I do not receive any payments or gifts from any pharmaceutical or medical device companies or anyone else and I do not sit on any boards (paid or unpaid).  Drug reps don’t ever visit me…I’m just not worth it because I won’t listen or accept any offers of “informative lunches,”  My only patients who suffer from lack of samples are those with asthma.  Pretty much everything else can be managed affordably and the samples only provide a false sense of getting something for free because then you’re stuck on a super expensive medication long term.

100% of my income is from my clinical work.  Approximately half is from monthly memberships and approximately half is from Medicaid.  With the memberships, I obviously get paid the same amount no matter what I do.  That was the point.  With Medicaid it sort of comes out the same…no matter what I do, they don’t pay very much.  🙂  That’s it.  No other income

I do take grad student who are applying to medical school and PA school, but I don’t get paid for that.

I live three blocks from my office and usually bike in.  I have on a few occasions forgotten to wear a helmet and it’s guaranteed one of my patients who lives in the vicinity will see me not following my own advice, Murphy’s law.  I sometimes have to bring one or both of my children with me if someone needs to be seen after hours.  They usually play nicely in the other room but they occasionally throw puppets or color on the wall.

I don’t kick anyone out if they suddenly find themselves with lots money and good insurance, but I do mostly see those who don’t have either.  I have recent experience with high deductible (aka “crappy” insurance, but before the Affordable Care Act so before it was actually required to cover a few things) and Medicaid.  I am always willing to discuss how much something will cost because I know that a majority of my patients have gone without medical care due to cost in the past and I don’t want that to happen again.  Together with a wonderful nurse, I also started a free clinic at Wellspring Church here in Englewood at which we mostly care for Englewood’s homeless.  We now have another physician and team of volunteers so we’re able to provide care every Sunday.

I also see mostly people who are a little different from mainstream (whatever that is!?).  Homebirth families.  LGBT families.  Homeschool families.  Small business owners and people who work for small businesses; electricians, plumbers, HVAC, construction, grocery, restaurants, animal breeders, etc.  Families who belong to Christian cost-sharing.  A surprising number of tattoo artists, photographers, painters, and a comic book artist.  Alternative care practitioners.  Homesteaders and urban homesteaders.  People who don’t want to take medication or get vaccines; because yes, they need medical care, too.  I love seeing such a wide variety of people; every day is interesting.  And because I homeschool, keep chickens, had my second baby at home, and have many friends and family who are artists or LGBT or hate Western medicine as a rule, most of my patients could easily be my friends as well.

At the same time, I am a medical doctor.  I am trained in medical problems and medical treatments.  I want to help people avoid them whenever they can, but I can’t and won’t prescribe herbs and treatments that I know nothing about.  I do prefer prevention to treating a problem, which is why I try to catch any risk factors early and recommend simple fixes like exercise, dietary changes, counseling, vitamins, and finding interesting hobbies.  I recommend books a lot.  And YouTube videos.

I am a proponent of universal healthcare here in Colorado, even though it means I’d have to give up on my dream of a membership based practice.  Because it’s more important to me that everyone have access to this basic necessity.  Civilized people make sure everyone has medical care.  In the spring of 2015, I’ll be collecting signatures to hopefully put this on the ballot in 2016.  While I know that I’m making a difference in my little corner of the world, policy change can help more people.

I am also a vocal advocate of SNAP (food stamps) after my own experience being on them after my strokes two years ago.  SNAP is a critical safety net that ensures that people have access to food regardless of their income.  It’s a basic, civilized thing to do.  As a physician, I support SNAP (rather than relying on charity like food banks and food baskets) because it allows my patients with diabetes to choose low carb foods, my patients with celiac to choose gluten free foods, and all my patients to have access to fresh fruits and vegetables that are rarely available at food banks.  We still need food banks and I am good friends with people who run food banks.  But SNAP should be the foundation.

Short of providing my sex-and-substances history (one lifetime partner and one lifetime drink on Match Day in the company of my husband and close friends), I think I’ve disclosed pretty much everything. 🙂  If anyone is worried about something I’ve left out, feel free to ask.  Because I know the doctor-patient relationship is extremely intimate.  I carry the secrets of many.  I know things that people have never told anyone else in the whole world.  And to be worthy of that responsibility, I think it’s important to be honest and transparent, to have integrity of self.

And to Dr. Leana Wen, in the words of Colin Powell, “Being responsible sometimes means pissing people off.”