Get Behind Me, Cowbell!


I used to suffer a recurring anxiety dream that I want to share with you. The great writer Henry James once said, “Have a dream, lose a reader.” But please, bear with me. 

Imagine being atop a green hillside looking down upon a peaceful valley vivid in the fixtures of late spring (okay, I don’t dream in color, but go with it…) with magnificent pink heads of wildflowers growing out of the land and the trees of the mountains, the pines and aspens and birches, all comfortable in their renewed fullness.

And animals are everywhere here too, no doubt feeling even more acutely this transformation, this sloughing-off the barren skeleton of winter, with its crunchy ocean of snow, absent livestock, dormant trees locked in deadness. A fox scuttles across the glade.

Everything is lined in promise. Cows walk along the mild slope and get into the alpine lake and drink with their cartoonish tongues. At a distance they seem quite dapper, stately, even regal. I’ve never had much admiration for cows but in the dream I go straight to the heart of their impressiveness. When they walk out of the water, the sun pools on their wet haunches and brawny chests. They eat grass with contentment. Life seems quite profound, very resonant. I feel tapped in to deep feeling, the way some might perhaps when smoking an expensive cigar.

But because I am facing only one side of the hill there is of course an unlooked-upon expanse at my back, outside the immediate perception. It sneaks up on me and has that awful weight of anxiety like the he obsession of misplaced keys or the delusion of the front door being open in the middle of the night—that kind of restless irrational fixation that finds its home in something eerily particular.

Then a bell clangs. I turn around to discover a rogue cow audibly sucking a diabolically large grass blade, the bell on its fat neck tolling at the slightest tilt of the strange head. Behind it the landscape is, incredibly, in winter. It confronts me with this hostility I interpret as a wish to disturb the fondness I just felt at viewing the other side of the hill. It implies I am not entitled to that transformation.

I awake sweaty and perturbed.

I typically suffer this troubled nighttime experience during some kind of personal or professional tumult when I am choosing to leave an old conduct for a newer yet foreign one. The cow I see as representative of the world I am necessarily leaving but which is still in some odd way an element of the one I am pursuing. It wants me to remain in its obsolescence and the anxiety is spawned from the unknowns of the future. But I know I must transform as much as the seasons must change.

In healthcare, choosing the resplendent hillside means deserting the closed-loop systems and paper-heavy processes of the old world that may be convenient with respect to office operations, as transforming requires a bit of elbow grease, but do not represent what patients have come to expect from healthcare. A fully transformed experience for the patient means access to remote care, predictive analytics, patient portals and personalized care: this is the green hillside.

And patients have become terrifyingly informed about the incredible technology out there thanks to the all-seeing Internet. They know what they want and know how to say it and this should be a hefty motivation to compel every provider to tailor care to such informed desires.

It frightens you to have a cow appear at your back, signaling do not for forsake me, but we must slip out of the stranglehold of antiquated seasons for vital renewals or else play winter to someone else’s spring. 

Do not embrace the obsolete cow. Its bell tolls for a dead world.

Scan Here


Some people do not share in the thrill of new technologies. They overheat and pine for a world that has moved past them. They are called Luddites and spotting them in public is easier since the outbreak of Covid-19.

As restaurants began to reopen after that long and painful hiatus, they were required to adopt certain technologies to safeguard against increased risk of spreading the virus through dine-in eating. Along with wearing a mask while not seated at the table, there are contact-tracing protocols whereby your personal information is incorporated into a database that the restaurant can consult should a patron later succumb to the impartial disease.

And my favorite of all— the adoption of the electronic menu, using the camera on your smartphone to scan a QR code, which seamlessly directs you to a digital list of food and beverage offerings. This is when the Luddite is at the threshold of outburst.

Look for the person with mask drooping off one ear like a punitive earing and iPhone raised high in the air betraying confusion, longing for a list of appetizers but getting only an alien symbol, begging some moderately competent person to appear and shepherd them through the complexity of pointing the barrel of a smartphone at what is for all intents and purposes a kind of target sign marked “Scan Here.”

In terrible versions of this scenario a quarantined menu is drudged up from dusty retirement, re-sanitized and re-sanitized and re-sanitized and then begrudgingly delivered to the technophobe.

Do we resent such people? I fear so.

We resent them, I fear, because we have moved on. Modernization is there to fulfill consumer demands. During this insufferably long pandemic consumers yearned for the reopening of restaurants, a semblance of normalcy in a bewildering moment. And why wait five minutes for a hard-copy menu to come to your table when it can be readied instantly on your smartphone. The restaurants did their homework and zeroed-in on operational changes that would both accommodate our wish for them to reopen while making for the safest environment possible considering the trial at hand.

This is an example of what modernization can resolve. If we were a people comprised predominantly of Luddites, mitigating our strange new world would have been impossible because we would push back against technology, the very thing offering our deliverance. We perpetually would have been moored at home smearing a redundant condiment over our three hundredth turkey sandwich.

In one year, the entire medical establishment has seen how vital modernization is to patient care, and luckily, there was an infrastructure in place that provided the consumer with a metaphorical menu, if you will.

The problem presented was how to provide care which everyone goes on needing in spite of a pandemic— cancer doesn’t cede ground to a more popular disease—when the location of this care is deemed unsafe. Well, as with restaurants, the medical industry adapted, leaning heavily on modern technologies, the conveniences of digitization to fill in these gaps. Doctors began to refer to patient portals for requests for prescription refills, offered alternatives to in-office visits through Telehealth, relied heavily on longitudinal care and well-captured data to answer the kind of questions that otherwise might be answered during in-person visits.

It is my belief that what began as solutions to problems of the moment will become status quo in medical care.  Once the nation has reached an acceptable level of immunity, these changes will not be dispensed with. What parent wants to take their thirteen-year-old to an appointment every month for a refill of acne medication when it can be done electronically in the patient portal? Everything is moving in a technocentric direction, and providers must keep up with this change in the spirit of our time.

After all, it is better for the consumer. And whom else do we answer to?


What Fun Doesn’t Look Like


A few days ago, The Wrap published a flattering article online about the peculiar joys offered throughout the pandemic by the sole remaining Blockbuster, which seems to enjoy timeless contentment in Bend, OR. That it took the uniquely disagreeable context of Covid-19 to remind the public of the “satisfaction” of going to the movie store should not be understated. Shining at the top of the list of virtues is that it gives people an opportunity to “walk around and [get] an idea of what they want to watch,” as opposed to beloved streaming platforms like Netflix and Amazon Prime that ask little more than brandishing the TV remote and enjoying a curated viewing experience made possible through modern and optimized technologies that record taste and suggest new ones.

Am I the only one who finds himself in a state of acute psychological duress even considering that ancient before-time when Netflix didn’t exist and the merchant of cinematic bliss was either anemic cable TV showings or the local video store, with its disorganized aisles and t-shirts and flavorless candy for sale? Contemplate all the frustrations alleviated by the advent of streaming platforms: no longer must you fight for the last copy of Men in Black II, no longer must you wallow in the turmoil of one more stop on the arduous commute home from the office, no longer must you stand in the unsmiling queue before the cashier fumbles through the directory trying to discern just which David Hampton you are, no longer must you endure all this only to discover five minutes into the screening that the film you methodically and nervously appointed tonight’s recreation is a complete flop, rendering the whole escapade humorlessly futile! Let Bend, OR enjoy its claim to the last Blockbuster, thank you very much.

The exceptional thing about evolution in technologies—and cultural embraces of them—is that they solve an inconvenience that the consumer had been unaware of but avidly adopted as soon as it was popularized. With the pitiful exception of the fetish for that one unkillable Blockbuster (and a fetish, of course, lays claim to a fixation not shared by the majority), Netflix necessarily erased the mind-numbing inefficiencies of the video store experience. Otherwise we wouldn’t be reading articles about the final Blockbuster!

Healthcare is not exempt from this type of consumer scrutiny. The majority of patients will no more tolerate providers that have not embraced modernization, whose practices do not incorporate patient engagement programs, alternatives to in-office visits, ways to prepopulate information and longitudinal care, than they would side with Family Video over Netflix or Amazon Prime. Optimization in healthcare, like any other industry, utilizes analytics to improve care, trim costs and gain efficiencies, all things the consumer is growing more attached to and would be pained to do without. Employing these technologies transforms practices and gives patients that modern healthcare experience they’ve come to expect.

Practices that resist modernizing, optimizing and transforming, anchor patients—that massive stratum of partial judges who dictate the future without having any foreknowledge of what it will look like—in a bleak sea of video stores that sooner or later they’ll flee, for a land where innovation has helped “realize” some unconscious wish.


One of the Internet’s gifts—and occasional annoyances!— is its space for people to self-publish their alleged expertise on a subject. Surely this must be some form of purging. I feel an odd mixture of depression and excitement toward these online message boards. The writers on healthcare forums vary from doctors, hospital executives, and private insurers, to young families whose finances have been wrecked by medical expenses.