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...
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
3/
Now we measure physicians on blood pressure, diabetes, and “compliance”—outcomes that failing systems once prevented.
No tools. No time. All the blame.
#quality #qualitymeasures #ACA
Now we measure physicians on blood pressure, diabetes, and “compliance”—outcomes that failing systems once prevented.
No tools. No time. All the blame.
#quality #qualitymeasures #ACA
October 4, 2025 at 4:16 PM
3/
Now we measure physicians on blood pressure, diabetes, and “compliance”—outcomes that failing systems once prevented.
No tools. No time. All the blame.
#quality #qualitymeasures #ACA
Now we measure physicians on blood pressure, diabetes, and “compliance”—outcomes that failing systems once prevented.
No tools. No time. All the blame.
#quality #qualitymeasures #ACA
2/
Flexner’s 1910 report professionalized doctors and made them the face of “health.”
But it also pushed public health to the sidelines.
#doctors #pcp #primarycare
Flexner’s 1910 report professionalized doctors and made them the face of “health.”
But it also pushed public health to the sidelines.
#doctors #pcp #primarycare
October 4, 2025 at 4:16 PM
2/
Flexner’s 1910 report professionalized doctors and made them the face of “health.”
But it also pushed public health to the sidelines.
#doctors #pcp #primarycare
Flexner’s 1910 report professionalized doctors and made them the face of “health.”
But it also pushed public health to the sidelines.
#doctors #pcp #primarycare
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
2/3
#Obesity is not an individual failure.
It’s the predictable outcome of how we build #environments, #markets, and #policies.
#Obesity is not an individual failure.
It’s the predictable outcome of how we build #environments, #markets, and #policies.
September 24, 2025 at 3:26 PM
2/3
#Obesity is not an individual failure.
It’s the predictable outcome of how we build #environments, #markets, and #policies.
#Obesity is not an individual failure.
It’s the predictable outcome of how we build #environments, #markets, and #policies.
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
👇
7/
So the real question isn’t “does fluoride work?”
It’s whether we’ll sustain #populationhealth protections that work quietly in the background—or let politics unravel them.
More thoughts here: www.pcplens.com/p/the-curiou...
So the real question isn’t “does fluoride work?”
It’s whether we’ll sustain #populationhealth protections that work quietly in the background—or let politics unravel them.
More thoughts here: www.pcplens.com/p/the-curiou...
September 10, 2025 at 3:48 PM
7/
So the real question isn’t “does fluoride work?”
It’s whether we’ll sustain #populationhealth protections that work quietly in the background—or let politics unravel them.
More thoughts here: www.pcplens.com/p/the-curiou...
So the real question isn’t “does fluoride work?”
It’s whether we’ll sustain #populationhealth protections that work quietly in the background—or let politics unravel them.
More thoughts here: www.pcplens.com/p/the-curiou...
6/
Other countries that abandoned water fluoridation didn’t leave a vacuum—they built alternatives: salt fluoridation, school mouth-rinse programs, universal dental coverage. In the U.S., we often dismantle without replacing.
Other countries that abandoned water fluoridation didn’t leave a vacuum—they built alternatives: salt fluoridation, school mouth-rinse programs, universal dental coverage. In the U.S., we often dismantle without replacing.
September 10, 2025 at 3:48 PM
6/
Other countries that abandoned water fluoridation didn’t leave a vacuum—they built alternatives: salt fluoridation, school mouth-rinse programs, universal dental coverage. In the U.S., we often dismantle without replacing.
Other countries that abandoned water fluoridation didn’t leave a vacuum—they built alternatives: salt fluoridation, school mouth-rinse programs, universal dental coverage. In the U.S., we often dismantle without replacing.
5/
The problem is that decisions about fluoridation aren’t made by weighing evidence. They’re driven by local politics, lobbying, and the loudest voices at council meetings. Evidence often matters less than ideology.
The problem is that decisions about fluoridation aren’t made by weighing evidence. They’re driven by local politics, lobbying, and the loudest voices at council meetings. Evidence often matters less than ideology.
September 10, 2025 at 3:48 PM
5/
The problem is that decisions about fluoridation aren’t made by weighing evidence. They’re driven by local politics, lobbying, and the loudest voices at council meetings. Evidence often matters less than ideology.
The problem is that decisions about fluoridation aren’t made by weighing evidence. They’re driven by local politics, lobbying, and the loudest voices at council meetings. Evidence often matters less than ideology.
4/
Wealthier households barely notice—dentists, toothpaste, even filters make up the gap.
But for low-income families, fluoridated tap water may be the only preventive care they get. Without it, the burden shifts: more ER visits, extractions, and school days lost.
Wealthier households barely notice—dentists, toothpaste, even filters make up the gap.
But for low-income families, fluoridated tap water may be the only preventive care they get. Without it, the burden shifts: more ER visits, extractions, and school days lost.
September 10, 2025 at 3:48 PM
4/
Wealthier households barely notice—dentists, toothpaste, even filters make up the gap.
But for low-income families, fluoridated tap water may be the only preventive care they get. Without it, the burden shifts: more ER visits, extractions, and school days lost.
Wealthier households barely notice—dentists, toothpaste, even filters make up the gap.
But for low-income families, fluoridated tap water may be the only preventive care they get. Without it, the burden shifts: more ER visits, extractions, and school days lost.
2/
Early studies showed #WaterFluoridation cut cavities in kids by 50–70%.
Even today, the best reviews still show benefit: 26–35% fewer decayed #teeth in children, lower extraction rates, and savings. Yet support is eroding.
Early studies showed #WaterFluoridation cut cavities in kids by 50–70%.
Even today, the best reviews still show benefit: 26–35% fewer decayed #teeth in children, lower extraction rates, and savings. Yet support is eroding.
September 10, 2025 at 3:48 PM
2/
Early studies showed #WaterFluoridation cut cavities in kids by 50–70%.
Even today, the best reviews still show benefit: 26–35% fewer decayed #teeth in children, lower extraction rates, and savings. Yet support is eroding.
Early studies showed #WaterFluoridation cut cavities in kids by 50–70%.
Even today, the best reviews still show benefit: 26–35% fewer decayed #teeth in children, lower extraction rates, and savings. Yet support is eroding.
4/ #SocialDeterminantsofHealth aren't about removing choice
- they're about creating environments where healthy choices are actually possible.
- they're about creating environments where healthy choices are actually possible.
August 27, 2025 at 3:15 PM
4/ #SocialDeterminantsofHealth aren't about removing choice
- they're about creating environments where healthy choices are actually possible.
- they're about creating environments where healthy choices are actually possible.
3/ Is choosing soda over water a "personal choice" when tap water contains lead and bottled water costs more than soda?
→ Is using alcohol or smoking a "lifestyle choice" when you're drowning in stress with zero access to mental health or community support?
→ Is using alcohol or smoking a "lifestyle choice" when you're drowning in stress with zero access to mental health or community support?
August 27, 2025 at 3:15 PM
3/ Is choosing soda over water a "personal choice" when tap water contains lead and bottled water costs more than soda?
→ Is using alcohol or smoking a "lifestyle choice" when you're drowning in stress with zero access to mental health or community support?
→ Is using alcohol or smoking a "lifestyle choice" when you're drowning in stress with zero access to mental health or community support?
2/ We get stuck arguing:
→ Individual choice vs. Government control
→ Personal agency vs. Paternalism
But we're forget that choice without options is NOT a choice
→ Individual choice vs. Government control
→ Personal agency vs. Paternalism
But we're forget that choice without options is NOT a choice
August 27, 2025 at 3:15 PM
2/ We get stuck arguing:
→ Individual choice vs. Government control
→ Personal agency vs. Paternalism
But we're forget that choice without options is NOT a choice
→ Individual choice vs. Government control
→ Personal agency vs. Paternalism
But we're forget that choice without options is NOT a choice
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
7/7
More thoughts here on how #illness is embedded in our physical and political #infrastructure —not just our bodies
www.pcplens.com/p/the-archit...
More thoughts here on how #illness is embedded in our physical and political #infrastructure —not just our bodies
www.pcplens.com/p/the-archit...
August 7, 2025 at 4:25 PM
7/7
More thoughts here on how #illness is embedded in our physical and political #infrastructure —not just our bodies
www.pcplens.com/p/the-archit...
More thoughts here on how #illness is embedded in our physical and political #infrastructure —not just our bodies
www.pcplens.com/p/the-archit...
6/7
If we want fewer sick people, we need fewer ERs and more better #zoning laws.
But that means shifting power—away from those who benefit from the status quo.
If we want fewer sick people, we need fewer ERs and more better #zoning laws.
But that means shifting power—away from those who benefit from the status quo.
August 7, 2025 at 4:25 PM
6/7
If we want fewer sick people, we need fewer ERs and more better #zoning laws.
But that means shifting power—away from those who benefit from the status quo.
If we want fewer sick people, we need fewer ERs and more better #zoning laws.
But that means shifting power—away from those who benefit from the status quo.
5/7
This isn’t mission creep. It’s misdirection.
We’ve built a system where #sickness is predictable—and profitable.
The farther upstream you go, the less accountability there is.
This isn’t mission creep. It’s misdirection.
We’ve built a system where #sickness is predictable—and profitable.
The farther upstream you go, the less accountability there is.
August 7, 2025 at 4:25 PM
5/7
This isn’t mission creep. It’s misdirection.
We’ve built a system where #sickness is predictable—and profitable.
The farther upstream you go, the less accountability there is.
This isn’t mission creep. It’s misdirection.
We’ve built a system where #sickness is predictable—and profitable.
The farther upstream you go, the less accountability there is.