Salus June 4, 2025

Jeremy

Bill B, we know you’re coming from New England, where they have been trying to dismiss primary care for quite a long time. There are advanced practitioners who are dismissive of primary care.  I will add to the metaphor that Gay has introduced. I think, Jack, wouldn’t you agree that fee-for-service would be like Go-Lightly for the healthcare system? It makes everything go faster, but that doesn’t necessarily improve the health of the patient unless they need surgery and need their bowels completely evacuated.

Jack

We all have the opportunity to take a little bottle of Go Lightly that will change your life.

Jeremy

As a resident, we joke that it really should be called Go-Heavily because that’s really what happens. I don’t know. There’s a sardonic joke that made it Go Lightly. But fee-for-service, I think, as Jack points out, makes everything turn into productivity, and the product then becomes the euphemistic bowel movement, so to speak, meaning that the ejection of the end product rather than anything to do with the quality of the experience while transmitted rapidly through the system. Is that accurate, Jack?

Jack

I think so. It’s funny, this whole conversation around poop. I’m laughing at it. One of the things that I do during all my well-child checks with kids is training them to always look at their poop because people are like, oh, I don’t look. It’s like, how can you not look at this? Because it’s going to be the thing that you most need to look at every day for the rest of your life, because it will tell you a lot about what’s going on. So, I teach that all the time.

Molly

What kid doesn’t love that assignment?

Bill B

That’s why so many sociologists say, if you want to understand the values of a society, look at the garbage. Look at what is being thrown away, what is devalued, and you’re going to gain more insight. For instance, I was often traveling for many years on a train from San Francisco to Sacramento. And often traveled by train on the East Coast, going down the corridor through New Jersey to Washington, D.C.  I love sitting by the window and looking at what’s at the side of the railroad tracks. The stuff that’s being thrown away says so much about our society. It’s the shit that’s telling us what is non-valued. And Jack, as you say, the shit is telling us what’s really happening. Gay, is any of this making sense?