Doodling. I recently gave a talk at the Health Evolution Summit conference in Dana point California. It was a humbling experience, as I was expecting to give the standard PowerPoint presentation, and was told: “no,” that instead, I would be out on the lawn in front of the wind and surf and be giving a talk on a flip-chart.

This provoked a great deal of anxiety, and prompted ego- and personality-rebuilding. Then I thought of my sister’s book recommendation “The Doodle Revolution.” And so I took my story, boiled it down into symbols, and give a talk, which was not unsuccessful.

Turns out, googling any concept attached to the word “symbol” allows you to see what other people have used for symbols, such as for “strategy” or “manager” or “project manager” or “consensus”. Try, for example, googling “consensus symbol.” Well, at least it starts the creative juices flowing.

I challenge any of you to understand my chicken scratch doodles and interpret them into a coherent narrative. The good news is, I’m no longer afraid that my terrible chicken scratch will be criticized. I know that it will, and it’s still helpful to me and to my audience. I’m learning to get over myself.

For those of you interested:

  • The “upside down spaceship” in the corner is really a handshake symbolizing “partnership”
  • “…and…but…therefore” comes from a previous blog post on storytelling*
  • The elephant is a reference to slow moving, large academic medical centers
  • The drowning man refers to Healthcare organizations in the age of acceleration
  • The USB symbol refers to technology companies


CMIO’s take:  What are you waiting for? Get out and doodle! OR, if you’ve doodled successfully (or even unsuccessfully), let me know in your comments!

Review: Excellent Sheep: The Miseducation of the American Elite and the Way to a Meaningful Life

Excellent Sheep: The Miseducation of the American Elite and the Way to a Meaningful Life
Excellent Sheep: The Miseducation of the American Elite and the Way to a Meaningful Life by William Deresiewicz

My rating: 5 of 5 stars

Lets be clear. I AM an EXCELLENT SHEEP, and saw myself critiqued in the pages of this insightful book.

My college-bound daughter discovered this book on the bookshelf of her college counselor, with whom she meets regularly in this, her junior year. I graduated, according to her, back in the paleolithic age, from a school in Tallahasse, Florida, that requires meters of excavation to uncover from the archeological record. Surely NOTHING I learned applies in this accelerated, Modern era.

[Actual quote from, at-the-time-7-year-old daughter: “That was back in the age of dinosaurs, when =I= wasn’t alive, but you were.”]

So, I dutifully picked up this book, as she found it too tiresome to have to explain to me what Modern high schoolers were facing, and how many misconceptions I had carried and how many opportunities I had missed during my own Jurassic years. She was certainly NOT going to replicate my folly.

OK, so I attended Harvard University as an undergraduate and Stanford University for medical school. We will just leave aside the snarky comments of “Ohhhh, you went to Haaahhhvahhd. I’m surprised you even talk to little people like us.” This lead to the decades-long behavior of being vague about my undergraduate career: “Oh, where did you go to school?” “Um, back East.” “Oh, where back East?” Um, Boston.” “Oh, Boston U?” “Um, no.” “So, where?” “Harvard.” “Ohhhh, Haaahvaahhhd! …”

But I digress. The Daughter has informed me that she will NOT be looking at Harvard, not interviewing, not planning on attending there. Instead, she’ll be seeking a college “experience” that is challenging, a smaller school with excellent teachers in smaller classes, a breadth of liberal arts subjects, as she is currently interested in EVERYTHING, good sports, great art, strong science, math, engineering, a place that will give her a chance to discover and grow, and not a treadmill rat race.

Compare that to my upbringing. I do recall the strong suggestion from my parents that “being a Doctor” seems like an excellent career choice to support a family and at least a few grandparents… Interestingly, my over-the-top uncle always insisted that the hard-working Chinese immigrant would “take over America” in several waves: First generation: study math and science, become Engineers! because poor language skills are not a handicap in this field. Second generation: continue math and science, but now, you have better language skills: become Doctors! Third generation: who cares about math and science, because with outstanding language skills: become Lawyers! Time to Take Over the government! So, 3 generations until the Immigrants run the place. Sure, I played my part.

Where was I? Oh yes, and that First Generation drive to excel pushed me into the biggest name University that my parents could think of: the big H. In the years since graduation, I must say that although quite a number of my classmates have gone on to do great things and look back with fondness on those years, a surprising number have mixed memories and some consider it a mistake: a roiling cauldron of 5000 high powered, driven students looking for a stepping-stone to a professional degree: MD, JD, MBA. And on the flip side, did Harvard open doors that were closed to grads from other schools? Perhaps a Stanford Med spot? Possibly, but not for certain. Would I have become a physician regardless? Almost certainly yes.

Big H was big. Economics 101 in Sanders Theater: 1000+ students in one class. Never met the professor. Psychology 101: more than 800 students. Inorganic Chemistry: 400 students, and I approached my first college exam, being ready to regurgitate, as my high school well taught me, the facts I had stuffed in my head. Instead I was faced with 5 impenetrable essay questions: “Let’s theorize a new universe where instead of the usual S and P electron orbitals, there are now 13 electrons in a shell. Hypothesize how molecules would form differently?” Just as I was flipping through the pages, realizing that I could answer NONE of the questions, one of the students in the front row (whom we later understood had taken too many NO DOZE the night before), began to have a seizure. He was carried out by paramedics. We looked at each other in a panic: apparently college exams KILL STUDENTS.

The pressures then were intense, and now that it is several times more difficult to navigate the waters to an admissions letter, I imagine the pressure is even greater. Reports of suicide and high rates of anxiety and depression seem to confirm these fears.

I think I was lucky in my ancient days: finding a small cadre of like-minded students, forming what we called the “Oligarchy” and causing all sorts of pseudo-governance shenanigans. For example, using my new Macintosh to print posters taking credit for social functions organized by others: “The OLIGARCHY welcomes you to tonights’ Dance.” “The OLIGARCHY invites you to come to a screening of Ingmar Bergman’s latest masterpiece.” “The OLIGARCHY is sponsoring the French Accent Table tonight at dinner.”

You see, amongst the pompous French, Spanish, German language tables at dinner at Dunster House, we formed the “French Accent” table, sat one row over from the French table, and proceeded with our best, overly-loud Monty Python accents to overwhelm, dismay and ultimately dismantle and chase away the overly serious. Seriously, though, finding a group where you can belong, can make all the difference in a large University that is seemingly uncaring, and too large to look after all the students all the time.

Excellent Sheep describes the slow evolution of students being shaped by geologic forces into perfect specimens, designed specifically to assemble the perfect high school resume: over a dozen AP courses, straight A’s, months of SAT and ACT prep, a collection of club presidencies, a collection of varsity sports lettermen jackets, and oh, yes, don’t forget those few months spent with the Peace Corp.

Julie Lythcott Haimes, freshmen dean at Stanford, writes in “How to Raise an Adult” that every year the Stanford freshmen class is more impressive than the last. Have we not perfected the high school resume? Justin Hoffman’s The Graduate was a perfect specimen, only to realize he was disenfranchised and fossilized in the older generation’s expectations.

Malcolm Gladwell notes, in his book “David and Goliath” that students with comparable SAT scores who attend the best school they can get into and graduate in the middle of their class, do far worse in their subsequent career (sometimes even quitting their chosen field because of overwhelming competition) than students who go to a strong, smaller school, find a good mentor, a comfortable yet challenging culture in which to excel and graduate nearer the top of their class.

I think I’m taking all this time, reminiscing about my pleistocene years, to meander around to my point. I’m actually fine NOT having my daughter attend Harvard. There are thousands of excellent schools that do not cater to, and do not want Excellent Sheep. They intend to grow strong adults, with a sense of identity, of curiosity, of perspective. Did Harvard serve me well? Sure, and maybe I was lucky. Do I want to use my advantages and push her into a Legacy spot in the Harvard Admissions queue? Surprisingly, I think my answer has become “no.”

Ms. Lythcott-Haimes perhaps should have the last word. I (ineptly) paraphrase: “Our children are NOT hot-house orchids, requiring perfect care and feeding. They are instead wildflowers of an unknown genus and species.” And it is up to all of us to help them discover what they will become.

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Pager inversus? Beeper Obliterans?

(images: and

There was a time when the last major industries using a pager were: drug runners and physicians. But then, drug runners switched to disposable, cash-purchased “burner” phones. Apparently, Breaking Bad and The Wire taught us about this. Having seen neither show (yet: saving up to “power-disk” them some day), I’m still faithfully carrying my pager around.

Why are physicians the last ones? I’d have to agree with other articles that reliability (signal penetrates buildings where cell signal might not), flexibility (don’t have to give out personal cell number, and don’t ‘have to’ respond to a page), low maintenance (change the AA battery once a month, so what if hospital power goes out), and low cost ($10 per month or less) are the main drivers. That, and massive inertia.

I’ve been in healthcare since 1985, and in that time, I remember wearing audio pagers (bee-doo-bee-doo! *static* Doctor, please call *static* 347 *static* Come QUICK! *static*). Sigh. What was the full phone number? Who? Where?

I’ve seen some services try to transition to texting (Please come tell Mr. Jones in 307 that he is HIV positive). Sigh. What was that thing about privacy? Did you really just tell AT&T about Mr. Jones?

I’ve seen other physicians miss critical messages because texting did not work in certain internal locations in hospitals. Gives a new meaning to “dead zones.”

With a growing number of hospitals installing internal cell-signal repeaters, it is possible that pagers are finally on their way out. I will miss them, when they’re gone. They did inspire an entire range of emotions over my career.
PRIDE: Hey! You mean medical students get to wear one?!
FEAR: Oh, man, this thing never stops. Can I just eat/pee/poop without being disturbed?
JOY: Finally, I have graduated residency and I am TURNING THIS DAMN THING OFF!
RESIGNATION: Oh, I have to wear one as an attending physician?
HOPE: Maybe, just maybe we can get rid of it and use our anticipated secure texting system

Finally, I recall my favorite research article, published in JAMA in 1992: BEEPER OBLITERANS. It references the older style “audio” pagers with a small “test” button on the top surface that was easy to accidentally “set off.” I won’t ruin it; you have to read it:


Read more. Post less. 

The opposite of a recursive meme: Here’s a social media post telling you to stop reading and posting on social media.

Why? I love my increased reading this past few years. It results in more creativity, more interesting things to say at work and at home, and a more fulfilled thought process. 

How? during my commute, a book club or 3, books piled on the coffee table, ignoring and trimming magazine subscriptions, choosing a book that fills a knowledge gap at work, stopping my podcasts. And trimming my social media and TV consumption (the hardest). 

Great suggestions in the Harvard Business Review article. Good (book) hunting to all of you.

Galileo! Galileo! And enjoy the holiday season, y’all

 It seems to me that we all have less time, too many emails and too much to do. Sometimes we need to look at opportunities to slow down and sit and listen. 

Today, our UCHealth leadership brought in the Denver School of Performing Arts orchestra, right into our hospital auditorium, and I caught a bit of their performance of ‘Bohemian Rhapsody.’ Fun, amazing, and brought a smile to my face. Here’s 30 seconds. Hope you all have a happy and enjoyable holiday season. 

Doctors and Long Haul trucking

(image from

A few years ago, I remember hearing that the “information revolution” has transformed all major industries in the US except for Medicine and Long Haul Trucking. But then, he said, “Long Haul Trucking is making its move!”

I asked one of my patients about this, a few years ago, and he described to me, how, in the “bad old days” as an independent contractor, he would haul a load from Denver to Chicago, drop off, go to the truck stop, and start asking around for anyone who could give him a lead on a load to go back to Denver, and it would often be hours or a day or so of detective work.

“Now,” he said, “I drop off, I go to the truck stop — the all have free wifi — I pull up a centralized database, search for Denver destination, and BOOM, I have a list of phone numbers to call to sign up for a load, have just enough time for lunch, and then I’m off.”

Indeed, it seemed that Medicine was on its own, the last holdout from the Information Revolution, with Long Haul Trucking leaving us in the dust.

Well, that was years ago, and we’ve since seen Meaningful Use, a tsunami of Digital Health startups, the rise of Predictive Analytics for healthcare, machine learning algorithms, and self-driving cars. We are fully into the information revolution in healthcare, with the expected backlash of Physician Burnout, and existential questions of how Computers and Doctors and Patients could possibly ever get along (more on this another time).

Meantime, Long Haul Trucking seems set for its next possible disruption: self-driving trucks. With over 3 million truck drivers in the US, is this a mass-extinction event? Mass unemployment?

Self-driving trucks at a mine in Australia:

Former Google(rs) are part of startup called OTTO, now part of UBER:

And this great blog “Self-Driving Trucks are Going to Hit us Like a Human-Driven Truck”

And, what does this next step mean for Medicine? Is IBM Watson (or some quiet future competitor) our OTTO event? Perpend.

My sister (the smart one)

In the world of ideas, well-written posts speak loudly. I have struggled to put coherent words together, and to post regularly enough to establish a voice. Those of you who have read and commented and “liked”, thank you. Both of you.

Michelle Lin MD

However, I have a sister. Michelle (@M_Lin) is an academic Emergency Department physician at UCSF-SF General Hospital, and runs an award-winning, million-follower medical website, called ALiEM ( At least one colleague has quipped: “Michelle is your SISTER!? Wow, she must be the smart one in your family.”

So be it. Kudos to the smart one. Her most recent article celebrates the brand new partnership between ALiEM, representing the new digital frontier of healthcare, with a well-established brand in medical literature, the Western Journal of Emergency Medicine. Congratulations, sis!

Open Notes: a 16 year journey

Upcoming press release:

UCHealth is excited to be the first in the state of Colorado to offer Open Notes to all 1.5 million patients in our system (as of May 2016). Open notes are now available across the spectrum of care, including outpatient clinics and emergency department notes to hospital discharge summaries. We believe that information transparency is crucial; an informed and engaged patient is a healthier patient.

Or, in Haiku form:
Not sure what Doc said?
Why hide medical advice?
Open Notes are here.

Surround yourself with people smarter than you

Lots of lego people

I’m grateful to work with lots of smart people. One of them is Zuzanna Czernik, who is first author on a paper recently published in JAMA. She notes the current despair about how Electronic Health Records (EHRs) take us away from the bedside of the patient. Her surprising investigation reveals that research studies, over the past 60 years, consistently state “residents spend surprisingly little time at the bedside.” I enjoyed co-authoring paper, and helping to find  a light at the end of this tunnel.

Time at the Bedside (Computing)
JAMA. 2016;315(22):2399-2400. doi:10.1001/jama.2016.1722

Link to my ResearchGate publications (including full text of this article)…

Launching a blog

View from near the top of Flatirons 1 and 2 hike, Boulder, CO with my kids and parents.

Hello world! Inspired by others (Tosha Kowalski, John Halamka, my famous sister Michelle Lin), I’m taking my first stab at a public blog with musings about Electronic Health Records, Patient Portals, information transparency, life as a CMIO, organizational change, psychology of individuals and organizations, communications strategies, science fiction, little black books, saving the planet, and anything else I find cool or interesting. Navel-gazing in short. I promise to keep it short. Hope you drop in from time to time. CT Lin MD



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