PCP Lens
@pcplens.com
Welcome to the Wonderful World of Healthcare: A journey through metrics, money, and madness.
I am an independent primary care physician in CT and run my own practice.
www.pcplens.com
I am an independent primary care physician in CT and run my own practice.
www.pcplens.com
#Health is no longer a binary state — sick or well.
It is a probability distribution where everyone is “pre-sick.”
How did this architecture, from Framingham's risk factors to our fitness trackers, get built?
And what does it obscure?
Full Article: www.pcplens.com/p/everyone-i...
It is a probability distribution where everyone is “pre-sick.”
How did this architecture, from Framingham's risk factors to our fitness trackers, get built?
And what does it obscure?
Full Article: www.pcplens.com/p/everyone-i...
November 16, 2025 at 6:13 PM
#Health is no longer a binary state — sick or well.
It is a probability distribution where everyone is “pre-sick.”
How did this architecture, from Framingham's risk factors to our fitness trackers, get built?
And what does it obscure?
Full Article: www.pcplens.com/p/everyone-i...
It is a probability distribution where everyone is “pre-sick.”
How did this architecture, from Framingham's risk factors to our fitness trackers, get built?
And what does it obscure?
Full Article: www.pcplens.com/p/everyone-i...
1/4
#QualityMetrics began as a tool to improve care—then morphed into a system to control it.
Today they manufacture blame, drive consolidation, and mask politics as “objectivity.”
www.pcplens.com/p/the-scorek...
#ValueBasedCare #HealthPolicy #medsky #imsky
#QualityMetrics began as a tool to improve care—then morphed into a system to control it.
Today they manufacture blame, drive consolidation, and mask politics as “objectivity.”
www.pcplens.com/p/the-scorek...
#ValueBasedCare #HealthPolicy #medsky #imsky
The Scorekeepers of American Medicine
The History of Quality Measures and Why They Persist
www.pcplens.com
November 13, 2025 at 7:00 PM
1/4
#QualityMetrics began as a tool to improve care—then morphed into a system to control it.
Today they manufacture blame, drive consolidation, and mask politics as “objectivity.”
www.pcplens.com/p/the-scorek...
#ValueBasedCare #HealthPolicy #medsky #imsky
#QualityMetrics began as a tool to improve care—then morphed into a system to control it.
Today they manufacture blame, drive consolidation, and mask politics as “objectivity.”
www.pcplens.com/p/the-scorek...
#ValueBasedCare #HealthPolicy #medsky #imsky
VC-backed companies chase the "law of diminishing returns" section on the Risk-Factor Yield curve, while we blame people for being unhealthy who are struggling to make ends meet.
There is more money in building products to reduce the "risk of risk factors" than #SDOH.
#health #medsky #imsky
There is more money in building products to reduce the "risk of risk factors" than #SDOH.
#health #medsky #imsky
November 6, 2025 at 6:58 PM
In 1980, Robert Crawford coined the term “healthism”: treating #health as a personal moral duty.
The result? When people get #sick, we blame their #choices instead of #SDOH.
www.pcplens.com/p/everyone-i...
(And yes, choices play a role, but so do #determinantsofhealth).
#medsky #healthpolicy
The result? When people get #sick, we blame their #choices instead of #SDOH.
www.pcplens.com/p/everyone-i...
(And yes, choices play a role, but so do #determinantsofhealth).
#medsky #healthpolicy
November 4, 2025 at 7:29 PM
In 1980, Robert Crawford coined the term “healthism”: treating #health as a personal moral duty.
The result? When people get #sick, we blame their #choices instead of #SDOH.
www.pcplens.com/p/everyone-i...
(And yes, choices play a role, but so do #determinantsofhealth).
#medsky #healthpolicy
The result? When people get #sick, we blame their #choices instead of #SDOH.
www.pcplens.com/p/everyone-i...
(And yes, choices play a role, but so do #determinantsofhealth).
#medsky #healthpolicy
New article: Everyone Is Pre-Sick
Risk Factor Yield Curve:
Payment models assume everyone lives in the “effective zone.”
Left = poverty overwhelms care
Right = diminishing returns
We need to fix the premise
www.pcplens.com/p/everyone-i...
#medsky #healthpolicy #imsky #valuebasedcare #SDOH
Risk Factor Yield Curve:
Payment models assume everyone lives in the “effective zone.”
Left = poverty overwhelms care
Right = diminishing returns
We need to fix the premise
www.pcplens.com/p/everyone-i...
#medsky #healthpolicy #imsky #valuebasedcare #SDOH
October 30, 2025 at 4:41 PM
New article: Everyone Is Pre-Sick
Risk Factor Yield Curve:
Payment models assume everyone lives in the “effective zone.”
Left = poverty overwhelms care
Right = diminishing returns
We need to fix the premise
www.pcplens.com/p/everyone-i...
#medsky #healthpolicy #imsky #valuebasedcare #SDOH
Risk Factor Yield Curve:
Payment models assume everyone lives in the “effective zone.”
Left = poverty overwhelms care
Right = diminishing returns
We need to fix the premise
www.pcplens.com/p/everyone-i...
#medsky #healthpolicy #imsky #valuebasedcare #SDOH
Blaming #doctors for causing #chronicdisease would be like blaming doctors for causing cholera in the 19th century.
The root causes of diseases are upstream.
www.pcplens.com/p/from-sewer...
#primarycare #preventivecare #healthpolicy #medsky #imsky
The root causes of diseases are upstream.
www.pcplens.com/p/from-sewer...
#primarycare #preventivecare #healthpolicy #medsky #imsky
October 8, 2025 at 2:06 PM
Blaming #doctors for causing #chronicdisease would be like blaming doctors for causing cholera in the 19th century.
The root causes of diseases are upstream.
www.pcplens.com/p/from-sewer...
#primarycare #preventivecare #healthpolicy #medsky #imsky
The root causes of diseases are upstream.
www.pcplens.com/p/from-sewer...
#primarycare #preventivecare #healthpolicy #medsky #imsky
1/
Life expectancy rose before antibiotics. Sewers, not stethoscopes, saved lives.
#healthcare #publichealth #managedcare #medsky #healthpolicy #imsky
🧵👇
Life expectancy rose before antibiotics. Sewers, not stethoscopes, saved lives.
#healthcare #publichealth #managedcare #medsky #healthpolicy #imsky
🧵👇
October 4, 2025 at 4:16 PM
1/
Life expectancy rose before antibiotics. Sewers, not stethoscopes, saved lives.
#healthcare #publichealth #managedcare #medsky #healthpolicy #imsky
🧵👇
Life expectancy rose before antibiotics. Sewers, not stethoscopes, saved lives.
#healthcare #publichealth #managedcare #medsky #healthpolicy #imsky
🧵👇
Life expectancy rose before antibiotics.
Building Sewers saved more lives, not doctor visits.
Yet today, we penalize doctors for bad outcomes that public health infrastructure prevents.
www.pcplens.com/p/from-sewer...
#publichealth #healthcare #healthpolicy #imsky #medsky
Building Sewers saved more lives, not doctor visits.
Yet today, we penalize doctors for bad outcomes that public health infrastructure prevents.
www.pcplens.com/p/from-sewer...
#publichealth #healthcare #healthpolicy #imsky #medsky
October 2, 2025 at 6:53 PM
Life expectancy rose before antibiotics.
Building Sewers saved more lives, not doctor visits.
Yet today, we penalize doctors for bad outcomes that public health infrastructure prevents.
www.pcplens.com/p/from-sewer...
#publichealth #healthcare #healthpolicy #imsky #medsky
Building Sewers saved more lives, not doctor visits.
Yet today, we penalize doctors for bad outcomes that public health infrastructure prevents.
www.pcplens.com/p/from-sewer...
#publichealth #healthcare #healthpolicy #imsky #medsky
1/3
In politics, obesity is framed as a 🏋️ personal responsibility. 🏃♂️
If people only learned to cook 🥦 healthy food 🥕 , obesity would vanish.
But what if the real driver is stress + environment❓
#medsky #healthpolicy #IMSky #prevention
👇
In politics, obesity is framed as a 🏋️ personal responsibility. 🏃♂️
If people only learned to cook 🥦 healthy food 🥕 , obesity would vanish.
But what if the real driver is stress + environment❓
#medsky #healthpolicy #IMSky #prevention
👇
September 24, 2025 at 3:26 PM
1/3
In politics, obesity is framed as a 🏋️ personal responsibility. 🏃♂️
If people only learned to cook 🥦 healthy food 🥕 , obesity would vanish.
But what if the real driver is stress + environment❓
#medsky #healthpolicy #IMSky #prevention
👇
In politics, obesity is framed as a 🏋️ personal responsibility. 🏃♂️
If people only learned to cook 🥦 healthy food 🥕 , obesity would vanish.
But what if the real driver is stress + environment❓
#medsky #healthpolicy #IMSky #prevention
👇
1/
If #fluoride in water reduces #cavities, why are more cities abandoning it?
The story is not about #science, but more about #politics, mistrust, and who pays when public health protections are dismantled.
www.pcplens.com/p/the-curiou...
#medsky #healthpolicy #imsky #dentacare #populationhealth
If #fluoride in water reduces #cavities, why are more cities abandoning it?
The story is not about #science, but more about #politics, mistrust, and who pays when public health protections are dismantled.
www.pcplens.com/p/the-curiou...
#medsky #healthpolicy #imsky #dentacare #populationhealth
The Curious Case of Water Fluoridation
How a Simple Ion Sparked a Century of Public Health Debate
www.pcplens.com
September 10, 2025 at 3:48 PM
1/
If #fluoride in water reduces #cavities, why are more cities abandoning it?
The story is not about #science, but more about #politics, mistrust, and who pays when public health protections are dismantled.
www.pcplens.com/p/the-curiou...
#medsky #healthpolicy #imsky #dentacare #populationhealth
If #fluoride in water reduces #cavities, why are more cities abandoning it?
The story is not about #science, but more about #politics, mistrust, and who pays when public health protections are dismantled.
www.pcplens.com/p/the-curiou...
#medsky #healthpolicy #imsky #dentacare #populationhealth
1/ "Personal responsibility" vs. #SDOH - why this health debate misses the point entirely. 🧵
#medsky #healthpolicy #imsky #health
#medsky #healthpolicy #imsky #health
August 27, 2025 at 3:15 PM
1/ "Personal responsibility" vs. #SDOH - why this health debate misses the point entirely. 🧵
#medsky #healthpolicy #imsky #health
#medsky #healthpolicy #imsky #health
Quitting #smoking is harder when everyone around you smokes.
We still blame individuals for “bad choices,” ignoring the conditions that make healthy behavior nearly impossible.
That’s the illusion of #choice in #health.
Article/Video: www.pcplens.com/p/the-illusi...
#SDOH #Medsky #healthpolicy
We still blame individuals for “bad choices,” ignoring the conditions that make healthy behavior nearly impossible.
That’s the illusion of #choice in #health.
Article/Video: www.pcplens.com/p/the-illusi...
#SDOH #Medsky #healthpolicy
August 21, 2025 at 4:22 PM
Quitting #smoking is harder when everyone around you smokes.
We still blame individuals for “bad choices,” ignoring the conditions that make healthy behavior nearly impossible.
That’s the illusion of #choice in #health.
Article/Video: www.pcplens.com/p/the-illusi...
#SDOH #Medsky #healthpolicy
We still blame individuals for “bad choices,” ignoring the conditions that make healthy behavior nearly impossible.
That’s the illusion of #choice in #health.
Article/Video: www.pcplens.com/p/the-illusi...
#SDOH #Medsky #healthpolicy
Structural Determinants of Health
Are the power plays of the past; policy choices, both visible and hidden, that still rig the odds today in favor of those already in power.
#healthcare #healthpolicy
Are the power plays of the past; policy choices, both visible and hidden, that still rig the odds today in favor of those already in power.
#healthcare #healthpolicy
August 14, 2025 at 4:25 PM
Structural Determinants of Health
Are the power plays of the past; policy choices, both visible and hidden, that still rig the odds today in favor of those already in power.
#healthcare #healthpolicy
Are the power plays of the past; policy choices, both visible and hidden, that still rig the odds today in favor of those already in power.
#healthcare #healthpolicy
1/7
Why do we keep blaming #doctors for a #healthcare system they didn’t design?
We say they're too reactive, too expensive, too focused on treatment.
But what if they’re just the last stop in a chain of upstream failures?
Why do we keep blaming #doctors for a #healthcare system they didn’t design?
We say they're too reactive, too expensive, too focused on treatment.
But what if they’re just the last stop in a chain of upstream failures?
August 7, 2025 at 4:25 PM
1/7
Why do we keep blaming #doctors for a #healthcare system they didn’t design?
We say they're too reactive, too expensive, too focused on treatment.
But what if they’re just the last stop in a chain of upstream failures?
Why do we keep blaming #doctors for a #healthcare system they didn’t design?
We say they're too reactive, too expensive, too focused on treatment.
But what if they’re just the last stop in a chain of upstream failures?
The Political Determinants of Health (PDOH) impact your health way more than your doctor’s prescriptions.
#PDOH determinants include: #Voting, #Government & #Policy.
A simplified flowchart shows how PDOH works.
Full article/video: www.pcplens.com/p/when-polic...
#healthcare #healthpolicy
#PDOH determinants include: #Voting, #Government & #Policy.
A simplified flowchart shows how PDOH works.
Full article/video: www.pcplens.com/p/when-polic...
#healthcare #healthpolicy
July 31, 2025 at 6:31 PM
The Political Determinants of Health (PDOH) impact your health way more than your doctor’s prescriptions.
#PDOH determinants include: #Voting, #Government & #Policy.
A simplified flowchart shows how PDOH works.
Full article/video: www.pcplens.com/p/when-polic...
#healthcare #healthpolicy
#PDOH determinants include: #Voting, #Government & #Policy.
A simplified flowchart shows how PDOH works.
Full article/video: www.pcplens.com/p/when-polic...
#healthcare #healthpolicy
Why does a zoning law have more impact on #obesity than your doctor?
Why does missing one form cut off #Medicaid?
What if your #doctor is just cleaning up after #policy failure?
More here: www.pcplens.com/p/when-polic...
Why does missing one form cut off #Medicaid?
What if your #doctor is just cleaning up after #policy failure?
More here: www.pcplens.com/p/when-polic...
When Policy Fails, Medicine Pays
Why Outcomes Follow Policy, Not Prescriptions
www.pcplens.com
July 30, 2025 at 3:56 PM
Why does a zoning law have more impact on #obesity than your doctor?
Why does missing one form cut off #Medicaid?
What if your #doctor is just cleaning up after #policy failure?
More here: www.pcplens.com/p/when-polic...
Why does missing one form cut off #Medicaid?
What if your #doctor is just cleaning up after #policy failure?
More here: www.pcplens.com/p/when-polic...
Your health is shaped more by policy than by prescriptions.
When Policy Fails, Medicine Pays: A primer on the Political Determinants of Health.
www.pcplens.com/p/when-polic...
#healthpolicy #healthcare #primarycare #pcp #medsky #SDOH #socialdeterminants #politics #medicine #policy
When Policy Fails, Medicine Pays: A primer on the Political Determinants of Health.
www.pcplens.com/p/when-polic...
#healthpolicy #healthcare #primarycare #pcp #medsky #SDOH #socialdeterminants #politics #medicine #policy
When Policy Fails, Medicine Pays
Why Outcomes Follow Policy, Not Prescriptions
www.pcplens.com
July 25, 2025 at 4:58 PM
Your health is shaped more by policy than by prescriptions.
When Policy Fails, Medicine Pays: A primer on the Political Determinants of Health.
www.pcplens.com/p/when-polic...
#healthpolicy #healthcare #primarycare #pcp #medsky #SDOH #socialdeterminants #politics #medicine #policy
When Policy Fails, Medicine Pays: A primer on the Political Determinants of Health.
www.pcplens.com/p/when-polic...
#healthpolicy #healthcare #primarycare #pcp #medsky #SDOH #socialdeterminants #politics #medicine #policy
🪱The Commercial Parasite Epidemic🪱
💰 Commercial companies extract profit w/o collapsing industry, i.e., they function as commercial parasites.
The greatest challenge to improve health lies in tension b/w wealth and health creation.
www.pcplens.com/p/chronic-co...
#health #healthpolicy #medsky
💰 Commercial companies extract profit w/o collapsing industry, i.e., they function as commercial parasites.
The greatest challenge to improve health lies in tension b/w wealth and health creation.
www.pcplens.com/p/chronic-co...
#health #healthpolicy #medsky
July 17, 2025 at 5:06 PM
🪱The Commercial Parasite Epidemic🪱
💰 Commercial companies extract profit w/o collapsing industry, i.e., they function as commercial parasites.
The greatest challenge to improve health lies in tension b/w wealth and health creation.
www.pcplens.com/p/chronic-co...
#health #healthpolicy #medsky
💰 Commercial companies extract profit w/o collapsing industry, i.e., they function as commercial parasites.
The greatest challenge to improve health lies in tension b/w wealth and health creation.
www.pcplens.com/p/chronic-co...
#health #healthpolicy #medsky
What happens when #disease #prevention meets shareholder value?
Our greatest challenge to improve #health may lie in the tension between #wealth and health creation!
Article/Video: Chronic Conditions, Corporate Causes
www.pcplens.com/p/chronic-co...
#medsky #imsky #healthpolicy #vbc
Our greatest challenge to improve #health may lie in the tension between #wealth and health creation!
Article/Video: Chronic Conditions, Corporate Causes
www.pcplens.com/p/chronic-co...
#medsky #imsky #healthpolicy #vbc
Chronic Conditions, Corporate Causes
What Happens When Disease Prevention Meets Shareholder Value
www.pcplens.com
July 11, 2025 at 1:20 PM
What happens when #disease #prevention meets shareholder value?
Our greatest challenge to improve #health may lie in the tension between #wealth and health creation!
Article/Video: Chronic Conditions, Corporate Causes
www.pcplens.com/p/chronic-co...
#medsky #imsky #healthpolicy #vbc
Our greatest challenge to improve #health may lie in the tension between #wealth and health creation!
Article/Video: Chronic Conditions, Corporate Causes
www.pcplens.com/p/chronic-co...
#medsky #imsky #healthpolicy #vbc
Is it personal choice—or engineered addiction?
From soda to plastic, corporations shape our "choices" and blame us for the fallout.
A look at the #CommercialDeterminants of Health:
www.pcplens.com/p/chronic-co...
#CDoH #PublicHealth #HealthEquity #healthpolicy #medsky # #prevention
From soda to plastic, corporations shape our "choices" and blame us for the fallout.
A look at the #CommercialDeterminants of Health:
www.pcplens.com/p/chronic-co...
#CDoH #PublicHealth #HealthEquity #healthpolicy #medsky # #prevention
Chronic Conditions, Corporate Causes
What Happens When Disease Prevention Meets Shareholder Value
www.pcplens.com
July 10, 2025 at 6:21 PM
Is it personal choice—or engineered addiction?
From soda to plastic, corporations shape our "choices" and blame us for the fallout.
A look at the #CommercialDeterminants of Health:
www.pcplens.com/p/chronic-co...
#CDoH #PublicHealth #HealthEquity #healthpolicy #medsky # #prevention
From soda to plastic, corporations shape our "choices" and blame us for the fallout.
A look at the #CommercialDeterminants of Health:
www.pcplens.com/p/chronic-co...
#CDoH #PublicHealth #HealthEquity #healthpolicy #medsky # #prevention
1/
Fax might die in healthcare
But don’t cheer just yet because what comes next may be worse!
#healthcare #interoperability
🧵
Fax might die in healthcare
But don’t cheer just yet because what comes next may be worse!
#healthcare #interoperability
🧵
June 26, 2025 at 6:15 PM
1/
Fax might die in healthcare
But don’t cheer just yet because what comes next may be worse!
#healthcare #interoperability
🧵
Fax might die in healthcare
But don’t cheer just yet because what comes next may be worse!
#healthcare #interoperability
🧵
📠 #Fax won’t die in #healthcare — not because it’s ideal, but because it still works.
In my latest piece, I break down why every attempt to kill it has failed - and if there is ever a replacement, it may become a #monopoly!
👉 www.pcplens.com/p/why-fax-re...
#healthIT #healthtech #interoperability
In my latest piece, I break down why every attempt to kill it has failed - and if there is ever a replacement, it may become a #monopoly!
👉 www.pcplens.com/p/why-fax-re...
#healthIT #healthtech #interoperability
Why Fax Refuses to Die in Healthcare
Spoiler: It’s not because doctors are stuck in the 90s.
www.pcplens.com
June 19, 2025 at 4:01 PM
📠 #Fax won’t die in #healthcare — not because it’s ideal, but because it still works.
In my latest piece, I break down why every attempt to kill it has failed - and if there is ever a replacement, it may become a #monopoly!
👉 www.pcplens.com/p/why-fax-re...
#healthIT #healthtech #interoperability
In my latest piece, I break down why every attempt to kill it has failed - and if there is ever a replacement, it may become a #monopoly!
👉 www.pcplens.com/p/why-fax-re...
#healthIT #healthtech #interoperability
A quick short video on “what is population health” and how we distorted the term when we imported it from Canada.
youtube.com/shorts/07rJG...
#populationhealth #vbc #valuebasedcare #health #healthcare #medsky #healthpolicy
youtube.com/shorts/07rJG...
#populationhealth #vbc #valuebasedcare #health #healthcare #medsky #healthpolicy
What is Population Health - Short
YouTube video by PCP Lens
youtube.com
June 16, 2025 at 10:29 PM
A quick short video on “what is population health” and how we distorted the term when we imported it from Canada.
youtube.com/shorts/07rJG...
#populationhealth #vbc #valuebasedcare #health #healthcare #medsky #healthpolicy
youtube.com/shorts/07rJG...
#populationhealth #vbc #valuebasedcare #health #healthcare #medsky #healthpolicy
💊 My last piece in my #Quality series: The Madness Of Medication Adherence.
#SDOH, not docs, drives poor outcomes.
Metrics worsen burnout & introduce complexity at point of care.
Time for empowerment > measurement?
www.pcplens.com/p/the-madnes...
#SDOH, not docs, drives poor outcomes.
Metrics worsen burnout & introduce complexity at point of care.
Time for empowerment > measurement?
www.pcplens.com/p/the-madnes...
June 12, 2025 at 4:17 PM
💊 My last piece in my #Quality series: The Madness Of Medication Adherence.
#SDOH, not docs, drives poor outcomes.
Metrics worsen burnout & introduce complexity at point of care.
Time for empowerment > measurement?
www.pcplens.com/p/the-madnes...
#SDOH, not docs, drives poor outcomes.
Metrics worsen burnout & introduce complexity at point of care.
Time for empowerment > measurement?
www.pcplens.com/p/the-madnes...
Did you know that #doctors are penalized when patients buy cheaper meds abroad or pay cash?
#HealthcareSystem punishes #PCPs for patients' survival strategies.
Deep dive into how we measure #pharmacy fills, not #health.
www.pcplens.com/p/the-madnes...
#medsky #healthpolicy #imsky #qualitymeasure
#HealthcareSystem punishes #PCPs for patients' survival strategies.
Deep dive into how we measure #pharmacy fills, not #health.
www.pcplens.com/p/the-madnes...
#medsky #healthpolicy #imsky #qualitymeasure
The Madness of Medication Adherence
The Impossible Mission of Quantifying Medication Compliance
www.pcplens.com
June 6, 2025 at 1:37 PM
Did you know that #doctors are penalized when patients buy cheaper meds abroad or pay cash?
#HealthcareSystem punishes #PCPs for patients' survival strategies.
Deep dive into how we measure #pharmacy fills, not #health.
www.pcplens.com/p/the-madnes...
#medsky #healthpolicy #imsky #qualitymeasure
#HealthcareSystem punishes #PCPs for patients' survival strategies.
Deep dive into how we measure #pharmacy fills, not #health.
www.pcplens.com/p/the-madnes...
#medsky #healthpolicy #imsky #qualitymeasure