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Who Am I?

I am a pulmonary and critical care physician in Southern Oregon. When not on fire every summer this is one of the most beautiful regions in the country. Though I guess all the wildfire smoke does go a long way towards keeping a pulmonologist in business ;)


My original degree was in computer science and I still love to program although I can't type as fast as I used to. I left software and went into medicine because I felt I wasn't doing enough to help people. Then I went back to software after my training because I found I now had the knowledge to not only help people directly as a physician, but now also to teach through my software.


Why is this website named "ThisIsNotAClinic"?


It was between my first and second year of medical school that I began working for a small clinic primarily seeing patients who could not afford good healthcare. Once a week I would spend a night doing HIV testing and counseling. The people that I worked with on a day-to-day basis were amazingly motivated, idealistic and wickedly funny. There were constant grumblings questioning the sanity of board managing the facility but it seemed far removed from myself and my job.

After summer was over and I went onto my second year of medical school I tried to make it back that one night a week for HIV testing but it became more and more difficult. I still knew people who worked in the clinic at that point and heard stories about a multitude of bad ideas coming down from the Board of Directors and a rather vindictive CEO. Memos were distributed focusing each month on some board member’s pet peeve. Decisions were made to save money at the expense of the staff working there and the patients that were being cared for. The board members questioned the integrity of many of the workers and those that questioned the board’s ideas were fired or made to quit.

The last time I showed up for HIV testing night the clinic looked very different. Most of the old staff that I had known and loved were gone and there was a spectacular new addition in their place. Perched loftily upon a filing cabinet near the secretarial desks that one needed to walk by to get to the examination rooms was a large glass jar. A few random coins lay at the bottom of it and there was a note taped across the front of the jar that read, “This is not a clinic”. The jar was the newest brainstorm of the board of directors.

The charges for medical services in the clinic were based upon each individual patient's income and so it was a clinic mainly frequented by low-income patients. This wasn’t paying the bills, and so the board of directors had decided to try to upgrade the status of their facility…not by investment, not by location, not by charity, volunteers, maintaining their good staff or even deceptive advertising. They were trying to upgrade their status in one of the cheapest and most powerful ways possible… semantics. Patients came, vitals were taken, they were put in rooms and doctors saw them. But this was not a clinic. Physicals and basic medical procedures were performed...but this was not a clinic. Medications were prescribed and follow-up appointments were made. But still…this was not a clinic.

Because “clinic” implied poverty. Because “clinic” was a dirty word. And anyone caught using the word “clinic” had to put money in the swear jar. If not a clinic, what was it then?

It was in fact a great summation of the problems of modern American medicine. Medicine is filled with people that start as idealists. We spend our days getting people medication that they need, giving nursing care, changing their sheets, cleaning their rooms, and holding their hand while we tell them horrible truths. We are neither angels nor saints, but are being made martyrs by investors, medical equipment companies, insurance companies, pharmaceutical companies, educational loan companies, and politicians.

They have driven medicine into the confines of the surreal. As I stared at that jar in melancholy bemusement I thought of Rene Magritte’s painting “Ceci n'est pas une pipe” (This is not a pipe). The surreal juxtaposition between what is real and what isn’t lay right before me. His “Treachery of Images” could just as easily have been the “Treachery of Words” since it is the interplay between the two that create his surreality. But it is one thing to make innocent philosophical mistakes or twist linguistics to point out a humorous truth and quite a different thing to use it to manipulate perceptions. Medicine has become a business built upon rules that are built upon other rules that are built upon more rules. Sometimes it seems like a house of cards. And although each individual rule may have made sense at the time to someone, the overall result is a schizophrenic methodology simultaneously both wanting to help people and take their money and run from them.


The Treachery of Images (or this is not a pipe)