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Posted by on in Current Medical Issues

Happy almost spring, although many of you are still being hit with snow and ice!  

I want to continue the theme I began 2 months ago where I discuss “upstreamists”, those who are “going upstream” to find the cause of problems in our healthcare system, and then working directly to create change. Last month I profiled Health Leads, a nonprofit organization that is providing information and connection for low-income patients, as well as providing access to many wrap-around services that affect health and wellbeing, such as having adequate food, transportation, and heat in the winter.

Yesterday I had a very stimulating conversation with a young physician who had just finished medical school in the UK.  He felt drawn to medicine by his desire to help others, like most doctors, but he did not gravitate to a particular specialty.   Instead, he’s been traveling around the US talking to upstreamists in order to tap into their experiences. His network includes those that create technological tools that try to fix some discreet dysfunctional piece of healthcare, rather than affecting the whole system. All of the projects he told me about were lovely little gems. But there is a problem with creating beautiful gems.

When you have something that is rotten underneath, applying beautiful gems to it does not cure the problem; it remains rotten. We need to look deeper to figure out what we can do to impact our healthcare system, from the inside out.

Dr. Rushika Fernandopulle of Harvard University, is doing just that with Iora Health.  I’ve been following him for a number of years.  Here is what Iora Health says about itself:

We’re changing health care from the ground up.

We believe better health care starts with better primary care. Our simple yet radically different approach to restoring humanity to health care is three-fold: Team-based care that puts the patient first, a payment system based on care, not billing codes and technology built around people, not process. ……….

 Our care team, which includes a dedicated advocate for each patient, works together to treat the whole person. We see people when they’re sick, but also when they’re well, so that we can keep them healthy. Here, the environment is caring and patients have a voice. It’s our job to give them everything they need to live happier and healthier lives.

Here is a fabulous and inspiring talk by Dr. Fernandopulle, who discusses how and why we need to change the healthcare system. 

Here is a short version, but I really urge you to watch the longer one—its way more inspiring.

And a freebie thrown in: The Hot Spotters is the seminal article on change in the healthcare system, by Dr. Atul Gawande, published in the New Yorker. This is a must read in my opinion, to know where the “rot” is.   It would not be an exaggeration to say that this article changed my life. 


Posted by on in Current Medical Issues

Happy (belated) New Year to everyone. I trust you are, like me, getting back into the flow of our normal lives after the end-of-the-year hiatus. 

Last month I talked about “going upstream” and the need for upstreamists in order to have any effect on the course of healthcare in this country. Over the next few months I’d like to profile some of the upstreamists doing important work that I think will change healthcare for the better.

The first organization I’d like to profile is Health Leads. Since their founding in 1996, Health Leads “has evolved form a small student-driven campus organization to a fully staffed 10 million dollar organization with programs in 15 hospitals and clinics.”

Rebecca Onie, co-founder and now CEO, began the organization with the belief that a different kind of healthcare system is possible and that the healthcare system is in crisis. The goal was to do something about the fact that poverty has a negative impact on health outcomes.

From the Health Leads website:

“Health Leads Advocates …. Work side by side with patients to navigate the complexity of the resource landscape……… The Advocates follow up with patients regularly by phone, email, or during clinic visits.”

Watch this compelling talk by Rebecca Onie to get a feel for what this organization does.


As always, I would love to hear what you think!

Best of Health,

Sima Kahn, MD
Founder, Healthcare Advocacy Partners

Posted by on in Current Medical Issues

I hope everyone had a great Thanksgiving, and will have a wonderful holiday season. In my last newsletter I mentioned going upstream, and here is the explanation:


There were four friends walking in the woods alongside a river, when they saw a baby floating by down the river. The friends ran to the river, jumped in, and rescued the baby. Feeling good about what they had done, the friends were shocked to see another baby floating by. Once again they jumped in to rescue the baby. But soon there were more babies floating by, and soon it seemed that the number was increasing. The friends formed a line, a “bucket brigade”, to quickly pass the infants from one to the other to rescue them as quickly as possible. And still they kept coming.


Finally, one of the friends got out of the river and started walking upstream. One of the others called out “where are you going?” The friend replied “I’m going upstream to see who is throwing babies into the river and stop them”.


I call this being an “upstreamist” and I was happy to see that term used in the article I have linked to below. Given the crisis of our healthcare system, we need to go upstream to the source of the problem(s) if we are going to really solve them.

Providing healthcare advocacy is one way to go upstream and avoid problems before they occur and need to be fixed.

Cultivate More Upstreamists to Transform Healthcare