Tens of thousands of people have been treated by ZDoggMD – at least to a few laughs.
Using satire, rap and sometimes, a Michael Jackson glove, hospitalist Dr. Zubin Damania takes his alter ego, ZDoggMD, to YouTube to sing about everything from insurance paperwork to prostate cancer.
The result is hundreds of thousands of online views, and comedy that parodies pop culture (he does an excellent Yoda impersonation) and pushes some boundaries (bodily fluids are not off limits).
"Sometimes I stop and think: Are we getting in trouble?" Damania says of the often indelicate videos he creates with coworkers and friends. "But the more we push it, the more positive the outcome."
And when the opportunity arose, he decided to put his critique into action by heading up a new clinic in Las Vegas that he hopes will address the many drawbacks of the health system he noticed while treating seriously ill patients as a Stanford hospitalist.
Damania delivered a talk at the 2013 TEDMED conference in Washington in April called "Are Zombie Doctors Taking Over America?" In it, he offered his take on the physician lifestyle right now: a hazy mix of rounds in the hospital, hours on the phone with insurance companies, tedious paperwork, and getting home late, only to worry about mistakes made somewhere along the way.
"There are so many pieces, but fundamentally the human relationship is ignored in this system," he said.
Between his unsatisfying work experience and well-received creative outlet, Damania said he was searching for balance in his profession when his friend Tony Hsieh, the CEO of the mega shopping website, Zappos, approached him with a proposition. The Las Vegas-based entrepreneur asked him to develop and lead a health care system as part of the Downtown Project, an initiative spearheaded by Hsieh to revitalize the city.
With a push from his wife, a radiologist at Stanford, Damania accepted. He said the fragmented care in the area now makes it ripe for innovation. "Our goal is to do it right in Vegas so that we can build and scale, and subtly disrupt what’s happening in health care," he said.
The idea of "disruption" is a buzzword for doctors and hospital leaders who are hoping to change the health care system. Damania said he was inspired by Clayton Christensen, author of The Innovator’s Prescription, who suggests developing new ideas on the fringe of the health care system.
The Vegas project fits that idea of "fringe" with a diverse community that includes small business owners, freelancers, artists and non-unionized workers -- and not enough primary care to serve the people who live and work there.
Damania said his new clinic is partnering with Iora Health, a company that has implemented a team-based, primary care model in Brooklyn, Atlantic City and other areas. The model will be tweaked for the needs of downtown Las Vegas.
"Zubin has a broad view, a systemic view of what needs to change in the health care system," said Alexander Packard, CFO of Iora Health. "He saw that we had the kind of culture that makes people feel well served."
Under the Iora model, there are health coaches, ideally from the local community, as well as nurses and physicians, working to treat each patient. Each morning the entire staff meets in a huddle -- a meeting to discuss each patient they are scheduled to see that day. Damania calls this a "non-hierarchical" approach, where time and money is preserved by realizing "not everything has to be done by a doctor."
Damania is adamant that insurance should be left out of primary care, where he said the incentives to take care of patients are often skewed by how insurance companies pay doctors for procedures. Instead, he proposes that patients pay a flat fee for primary care and have a wraparound insurance plan for emergencies or specialty care.
"We don't use auto insurance to rotate our tires -- there would be no accountability that way," he said.
The Downtown Project clinic will have a monthly membership fee of less than $100 that will cover all appointments and access to caregivers through both visits and e-mail or phone. Damania said he expects that some employers will elect to pay that fee for workers as part of an employee benefit plan and that he has already contracted with a very large employer in the area.
The clinic is set to open its doors in the fall of 2013, and Damania says he thinks it can help curb the cost of care through better use of primary care treatment and diagnosis. With this kind of reform, he wants to return to the career he set out to do in medical school -- being a hospitalist.
And while Damania is taking steps toward his vision, ZDoggMD is no less ambitious. After Damania’s daughter introduced her elementary school teacher to the videos -- a scary parent-teacher moment for the creator -- he's made plans to tailor health-infused rap songs for the youngest inheritors of the health care system.
He calls it Schoolhouse Doc.