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 🙂

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 🙂 .

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)

Presentation: Social Media, New Technology and Total Health – Nurses are Social

I was honored this last week to be invited to the the first ever Kaiser Permanente “Celebrating Triage/Advice Nursing” conference, where I presented the keynote, “Social Media, New Technology for Total Health.”

For people who are unaware of this branch of nursing, it is a group of health professionals accomplished in other settings like the hospital, or medical office, who become skilled at telephonic and other forms of remote care. This is very much “health information technology,” and I would argue that these professionals are the most advanced in all of healthcare in its practice.

These RNs are practicing mHealth, today

At the conference, I asked the RNs to engage in a dialogue about what they were seeing in the population they were supporting, and they have important insights, because this is impacting their work, today. It might not be said that members using cell phones are having the same impact in physician practice of medicine as they are for this group.

For example, they told me how calls today using cell phones often are broken up due to call drops, are often more pressured/rushed due to the environments members are calling from (everything from parking lots, to moving cars), and are changing the way they work with members. In one example, I was told about  workplaces where the nurses can only ask questions with “yes/no” answers to preserve confidentiality.

RNs are more social

The other thing that impressed me as a statement made by Janette Wackerly, RN, MBA, RN, California Board of Registered Nursing. She said:

“RNs are very social animals, are we not?”

To a very strong audience response.

I had not previously considered the differences between RNs and MDs in the uptake of social media, and it made me think that RNs may very well have a special/leadership role in health care’s use of social media. Even though my personality inventory registers off-the-charts extraversion, I don’t think MDs in genral would self-identify as strongly social (or extraverted) as this audience did and acted.

This is a good point in which to recognize the work of Phil Baumann ( @PhilBaumann ) – I mentioned his work to the group, and in my research most or all of the roads lead to him in promoting RN involvement in social media, which is a good (great) thing.

Kaiser Permanente has over 42,000 nurses; 1,000 of them are advice RNs. The nurses in this group are specialists in providing care anywhere, and my own observations, prior work, and the voices of members confirm the great service they provide.

Slides are below, click on any to enlarge. I am trying to get these to upload to my slideshare account and will update this post if I am successful.

Health Information Technology Basics (California Nurses Association)

Health Information Technology Basics (California Nurses Association) – Cautionary, and interesting take on Electronic Health Records, from the California Nurses Association: "RNs have to work collectively to control health information technology rather than trying to fix it. It’s important to recognize that tinkering can’t fix HIT because its primary purpose is to mechanize, or routinize, patient care. It’s designed to quantify the unquantifiable, to replace the patient with an imaginary statistical norm. High-quality healthcare can’t be mechanized because it depends on people—on patients and caregivers—and people are infinitely more complex and capable than computers can ever be."

When physicians are ready to promote patient empowerment / engagement, what do we want them to do?

This question was posed to me by Ann Barber, MD, who I just spoke with. Ann reached out to me because she has been following the work of the group at, and specifically their call to recruit physicians to support the patient empowerment movement. Ann is an internist who specializes in hospital medicine, and has recently relocated to New York.

Ann asked me the question in the title of this post, and in talking with her, I decided to ask it here as well, because I’m unsure of the answer.

I wondered if this is because I/we have assumed that the majority of physicians are not interested in empowering patients, and therefore we don’t know how to support those that are?

I did a mini-check in with myself on this, and although I have alluded to some physician groups still feeling challenged by the idea of patient empowerment on this blog, the majority of my writing here points to the idea that physicians are very interested in empowering patients, because they want to perform well for them. The overwhelming majority of my posts here point to that idea, and here’s just one example.

Back to the question – where should a physician start when they have the energy and drive to make a difference in this area? When they interview for positions, what vocabulary should they use to describe what they are looking to do? How do they find the institutions in their communities that are already forging ahead in this area? If there are no institutions identified, how do they find the ones that are open to new ideas/thinking in this area?

My suggestion was to walk the hallways of any potential medical center employer and observe and ask questions – how are patients and families involved in their care? Do nurses and doctors round at the bedside (like they do at Medical College of Georgia, and hospitals in the Kaiser Permanente system [article in Harvard Business Review describes this] )? Are there visiting hours? How does the institution keep families and informed throughout a hospital stay?

I recommended a few resources, including the Wachter’s World Blog, written by hospitalist expert Bob Wachter, MD, the Institute for Family Centered Care, to find institutions in a community that are practicing patient and family centered care in New York, and of course, HelloHealth in Wlliamsburg.

I think the inpatient setting is the next frontier of patient and family involvement in their care, enabled by technology, and welcome the creativity of Ann and other hospital medicine specialists who want to make a difference for patients and famlies everywhere, which is why I wanted to think about this more.

Are there other ideas for Ann and the physicians in our profession who are among the “already recruited?”, in New York (and beyond)? Post them in the comments, please!

And thanks to e-patients and all the patients who have made it easy to remember who I am accountable to.