Photo Friday: Reminder about the future – it arrived

2016.11.30 This Week at Center for Total Health 02187
2016.11.30 This Week at Center for Total Health 02187 – Gay and Lesbian Medical Association convening of LGBTQ health leaders at the Kaiser Permanente Center for Total Health(View on

When I was in medical school,

  • I didn’t meet or know many doctors who were capable or interested in taking care of all of me because of my identity, much less as leaders in making this the norm in health care. This is because doctors like that would be denied access to medical education based on their own identity.
  • There were no openly gay physicians on the Board of the American Medical Association (because you couldn’t even be a member of the AMA if you were openly gay).
  • I thought a person only needed to be a human being to receive health care.

In 2016,

  • there are doctors, nurses, nurse practitioners, physician assistants, therapists, public health professionals who are capable, interested, and leading in taking care of all of a person, as their authentic self. From around the world.
  • The AMA has a physician who is openly gay on its Board of Trustees.
  • There’s a Gay and Lesbian Medical Association that supports people in being an authentic human in health care. Because why would a person only want a part of themselves to be healthy? I haven’t met anyone in that situation.

Still a lot of work to do, and still/yet, this century has a lot going for it πŸ™‚

More photos below. Click to enlarge.

Photo Friday: Where We Came From: Kaiser Foundation School of Nursing

2016.11.03 KFSN Alumni Association, Oakland, CA USA 08626
2016.11.03 KFSN Alumni Association, Oakland, CA USA 08626 Left to Right: Ted Eytan, Deana Medinas, Claire Lisker, Doloras Jones, Phyllis Moroney (View on

On a semi-recent trip to The Garfield Innovation Center (@KPGarfield), I asked Marilyn Chow, RN, PhD, FAAN Vice President, National Patient Care Services (@InnovationChow) about the nurses who were pictured on the walls of the Center and whose names adorned the innovation spaces. She said I could actually meet them, and so, we had lunch.

Deana Medinas, Clair Lisker, Deloras Jones, and Phyllis Moroney are graduates of the Kaiser Foundation School of Nursing (KFSN), which was open from 1947-1976, and graduated 1065 health professionals.

They didn’t know as much about Kaiser Permanente, the health system when they chose KSFN. They knew the Kaiser Foundation School of Nursing was ranked #1 in California when they came to learn. And then they practiced and helped build Permanente Medicine, including the creation of all of us.

This story is similar to mine – I knew that training in family medicine was top rated in the Permanente residency that I matched into. It’s dissimilar to mine because there were numerous studies published of the success of this program by the time I left medical school.

Clair Lisker was a student of Dorothea Daniels, who was the first administrator of Permanente Foundation Hospital Los Angeles, in 1953, and then administrator of Kaiser Permanente San Francisco. Phyllis Moroney was the first Nurse Practitioner in California. Deana Medinas became the Medical Group Administrator for Kaiser Permanente Hayward.

There’s a beautiful new sculpture devoted to the KFSN on the grounds of the brand new Kaiser Permanente Oakland Hospital that I promised I would go see before the end of the day.

My colleague Vince Golla (@VinceGolla) allowed me to turn a meeting about the future into a meeting about the future by going to see the sculpture as promised.

Most human beings encounter nurses in their life journey. Permanente physicians like me are trained by nurses in our life journey. My feeling is that to know where you’re going, it’s important to know where you came from, and usually you find people who live in the future, too.

2016.11.03 KFSN Alumni Association, Oakland, CA USA 08640
2016.11.03 KFSN Alumni Association, Oakland, CA USA 08640 (View on

Doctors are allies in the 21st Century

It was a great joy to co-host the Community Clinician Roundtable – Care of Transgender Patients with the National Center for Transgender Equality (@TransEquality) at the Kaiser Permanente Center for Total Health (@KPTotalHealth) yesterday.

The care of people who are transgender requires a multidisciplinary approach, and as I mention in my intro slides below, clinicians (and attorneys) who are in this space are by definition working in the future of health care. Transgender person health has a specific reliance on a strong medical-legal partnership, because our society has placed restrictions on the access and realization of a person’s gender identity that’s dependent on the clinician role. It’s just the way it is today.

And… “doctor as ally” should be the norm all around for all humans. I have called myself an ally for at least a year now, and now I know it means a lot more than being a health advocate – it means being a part of a team in a health system, a partner in society to end special mistreatment of people and promote good health for all.

Being an ally also carries a special responsibility which is, at times, to experience the same bias that the people you serve face. Allies get included in hostile attitudes/behaviors through association. This is why it’s a special honor that I have enjoyed, and why I have special respect for someone who identifies as “ally.” Sometimes allies are marginalized in subtle ways – it’s like we are the only people in a room full of strangers. The photo above says that that’s just a feeling – there’s a whole room of just allies. You’re welcome in any time πŸ™‚ .

Thanks a ton to all the surgeons, physicians, therapists, nurses, office managers, policy experts who are standing with and for every human being as they achieve their life goals through optimal health. We are your #allies!

Photo Friday: Faces of Innovation

Left to right: Lesley Levine, MD, John Mattison, MD, Ted Eytan, MD, Tad Funahashi, MD, Kaiser PermanenteView Faces of Innovation 39947 on

I took these photographs, except for the one above (I know a better camera when I see it) at Kaiser Permanente’s annual Innovation Retreat hosted by our Executive Vice President and Chief Information Officer Phil Fasano (@FasanoPhil).

In a recent Photo Friday (Photo Friday: Why aren’t more people asked about their goals? #TeamJess | Ted Eytan, MD) I said that I know some of the best doctors in the world. That’s still true, and it includes doctorates of Philosophy, Nursing, as well as other healers who innovate in an integrated care system less by building new things (they do that too), more by solving problems across the spectrum of health, as part of something bigger than our individual aspirations. Always a great reunion with the future. Rest of my photos below, enjoy.

Now Reading: Registered nurse supply grows faster than projected amid surge in new entrants ages 23-26

This is an update on a paper I commented on a year ago (See: “Now Reading: The changing nursing profession“). That study noted a surge in younger entrance into the nursing profession. This one points to a continuation of that trend, and possibly an erasure of the pending nursing shortage:

However, since 2002 the number of young registered nurses has grown at a rate not seen since the 1970s. Between 2002 and 2009 the number of full-time- equivalent RNs ages 23–26 increased steadily by 62 percent (95% confidence interval: 42, 82; p < 0:001) to approxi-
mately 165,000 full-time equivalents.We examined characteristics of registered nurses newly entering the workforce in 2009 versus 2001–02 and did not find large or significant differences in char- acteristics such as sex, nationality, or ethnicity (data available upon request).


Our projections suggest that the supply of registered nurses will be roughly 15 percent below this projected 2030 need if entry into nursing remains at recent levels. However, they also suggest that the supply of RNs would surpass this demand, reaching just over 1,000 full-time-equivalent registered nurses per 100,000 residents, if entering cohort sizes continue to grow at current levels, or 2 percent per year.

In my glass half-fullness, it is great to see the profession achieving good growth, and hopefully with a new generation, savviness with technology and social media. As I commented a year ago “RN’s do belong in social media, and we should support their growth and development as leaders in this field.” Still agree!

Nurses and Nurses Week

An internist, a family physician, and a nurse walk into an innovation meeting….

Last week, at the Innovation Learning Network in person meeting we experienced “person down,” with one of our colleagues experiencing a significant health issue on site. Luckily Lyle “Dr. Lyle” ( @drlyle1 ) Berkowitz was present and did a quick assessment and established that the condition was not life threatening. The family physician (me) added thinking around immediate comfort and positioning. Then Marilyn Chow, a nurse, came.

As Lyle and I discussed the drug regimen and the likely possibilities of the problem, Marilyn got in around us and went directly the patient. She touched the patient, took a detailed history, and began relaxation and visualization exercises, without missing a beat.

This is the most recent example of the skill and talent that nurses bring to health care that I have experienced. There are many many more. Nurses are professionals in their own right; they often solve problems that physicians cannot, with skills that physicians don’t have. This is on purpose, we are a team.

As I thought about this, I saw on Kaiser Permanente’s internal social network that it’s National Nurses Week, and that KP has set up a special website to honor the 47,000 nurses here, and 3,000,000 Registered Nurses nationwide. That’s what prompted me to write this post.

The physicians who I most respect and admire are the ones who bring in all members of the team (including the patient) by understanding what they do, what they are good at, how they help heal people better. I am seeing this a trend with medical groups on a systemwide scale and … it’s awesome.

I feel the same way when it comes to social media. I have been writing recently about physicians and social media; however, same idea applies, more partnership is better, and nurses do contribute uniquely to this medium (see: Social Media, New Technology and Total Health – Nurses are Social )

I was fortunate to train at a place where nurses and doctors refer to each other by first name. I thought “I like this” when I first experienced it; now I know that the highest level of respect you can provide someone is to treat them as your equal.

I try, whenever possible, to shadow nurses when I shadow doctors. If you are wondering what you can do to learn about the contribution of nurses to health and health care, I recommend that you shadow the nurses around you, too – you can learn 10 new things in 10 minutes, I guarantee it.

And, I do always get inspired by nursing leaders like Marilyn Chow who affirm the need and importance of nurses, and all of the nurses I have ever known, for teaching, training, learning, and occasionally rebooting me.

Happy Nurses Week, also happy Nurses Day, Month, Year, hour, minute, second. Can’t wait to watch and work with the single largest health care workforce as they continue to co-lead improvements in health and health care!

(PS you can send a special Nurses Week e-card to the nurses you know at the Happy Nurses Week website as well)