Turning the Tables on Health

Zubin Damania, MD, Puts a New Spin on Primary Care

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TexMed 2014 Feature — April 2014 

By Kara Nuzback
Reporter

Tex Med. 2014;110(4):51-55. 

Modern health care has become a monstrous system filled with baggage and regulations, but physicians can turn the tide by experimenting with new models of care that put the focus back on the patient-physician relationship. That's the crux of the message Zubin Damania, MD, will spread when he headlines the General Session at TexMed 2014 in Fort Worth May 2.

"None of us intended to have the system that we have," he said. "Patients all know it's a horribly dysfunctional system."

In his presentation, Redefining the Culture of Medicine, he'll delve into the ethical challenges to delivering excellent care in a troubled health care system while proposing ways to revitalize it. Dr. Damania says he wants to create a new system that will allow doctors to retain their passion for patients, and he plans to share his mission with physicians at the Texas Medical Association's annual conference next month. His keynote speech will examine the everyday strife physicians face in a highly regulated health care system while highlighting ways doctors can bring joy back into the practice of medicine. 

Dr. Damania is the founder of Turntable Health, a Las Vegas-based practice that fosters a new type of primary care — one that focuses on prevention by offering nutrition classes and group therapy along with regular patient visits.

What sets Dr. Damania apart from past General Session speakers is his alter ego, "ZDoggMD," a rapper well known in physician circles for his musical antics, dope beats, and fresh lyrics. ZDogg has attracted thousands of Internet viewers by transforming catchy songs by Miley Cyrus, Usher, Notorious B.I.G., and other popular artists into side-splitting music video parodies about infections, first aid, pharmaceuticals, and other health care topics. View some of ZDogg's videos at ZDoggMD.com or on YouTube.

Dr. Damania says the bureaucracy in modern medicine makes TMA important because the organization helps doctors "push back." TexMed attendees can expect a few laughs from Dr. Damania's speech, but he hopes his message will resonate on a more serious level.

"You can find a way to do the right thing," he says. "Once you find it, you reengage with that passion that drove you into medicine in the first place."

Dr. Damania says he's excited to visit Fort Worth and participate in his first TexMed conference. 

"And I'm really excited to talk to Texas physicians," he said. "I think Texas has incredible health care and incredible providers, and I can't wait to learn as much as I can while I'm there."

As for whether the audience can also expect a live ZDoggMD performance, Dr. Damania is keeping mum. 

"I'm a studio gangster," he said. "If push comes to shove, I'll throw some rhymes down."

You can hear Dr. Damania speak about the changing face of medicine and what physicians can do to improve the health care landscape Friday, May 2, at 3:30 pm during the TexMed 2014 General Session at the Fort Worth Convention Center. (See "Are You Ready? Register Today for TexMed 2014.") 

Rebel Without a Pause

After finishing his residency in internal medicine at Stanford University in 2002, Dr. Damania entered the field of medicine with energy and excitement. He expected to spend one-on-one time with patients and give them the best care possible. But 10 years into his career as a hospitalist, he says, the passion had drained from him. 

"Something in my personality had changed," he said. 

Feeling overwhelmed by the "bureaucracy of modern health care," Dr. Damania says he felt like a "cog in a giant machine," spending most of his days documenting with electronic health records (EHRs) and completing administrative tasks instead of caring for patients.

"It had been death by 1,000 paper cuts over the course of 10 years," he said. "There was no hope on the horizon. So much time was spent on nonmedical stuff." 

Patient interaction consisted of rushed, impersonal visits. 

"I knew that this was not who I was," he said.

Dr. Damania says his breaking point occurred one day when, despite a full schedule and a packed waiting room, he spent an extra hour with a dying patient. Dr. Damania says he gave the patient one-on-one time and shared palliative care options. 

"The experience reminded me why we do this," he said. 

Dr. Damania says he wondered why he wasn't providing this level of care all the time. In what he calls a "cry for help," he created and released his first rap video. In 2010, he began writing and recording humorous rap parodies focused on medicine, including "Hard Doc's Life," a parody of "Hard Knock Life" by Jay-Z, and "What Does the Doc Say?" his take on "What Does the Fox Say?" by Ylvis.

The videos have received thousands of views, and Dr. Damania has developed a following among other young doctors who struggle with burdensome government regulations and daily administrative hassles. (See "The Rhythm and the Rhyme: The Rapper, the Physician.")

Dr. Damania says physicians practicing in traditional settings don't have to take on a hip-hop alter ego to incorporate elements of the Turntable model into their practices. One suggestion he has for physicians involves accepting some direct-pay patients, a move he says frees doctors from the constraints of the traditional insurance model, allowing them to deliver better care.

If doctors feel they have delivered the best care they can give to a patient, some of the joy returns to practicing medicine, Dr. Damania says. He says even though Turntable Health is a company, it empowers doctors to practice autonomously, "the way they've always wanted to practice. We're reconnecting with why we went into medicine."

Fight the Power

Dr. Damania's music videos caught the eye of Tony Hsieh, chief executive officer of Zappos, Inc. He encouraged Dr. Damania to move from his home in the California Bay Area to Las Vegas to create a better health care archetype.

Dr. Damania opened the doors to Turntable Health in December. Its mission is "to fix health care for everyone," he says.

In less than two months, the facility had 250 members. Dr. Damania says he wants his practice to serve as a model for a new wave of health care. Turntable members pay an $80 monthly flat fee for primary care. The practice offers same-day or next-day appointments, 24-7 access to physicians by phone, nutrition classes, yoga, and group therapy. 

"You have the ability to impact multiple aspects of people's lives," he said.

The organization's operating partner, Iora Health, based in Cambridge, Mass., has been experimenting with a similar model for several years, Dr. Damania says. Iora has a handful of flat-fee practices, but they cater to individual sponsors, such as unions and colleges.

"We've seen the early pilots," Dr. Damania said. "Now we want to optimize and bring the model to everyone."

Unlike a clinic funded by a union or an employer, Turntable is open to the public.

"We're not the first, but we think we're the more sustainable solution to get it established," he said.

Patient feedback has been positive, he says. Postvisit surveys show a 97-percent satisfaction rating from the first 50 patients. 

Many patient members struggled with poor health care in the past and are grateful the facility opened its doors, he says. Turntable Health attracts patients from a broad socioeconomic spectrum but doesn't accept Medicare or Medicaid patients. 

Several small businesses and young entrepreneurs in the city provide Turntable Health membership to their employees, including Project 100, a transit service that offers shared electric cars and bicycles, shuttles, and chauffeured vehicles for a flat monthly fee.

"The demographic is younger, but they're not necessarily healthier," Dr. Damania said, adding that these patients often struggle with substance abuse problems and mental health concerns. 

He says Turntable Heath focuses on the relationship between the patient and the physician, a critical aspect of health care that he plans to examine in his TexMed presentation. 

"If we do the right thing for the patients, they're going to respect that," he said. 

Turntable Health is now free for many members of the Nevada Health Co-Op, a state health insurance cooperative created under the Affordable Care Act. Dr. Damania plans to build more Turntable locations — first in the Las Vegas suburbs, then in other states. 

"If we could make it work in Las Vegas, we think we could make it work anywhere," he said.

Kara Nuzback can be reached by telephone at (800) 880-1300, ext. 1393, or (512) 370-1393; by fax at (512) 370-1629; or by email.

SIDEBAR

The Rhythm and the Rhyme: the Rapper, the Physician: Q&A with Zubin Damania, MD, and his alter ego, "ZDoggMD"

ZDoggMD

Q: When did your hip hop career begin?

A: In the womb, son! When they slapped an ultrasound probe on my mama's belly, the doc was like what what? That's a dope beat! Even my fetal heart had rhythm, yo. 

Q: What is your rap topic of choice?

A: Poop. Most of my rhymes somehow come back to poop. We did a joint on ulcers and black poop, on Clostridium difficile and infected poop, on hemorrhoids and painful poop, and on constipation and not enough poop. Poop, son. Feces. 

Q: Who are your fans?

A: I've got fans? Yes!

Q: Who are your musical inspirations?

A: Beethoven, Schoenberg, Kenny Rogers, Dr. Dre — in that order.

Q: How do you plan to develop as an artist?

A: I'm going on some awards show and publicly call Dr. Mehmet Oz a "sucker MD," thus generating an East Coast-West Coast medical rap beef. 

I'll then conveniently suffer a "wardrobe malfunction" on live TV, generating yet more delightful controversy and millions of YouTube views. Following this up with a very public meltdown and arrest for possession of illegal laxatives, I'll pretty much have written my ticket onto the cover of People magazine. 

Boom! Watch your back, Justin Beiber.

Q: What aspect of Texas are you most looking forward to?

A: Seeing the instruments. I've been hearing about these Texas Instruments since I was a boy. They better be dope.

Zubin Damania, MD

Q: When did your medical career begin?

A: In the womb. My mom was doing her residency when she was pregnant with me.

Q: What is your specialty?

A: Hospital medicine (trained as an internist). I got to routinely see patients who were in the hospital as a result of the lack of access to primary care. Now I'm trying to grow a new model of primary care via our start-up, Turntable Health.

Q: Whom are you trying to reach in your practice?

A: Everyone — patients of all ages and socioeconomic backgrounds, and doctors and nurses excited to practice medicine the way they always hoped it could be practiced.

Q: What or who inspired you to become a doctor?

A: Medicine is a calling that often chooses you, as opposed to the other way around. But I have to say having two physician parents was a huge influence on me in choosing my career.

Q: How do you picture your career developing?

A: My hope is to create a means through which health care professionals can practice at the top of their licenses, free of insurance-related red tape, and instigate grass-roots, bottom-up health care reform led by health professionals. 

Q: What aspect of Texas are you most looking forward to?

A: Meeting all the great folks there and experiencing the legendary hospitality firsthand.

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RELATED STORY

Are You Ready? Register Today for TexMed 2014

Register today for the Texas Medical Association's free annual conference, and join thousands of fellow Texas physicians, as TexMed 2014 descends on Fort Worth May 2-3 for a weekend of continuing medical education (CME) events, networking, policymaking, and all-around fun. 

TexMed is TMA's largest event of the year, offering more than 80 hours of CME, an extensive gathering of exhibitors to help with every aspect of your practice, and, of course, this year's keynote speaker, Zubin Damania, MD — perhaps better known for his alter ego and street persona, "ZDoggMD."

In his TexMed General Session presentation, Redefining the Culture of Medicine, Dr. Damania will delve into the ethical challenges of delivering excellent care in our dysfunctional health care system and will propose ways to revitalize it. 

Be sure to connect with Dr. Damania via his website before attending TexMed 2014, and check out ZDogg's personal invitation for you to go to Fort Worth.

Visit the TexMed 2014 webpage for a full schedule of events, CME, exhibitors, lodging information, and fun things to do in and around Fort Worth.

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