Dr. Aaron Blackledge opened his San Franscisco clinic, CarePractice, in 2008.  Today it is the fastest-growing primary care practice in the Bay Area.   We have ideas about how the new community-based, patient-centered models will do more than any legislation to define the future of health care in the U.S., but we cannot express it any better than Aaron Blackledge can.  In his own words, he describes what he did to change the game:

“In the beginning I told my employee–at the beginning there was only one–that if he had friends or family that needed to be seen that he had the authority to set the price on his own without asking me for permission depending on how much they could afford or how much of a deal he wanted to give them.  This may seem crazy to some people, but I think I benefited in so many ways from this practice and feel lucky I came up with at the beginning of Care Practice. It really helped to empower my staff and bring in clients that loved Care Practice.  It reminds me now that since we have grown so much in the past 3 months I am not sure if all the new staff are aware of this ‘policy.’  I will have to remember to tell people about this tomorrow.

“I went to Sarah Lawrence for my undergrad degree.  I was a dance major.  My background is artistic as well as medical.  I have taken many improv classes.  My artistic background helps me look at medicine as a design, a feeling, an experience, that the current medical establishment so horribly lacks.  I know Jay (Parkinson of HelloHealth) is a very accomplished photographer.  I don’t think it’s a coincidence.  Artists are used to facing the unknown, the blank canvas or the empty stage.  We’ve done the same with the medical profession.  What we’re doing didn’t exist before we did it.

“I come from a social activist background.  I never desired to be an entrepreneur.  Never desired to own my own company.  I left my last job and was canvassing for Obama in California.  I heard that Super Tuesday speech, where he said,  I’m paraphasing, ‘Be the change you seek.’  And I thought why isn’t anyone doing this?  And I finally realized you know what, this is my moment, this is my time.  And if I’m going to do it, I’m not going to do it partially.

“I tapped into my altruistic desires, into what it meant, and then I risked everything.  Every dollar I owned, or that I’d ever saved, and put it all into this.  If I needed to spend money on something to make this happen, I spent it.

“All my friends thought I was absolutely crazy.  They couldn’t believe it.  Some of them thought it was going to be some raggedy little space, not the big facility that we have.  Everyone else is closing up shop and joining Kaiser.  And they’re like, ‘What, you’re opening a clinic?!  What are you thinking?!  But I looked at it like this:  There’s no access to care in this city.  There are vice presidents of companies that can’t get in to see a doctor for like a week.  If do it transparent, intuitive, and don’t charge a lot…and I really wanted to show that the future of networking and connecting with patients was through social media.

“I put it in a place where there were lots of young people who’d talk about it.  Mention it on their Facebook, on their Twitter, on their Yelp.  I chose the neighborhood I’m in, Mission Dolores, specifically for that purpose.  I’d heard the story about Tommy Hilfiger opening stores in urban areas and basically letting people shoplift from him, and that was sort of my thinking.  Everything has to exceed expectations.  It’s not what you come in with that matters, it’s about what you walk out with.  We’re building CarePractice as an entity that resonates in the community.  Giving free care to the busboy at the little restaurant who cuts his hand…taking care of one of the guys at the bike shop who has an eye infection.  I wanted to express the view that taking care of people is about more than money, and that is how we’ve grown.

“My place looks kind of fancy, but it’s equipment and furniture I’ve bought from doctors closing their practices, CraigsList, Ikea and eBay.  Everything I have is used.  I put the money into the space, because I wanted that experience.  People don’t even know why it is that it’s different, but it is powerful.  The people who designed it (Indicate Design Groupe) design a lot of restaurants and retail spaces.  They’re used to saying to their clients, ‘Okay this is definitely going to be popular, people are going to come here, you focus on the food.’  And that’s the way we think about CarePractice.  They said to me, ‘You take good care of your patients, because we’re going to bring the people.’  So we focused on the roll-out like a restaurant opening.  People identify with that.   We are like a favorite restaurant.  People point us out as their clinic.

“I want to give you real examples of neighborhood care.  Basically it usually involves simple things for people with little money or struggling that we know through the neighborhood.  The Latino laborers of the contractor who helped to build Care Practice always come to me for their bumps and illnesses and I see them for free.  There is also a shop right next to us and I see a lot of the employees for simple stuff for free or significantly reduced prices and they always tell me if my car is chalked or run up to my car when it is about to get ticketed and pretend like it is their car when the DPT comes.   They are always ready to help me carry in supplies when I need help, which is often.  Another example is the security door guy at a neighborhood shop who I always talk to on the street.  He wanted to quit smoking and asked me to get him some Chantix so I ordered him some at cost and he just yelled out to me a week ago when I walked by that it had been 5 months since his last cigarette.  I didn’t charge him anything besides the cost of the meds. When you create that type of sentiment in a neighborhood it is a powerful component to branding a business.

“You (i.e. GameChangers) talk about the beginner’s mind, improvisation, and not being afraid to feel like a dumbass and make mistakes the first time around.  That’s the way I look at it, too.  Build a company that serves patients first.  I want every one of my employees to see that we’re generous.  Every interaction is an opportunity to show your character.  And in an age of social media, it is magnified by ten.

“I think the health care system is so ready for change, and people are so unhappy, and the amount of money being spent is so huge that I think can happen very quickly, and not necessarily through legislation, but through individual action.  Ten thousand doctors getting up and walking out of the room and saying we’re not going to do it that way any more, we’re going to do it differently, can change it.  That is my goal.

“People often ask me about health care reform, ‘What if we have single payer?  What if we have this or that?’  My response is that I don’t care.  I can turn on a dime.  I can turn the entire practice around and move in a different direction, and I can do it in a day.  If we went to a Canadian style health care model, pfff, I don’t care, I’d change overnight.”

There’s been a lot of water under the bridge in those 20 years, but we picked up like it was just yesterday back in Jasper, Indiana, when we were dreaming about the bigger world away from there, and aching to get at it.

Well, here we are. Still aching, but with the aches in different places. And I am so profoundly moved and humbled by what my friend has done, and how he has chosen to live his life.

Grammy has made it his business to help people who would otherwise die alone under a bridge somewhere have their last days be good days. He has made it possible for human beings who would otherwise be forgotten to be remembered, made it possible for love to have one last chance to live on.

He has raised millions of dollars for programs and facilities that care for the dying poor. He gave me a tour of the Abbie Hunt Bryce Home in Indianapolis run by Visiting Nurse Service (VNS), Inc., for which he helped raise the funding and is the staff physician. He introduced me to Betty, a resident there who was the happiest person I met all day. She wanted to dance. Residents come here with no caregivers, and no place to live. Upon moving in, they have both. Over fifty volunteers from the community cook meals and provide services to the Home.

At Wishard Hospital, I sat in on a class in palliative care Grammy taught to third year med school students. He tried to get them to feel for people and families with end-of-life decisions to make, but it was not a very feeling audience. He had them read aloud poetry (which he then repeated from memory) by writers whose spouses had died. When the students read the poetry, it was empty and unemotional. When Grammy read it, it was straight from the heart.

He offered the students this insight: When someone near the end of their life says to their doctor, “Do everything you can,” maybe they are not talking about hooking them up to machines in the ICU. “Maybe,” he suggested, “what they’re saying is do everything you can to contact my family. Do everything you can to save me from dying alone, out on the street. Do everything you can to find a Veterans check I’m owed and give it to my sister. Do everything you can to keep me off the machines. Do everything you can to listen to me, because I have something to say.”

On the cellular level of our biology — and a process called apoptosis that allows our entire physical makeup, every cell in our body, to die so that new cells can grow — we all experience death on a daily basis. The death of each cell holds the potential to initiate the life of a new one. Stronger cells grow in place of weak ones. Healthy cells in place of diseased ones. Or the reverse can be true. The choice is most often ours to make. In letting the fate of a person’s death bring bring about a better reality, Grammy is simply honoring a fact of our shared biology.

He told me about a patient named Cowboy Smith, originally from Chicago, a homeless man who lived under a bridge in Indianapolis when they first met. Grammy brought him an electric generator to help him through one extra harsh winter. When Cowboy finally had to check into the hospital where he was diagnosed with incurable lung cancer, he was at first wary and defensive, but Grammy got him to open up, and Cowboy ended up singing the blues in a beautiful voice for the staff. When he began disappearing from the hospital for a day or two at a time, Grammy learned that he was picking up uneaten food from hospital trays and taking it to his dog, Cowgirl, who was still living back under the bridge.

Grammy tracked down Cowboy’s son, a Harvard graduate with a doctorate in Divinity, and he and Cowboy re-united after being estranged for many years, and Cowboy got to meet his son’s new wife. He introduced Cowboy to a writer, David Wendell Moller, who included Cowboy’s story in his book, Dancing With Broken Bones.

On Cowboy’s final day, as he lay dying in his bed at the Bryce Home, someone asked, “Where’s Cowgirl?”

Grammy sent for the dog. When she arrived at the Bryce Home, where she’d never been before, she ran straight to Cowboy’s bed and jumped in next to him, and rested her head on his chest until he died.

It has never been more apparent than it is today that we are in this game together. Most of us have many freedoms for choosing how we are going to play it. My friend Grammy plays it with his own particular gifts of calling attention to what would otherwise go unnoticed, feeling what would otherwise go untouched, listening to what would otherwise go unheard. And little by little, in a thousand subtle ways, the game changes, and something new and better comes to life.