My professional journey has been about one thing: how do we get the healthcare that we would want to our patients? How do we create healthcare as it could and should be?
Medical Education
I grew up swearing the one thing I would never do is be a doctor. And my childhood heros were not doctors but explorers and inventors — Marco Polo, Daniel Boone, Lewis & Clark, as well as Leonardo da Vinci, Thomas Edison, the Wright Brothers, and Nicola Tesla. So it was remarkable that after taking time out of college to figure out life and the universe, I found myself back in college and then pursuing medicine. Both were very providentially directed and not what I wanted to do.
My prior year and two quarters of college had not involved any pre-Med requirements. It was time for the heavy haul, cramming a year of Physics into the summer, and the following year taking the Medical College Admissions Test (MCAT) over the four core subjects while still in the middle of two of those four one year subjects. My scores were good. Medical schools thought it was cute that I was anxious to get into medical school the following year. Another providential process and I began medical school that next summer without an undergraduate degree, something that is very rare.
Medical school was about survival. I had seen the wreckage of my father and my wife’s father — both well-intended human beings going in, but very broken and dysfunctional out the other end. Residency was more survival and finding a path that was a close as possible to the whole version of human health I had come to believe in prior to medical school. Preventive Medicine residency was a close as it got and included a Masters of Public Health degree in Epidemiology — the science of medical research.
Lifestyle Medicine Beginnings
After some of us finished residency a group of us that were still around the university in various faculty affiliations would meet and try to figure out what was missing in healthcare and what could be done about it. One of my colleagues in this group founded the American College of Lifestyle Medicine (ACLM).
Building Clinical Experience
In subsequent years I was gaining clinical experience in occupational medicine, private practice, primary care, integrative medicine, and lifestyle medicine. I had come to realize how limited the scope of my medical education had been, and spent a fair amount of time and energy exploring and learning about the full scope of healthcare, including what would be considered alternative or integrative approaches. I attended conferences, trainings, visited practitioners in their practices, and learned from many patient’s experiences as I saw many of the most complex and difficult cases that were not finding answers from standard medicine.
Developing Lifestyle Medicine
Around 2007 ACLM was going down the drain. Everyone was busy with their personal lives and careers, and there was no sponsor or financial supporter. I had started to get involved again. It was way too important to let die, so it became my full time “fetus” — like I was pregnant with it in my belly — for the next 5+ years. We cleaned up a very large mess, organized, built basic infrastructure, and systematically developed the creature for the long haul to be a respectable, professional, science-based organization. We developed professional organizational alliances, we brought a former US Surgeon General, top lifestyle scientists, and other leaders onto our Advisory Board, developed conferences, created early standards for the field, and very importantly a passionate culture that cared about making a difference for our patients. I introduced the concepts of “treating the cause,” lifestyle vital signs, and other foundational elements.
In early 2013 the operating board chose a path that was politically correct and against what was in the best interest of patients and our paths separated and I bowed out. It was heartbreaking but staying on mission and pursuing real change is hard.
Lifestyle Medicine Foundation
Lifestyle medicine was still very important and I continued to help develop the field through a sister non-profit organization we had set up, the Lifestyle Medicine Foundation. We continued to develop the spirit or culture of the lifestyle medicine space with creating recognition awards for the pioneers and leaders. We did this in coordination with ACLM for a number of years, and once they had gotten to a more functional place we turned it completely over to them. We also explored creating online content directly for consumers, and learned the pros and cons and dynamics of the grant-dependent non-profit space. Eventually this organization was turned over to others in the lifestyle medicine space and is currently used as a vehicle for channeling funding to support lifestyle medicine training for professionals in less affluent countries.
Real-World Implementation
After ACLM it made sense to develop resources and services to support LM in clinical practice. Providers were excited about a different and better kind of healthcare but had no idea how to make it work financially typical in systems that were all about pills and procedures. I had spent years learning the operations side of medical practice and set up my own practice from scratch so I would understand the business side of medical practice — at least in the United States. I wanted to be able to operationalize lifestyle medicine in the real-world for others.
We set up a business entity and started helping institutions and individuals implement financially sustainable ways of doing lifestyle medicine practice in the real world. But it soon became apparent that providers were trying to do lifestyle medicine clinically in ways that looked like writing a prescription for broccoli instead of a medication. That was not lifestyle medicine. That was not what I was seeking to operationalize. Providers still needed a whole different approach to patients and clinical practice that was very different from the one they knew. Back to the drawing board.
Frameworks for a Different Kind of Healthcare
Around this same time, I turned some of my attention to developing clinical models in my own practice which I have used as a laboratory for many years. Lifestyle medicine is about working with humans to change their habits of living. Change is hard. Where are the models of how humans work so I know how to engage with them effectively to do this change? I couldn’t find any. It was a massive hole in our current healthcare space. So we would have to develop a whole new set of guiding frameworks for how healthcare could and should be done. From scratch. A framework for how to put all the clinical pieces together in a rational, prioritized, functional manner. A system for lifestyle vital signs – assess the causative forces of health and disease as the basis of care. A framework for how humans work, and don’t. And a framework for how people have come the point at which we engage with them, with the dominant forces and trajectories of their lives.
Truly About the Patient
Around this time there was increasing talk about involving patients in healthcare processes and decisions. They were all very peripheral and didn’t do much more than survey them if they were more satisfied with what different healthcare variations were being tried. Stanford Medicine X conferences actually involved patients in planning, speaking, executing projects, etc. I participated for a number of years, doing smaller talks several years. It was a fascinating mix of activist patients, healthcare industry leaders, and entrepreneurs from Silicon Valley and all over the world. I learned a lot. About what was attempted and what did or didn’t work, and why, in trying to change healthcare in the real world.
It was during probably the 30th or 40th conversation with a passionate person seeking to change "the healthcare system" for patient benefit that a light bulb went on. What is a “system?” By definition a set of parts working together in synchronicity for a common purpose. Is that what we have in the United States? Not at all! Well, functionally what is our healthcare most like? I had learned a lot about the real machinations of healthcare behind the curtain by this point in time. Incentive structures throughout all of healthcare were misaligned with patient best interest. Pharmaceutical companies doing their thing, device manufacturers doing their thing, insurance companies doing their thing, etc. It is very much like a many-ringed circus. There is one big tent or space, but everyone is running their own show for their own purposes. Things make sense only within one ring, while overall it is chaos. So, I like others, was spending tremendous energy and time on changing a “system” that didn’t actuallyexist. It was a mirage. We needed to spend our energy on reality.
Entrepreneurial Change?
If there was no “system” to engage, perhaps we could have positive impact getting key tools into use in the for-profit circus. I was an explorer and inventor by nature, so this could be good. I worked with several start-ups on apps or platforms relative to lifestyle medicine. But I came to understand the product pipeline, business structures, and what was at the other end of the pipeline: the same big-boy players that currently dominate the healthcare space. They are all focused on profit, not patients. They buy up all the innovation to continue to dominate the market. All the start-ups defined success in terms of “the exit” — the financial sell-out to the highest bidder. Sure, they would like to do something that helped patients. But profit was still their clear priority for which patient good would be sacrificed in the process. This did not lead to the sustainable change that is needed. So now what?
How Humans Work
Each time we thought we were getting to a buildable foundation we kept finding that we needed to go deeper to build what would matter and endure. We were finally at bedrock: human nature. Why do we do what we do, why we do it? Why have we ended up in a place and state where we as a society do mercenary medicine instead of the mercy medicine of human history. We always have to balance a budget. But when mercenary dynamics distort and contort healthcare industry, politics, institutions, and practice to such extreme degrees, this is an inherently unsustainable foundation to do anything upon. Compassion is sustainable. Ever increasing profits is not. How do we find our human compassion again? How do we operationalize it into the real world?
We needed a working understanding of how humans work. This sounded familiar. It was what was most needed to do a different and better kind of whole-person patient care. It was also what was most needed to have a functional healthcare system as a whole. People had to be more important than profit. People needed to work in sustainable, constructive ways. They could still make a good living. But not paying healthcare insurance CEOs billion dollar bonuses for keeping more patient money than is provided for patient care. Yes, people would see this as daunting, overwhelming. But we were at the end stage of the frog in the boiling water experiment, finding ourselves in a terminal condition and not realizing how we had gotten to this point.
Addressing how we do human was the work that was most needed. That would endure. That really mattered. That would enable all manner of enduring building to happen. We needed the blueprint of how we humans work. And thus to understand how we work and why we often don’t. It would show us how to be in sync with and move toward sustainable reality. Including mercy medicine again. It would show us how to be human, when we seem to be losing a viable version of humanity on this planet.
Life Work
This is my primary life work now. Sharing how we humans are wired, how we work, and why we don’t when we try to function backward. Teaching its implementation in various formats and for a wide variety of applications. Teaching others to teach it. We need to learn how to do human in healthcare, education, personal relationships, legislation, corrections, parenting, etc. This is the change that is most needed. This will make the world a truly better place.
Medical Education
I grew up swearing the one thing I would never do is be a doctor. And my childhood heros were not doctors but explorers and inventors — Marco Polo, Daniel Boone, Lewis & Clark, as well as Leonardo da Vinci, Thomas Edison, the Wright Brothers, and Nicola Tesla. So it was remarkable that after taking time out of college to figure out life and the universe, I found myself back in college and then pursuing medicine. Both were very providentially directed and not what I wanted to do.
My prior year and two quarters of college had not involved any pre-Med requirements. It was time for the heavy haul, cramming a year of Physics into the summer, and the following year taking the Medical College Admissions Test (MCAT) over the four core subjects while still in the middle of two of those four one year subjects. My scores were good. Medical schools thought it was cute that I was anxious to get into medical school the following year. Another providential process and I began medical school that next summer without an undergraduate degree, something that is very rare.
Medical school was about survival. I had seen the wreckage of my father and my wife’s father — both well-intended human beings going in, but very broken and dysfunctional out the other end. Residency was more survival and finding a path that was a close as possible to the whole version of human health I had come to believe in prior to medical school. Preventive Medicine residency was a close as it got and included a Masters of Public Health degree in Epidemiology — the science of medical research.
Lifestyle Medicine Beginnings
After some of us finished residency a group of us that were still around the university in various faculty affiliations would meet and try to figure out what was missing in healthcare and what could be done about it. One of my colleagues in this group founded the American College of Lifestyle Medicine (ACLM).
Building Clinical Experience
In subsequent years I was gaining clinical experience in occupational medicine, private practice, primary care, integrative medicine, and lifestyle medicine. I had come to realize how limited the scope of my medical education had been, and spent a fair amount of time and energy exploring and learning about the full scope of healthcare, including what would be considered alternative or integrative approaches. I attended conferences, trainings, visited practitioners in their practices, and learned from many patient’s experiences as I saw many of the most complex and difficult cases that were not finding answers from standard medicine.
Developing Lifestyle Medicine
Around 2007 ACLM was going down the drain. Everyone was busy with their personal lives and careers, and there was no sponsor or financial supporter. I had started to get involved again. It was way too important to let die, so it became my full time “fetus” — like I was pregnant with it in my belly — for the next 5+ years. We cleaned up a very large mess, organized, built basic infrastructure, and systematically developed the creature for the long haul to be a respectable, professional, science-based organization. We developed professional organizational alliances, we brought a former US Surgeon General, top lifestyle scientists, and other leaders onto our Advisory Board, developed conferences, created early standards for the field, and very importantly a passionate culture that cared about making a difference for our patients. I introduced the concepts of “treating the cause,” lifestyle vital signs, and other foundational elements.
In early 2013 the operating board chose a path that was politically correct and against what was in the best interest of patients and our paths separated and I bowed out. It was heartbreaking but staying on mission and pursuing real change is hard.
Lifestyle Medicine Foundation
Lifestyle medicine was still very important and I continued to help develop the field through a sister non-profit organization we had set up, the Lifestyle Medicine Foundation. We continued to develop the spirit or culture of the lifestyle medicine space with creating recognition awards for the pioneers and leaders. We did this in coordination with ACLM for a number of years, and once they had gotten to a more functional place we turned it completely over to them. We also explored creating online content directly for consumers, and learned the pros and cons and dynamics of the grant-dependent non-profit space. Eventually this organization was turned over to others in the lifestyle medicine space and is currently used as a vehicle for channeling funding to support lifestyle medicine training for professionals in less affluent countries.
Real-World Implementation
After ACLM it made sense to develop resources and services to support LM in clinical practice. Providers were excited about a different and better kind of healthcare but had no idea how to make it work financially typical in systems that were all about pills and procedures. I had spent years learning the operations side of medical practice and set up my own practice from scratch so I would understand the business side of medical practice — at least in the United States. I wanted to be able to operationalize lifestyle medicine in the real-world for others.
We set up a business entity and started helping institutions and individuals implement financially sustainable ways of doing lifestyle medicine practice in the real world. But it soon became apparent that providers were trying to do lifestyle medicine clinically in ways that looked like writing a prescription for broccoli instead of a medication. That was not lifestyle medicine. That was not what I was seeking to operationalize. Providers still needed a whole different approach to patients and clinical practice that was very different from the one they knew. Back to the drawing board.
Frameworks for a Different Kind of Healthcare
Around this same time, I turned some of my attention to developing clinical models in my own practice which I have used as a laboratory for many years. Lifestyle medicine is about working with humans to change their habits of living. Change is hard. Where are the models of how humans work so I know how to engage with them effectively to do this change? I couldn’t find any. It was a massive hole in our current healthcare space. So we would have to develop a whole new set of guiding frameworks for how healthcare could and should be done. From scratch. A framework for how to put all the clinical pieces together in a rational, prioritized, functional manner. A system for lifestyle vital signs – assess the causative forces of health and disease as the basis of care. A framework for how humans work, and don’t. And a framework for how people have come the point at which we engage with them, with the dominant forces and trajectories of their lives.
Truly About the Patient
Around this time there was increasing talk about involving patients in healthcare processes and decisions. They were all very peripheral and didn’t do much more than survey them if they were more satisfied with what different healthcare variations were being tried. Stanford Medicine X conferences actually involved patients in planning, speaking, executing projects, etc. I participated for a number of years, doing smaller talks several years. It was a fascinating mix of activist patients, healthcare industry leaders, and entrepreneurs from Silicon Valley and all over the world. I learned a lot. About what was attempted and what did or didn’t work, and why, in trying to change healthcare in the real world.
It was during probably the 30th or 40th conversation with a passionate person seeking to change "the healthcare system" for patient benefit that a light bulb went on. What is a “system?” By definition a set of parts working together in synchronicity for a common purpose. Is that what we have in the United States? Not at all! Well, functionally what is our healthcare most like? I had learned a lot about the real machinations of healthcare behind the curtain by this point in time. Incentive structures throughout all of healthcare were misaligned with patient best interest. Pharmaceutical companies doing their thing, device manufacturers doing their thing, insurance companies doing their thing, etc. It is very much like a many-ringed circus. There is one big tent or space, but everyone is running their own show for their own purposes. Things make sense only within one ring, while overall it is chaos. So, I like others, was spending tremendous energy and time on changing a “system” that didn’t actuallyexist. It was a mirage. We needed to spend our energy on reality.
Entrepreneurial Change?
If there was no “system” to engage, perhaps we could have positive impact getting key tools into use in the for-profit circus. I was an explorer and inventor by nature, so this could be good. I worked with several start-ups on apps or platforms relative to lifestyle medicine. But I came to understand the product pipeline, business structures, and what was at the other end of the pipeline: the same big-boy players that currently dominate the healthcare space. They are all focused on profit, not patients. They buy up all the innovation to continue to dominate the market. All the start-ups defined success in terms of “the exit” — the financial sell-out to the highest bidder. Sure, they would like to do something that helped patients. But profit was still their clear priority for which patient good would be sacrificed in the process. This did not lead to the sustainable change that is needed. So now what?
How Humans Work
Each time we thought we were getting to a buildable foundation we kept finding that we needed to go deeper to build what would matter and endure. We were finally at bedrock: human nature. Why do we do what we do, why we do it? Why have we ended up in a place and state where we as a society do mercenary medicine instead of the mercy medicine of human history. We always have to balance a budget. But when mercenary dynamics distort and contort healthcare industry, politics, institutions, and practice to such extreme degrees, this is an inherently unsustainable foundation to do anything upon. Compassion is sustainable. Ever increasing profits is not. How do we find our human compassion again? How do we operationalize it into the real world?
We needed a working understanding of how humans work. This sounded familiar. It was what was most needed to do a different and better kind of whole-person patient care. It was also what was most needed to have a functional healthcare system as a whole. People had to be more important than profit. People needed to work in sustainable, constructive ways. They could still make a good living. But not paying healthcare insurance CEOs billion dollar bonuses for keeping more patient money than is provided for patient care. Yes, people would see this as daunting, overwhelming. But we were at the end stage of the frog in the boiling water experiment, finding ourselves in a terminal condition and not realizing how we had gotten to this point.
Addressing how we do human was the work that was most needed. That would endure. That really mattered. That would enable all manner of enduring building to happen. We needed the blueprint of how we humans work. And thus to understand how we work and why we often don’t. It would show us how to be in sync with and move toward sustainable reality. Including mercy medicine again. It would show us how to be human, when we seem to be losing a viable version of humanity on this planet.
Life Work
This is my primary life work now. Sharing how we humans are wired, how we work, and why we don’t when we try to function backward. Teaching its implementation in various formats and for a wide variety of applications. Teaching others to teach it. We need to learn how to do human in healthcare, education, personal relationships, legislation, corrections, parenting, etc. This is the change that is most needed. This will make the world a truly better place.
To your health and happiness!