Dr. Jeffrey Kaibin Lin, Public Health Family Physician, Los Angeles Department of Health Services
There’s more to health than medicine, a doctor and a hospital. How do we shift health care to include overall well-being? Dr. Jeffrey Kaibin Lin, a physician at the Los Angeles Department of Health Services, shares his experience working in a Transitions Clinic, the comprehensive services they offer and his vision of a completely open access, equitable universal healthcare system guided by compassion.
Dr. Jeffrey Kaibin Lin, a former art director and designer, is now a public health family physician employed by the Los Angeles Department of Health Services. He provides primary care services in the correctional health setting. He is also clinical faculty with the Harbor-UCLA Family Medicine Residency Program (where he completed his training) and is currently setting up a transitions clinic for individuals returning to community from incarceration. He believes that healthcare is a human right, and is a member of Physicians for a National Health Program, which advocates for a publicly-financed non-profit single-payer national healthcare system.
Show Notes
What health care looks like today and a vision for 2049. [02:44]
A view of free and accessible healthcare delivery system similar to a public utility. [05:37]
How would that system be administered and funded? [06:57]
A perspective of how design and medicine have the same goals. [10:01]
What is a Transitions Clinic and how does it help individuals returning from incarceration? [11:22]
How can medical school be redesigned? [14:07]
Comprehensive medical training creates more opportunities for physicians. [16:42]
Advice for prospective med students. [18:43]
An inclusive approach to qualifying for med school. [19:44]
When accepting students, where should the emphasis be placed? [23:33]
It’s not easy to talk about universal healthcare, but it's necessary. [25:54]
Transcript
Bisi Williams: I'm Bisi Williams. You're listening to Health 2049.
Dr. Jeffrey Kaibin Lin: This would require, for instance, it would require people to believe that other people are as equal to them, and other people deserve what you deserve. It requires people to think, I'm willing to allow my taxes to go into a system to potentially pay for somebody else. You just have to believe that.
Bisi Williams: [01:46] Today, we're in for a treat. My next guest describes himself as a visual person. Not only can he design the future, he's also trained to heal people. Dr. Jeffrey Kaibin Lin, a former art director and designer, is now a public health family physician employed by the Los Angeles Department of Health Services, providing primary care services in the correctional health setting. He is also clinical faculty with the Harbor-UCLA Family Medicine Residency Program, where he completed his training and is currently setting up a transition clinic for individuals returning to community from incarceration.
He believes that healthcare is a human right, and he is a member of Physicians for a National Health Program, which advocates for a publicly financed, nonprofit, single payer, national healthcare system. Dr. Lin, it is my pleasure to welcome you to our show.
Dr. Jeffrey Kaibin Lin: [02:36] Thank you.
Bisi Williams: [02:37] I'm so excited to get started. So tell me, what does healthcare look like in 2049 to you Dr. Lin?
Dr. Jeffrey Kaibin Lin: [02:44] 2049 is not that far off, we're talking about 2020, 2021 right now. I think what we know as healthcare today and for many years has been a series of closed doors, a series of denied charges, a series of flaming hoops, paperwork, bureaucracy, phone calls. All of that. None of it feels particularly available or accessible. And I think that is the problem. And I think everyone knows this. Everyone who's tried to get a doctor's appointment or pick up some medications from the pharmacy. Everybody is familiar with this issue of just lack of access or lack of ease.
And so the future, I think this is acknowledged. I think people understand this and it really is working towards a completely open access, equitable universal healthcare system. I think when people talk about the future of medicine, maybe it's about technology and the new robotic surgery or nanopill or something like that. Or maybe there's new medications that come out that can treat all these kinds of diseases. Or there's genetic blood screen that can tell you every single possibility of whatever disease you're going to get in the future. But all those things don't matter if people can't access it, if people can't afford it.
If there's an exorbitant price for any of these cool new things, none of it matters if nobody can use it. The healthcare slice of the economy is like some crazy exorbitant number, and then people's individual healthcare spending is also really high compared to what they get. And so all that has to change. And so Health 2049 is about completely accessible, completely free healthcare for all individuals, all human beings, regardless of where they're coming from, what their need is major or minor.
There's so much waste as it is right now. So there's plenty of space and resources to achieve that, because health isn't just a medicine and a doctor and a hospital. Health is so many different things. It's behavioral health. It's where you live. It's where you play, it's what you eat, it's who you interact with, it's where you work. It's an all encompassing concept of wellness and wellness, not being necessarily like a soft thing as a separate category of health. But just like how you live and survive in this world happily. And so medicine is almost like this subset underneath that. And we have to change these definitions and silos or categories and make it a more all encompassing vision.
Bisi Williams: [05:26] I think you make a great point when you think about it, from the macro to the micro. I want you to just tell me with this vision and this way of living, how does it make the world a better place?
Dr. Jeffrey Kaibin Lin: [05:37] I think it demands thinking about other people. There's a lot of selfishness. There's a lot of I'm taking care of myself. I'm taking care of my family and that's kind of it. And I think greed leads to inequity and inequity leads to just destruction. So this would require, for instance, it would require people to believe that other people are as equal to them and other people deserve what you deserve. It requires people to think I'm willing to allow my taxes to go into a system to potentially pay for somebody else.
You just have to believe that. And I think sometimes people will drive down the road or highway and not realize, oh, actually, this is a taxation at work or. Oh, good thing there's this traffic light here because even though I didn't really pay for it myself, we all paid for it. And so I think health care as a piece of infrastructure or healthcare delivery as a piece of infrastructure that exists for everybody to use where obviously we're not there. But I think that's what the mind shift has to be, and people would be comfortable with that. You can think of healthcare delivery as almost like a utility.
Bisi Williams: [06:51] So how do you imagine the system of care you describe will be administered and funded?
Dr. Jeffrey Kaibin Lin: [06:57] So I know I'm talking kind of very abstract in some ways, but I mean, the nitty gritty would be you have all healthcare systems, they can kind of be separated. But the patients would be at the center of this. And so an individual person who has some kind of healthcare need, whatever it may be, it could be an emergency. It could be maintenance. And so they need access to some sort of facility. And so these facilities, whether it's an emergency room or a doctor's, office or psychiatrist or whatever, they would be part of a large network.
And if we could just talk the USA across the country who is kind of contracted with this national healthcare program to provide services, different models could be a fee for service. So whichever doctor is going to see you in the emergency room, gets paid a certain amount or compensated a certain amount, or they have some salary. And no matter how many people they see or how many people they treat, they have a certain salary. This salary is paid for through basically taxation. This is individual taxation based on your income.
This is corporate taxation because there are gigantic financial entities that exist in this country which generate trillions of which a one percent or half a percent or .01 percent could be used to fund this healthcare program. And so that's kind of the three chunks. I know it's a lot more complex than that, but just to think that for the patient, there's nothing for them to pay because they've already paid in. They've paid their taxes. It may be retail taxes. It may be income taxes. They've already paid in so they don't have to pay anything else.
Compare one individual who has seven different medical problems and is super sick. That's just the term we use. And then you have another person who runs every day and is super healthy and maybe doesn't have that much healthcare expenditure or healthcare need. These are two very different individuals who need to exist in the same kind of universe. They would contribute the same based on their activity in the economy, if they buy things, if they work, even if they don't work they are still purchasing things.
And so all these chunks, they're still contributing equally. But the person who's super healthy and takes care of themselves and has no need has to kind of buy into the fact that they're cool with that and that they don't need to see a doctor every month for some crazy medical condition, but they're okay with somebody else doing that. And so that kind of unifying, like we're all in this together. We're all building towards something. Some people don't like that. But I think that's the only way to have a universal program is to acknowledge that.
Bisi Williams: [09:45] So as a designer and a physician, your education is unique because you are trained in the design method of visual culture and communication. And you're also trained in the scientific method of evidence-based verbal culture. Could you describe the difference between the two learning cultures?
Dr. Jeffrey Kaibin Lin: [10:01] You know, I loved being a designer. It was problem solving. It was trying to create things that could telegraph something instantly, especially in advertising. You want to have your eye pass over something and know exactly what that means. And if you look really deep, then there was a lot to look at. And so your goal is what I remember was that okay? You want this to be universal? You want us to speak to as many different people as possible, but on the opposite end, maybe you want design that's very specific for a particular audience.
Hey, that speaks to me personally and individually. I think medical education and healthcare, you're talking about communication. You're talking about making the case for somebody to do something. So when I'm speaking with a patient or a group of patients, I'm trying to make the case for them to maybe take my advice. And that's the same goal that I had as a designer, trying to communicate a message and have somebody get it on the other end. They're not the same, but they have the same goals. They have the same goals of just trying to get a point across
Bisi Williams: [11:14] What is a Transitions Clinic for individuals returning from community incarceration? And why are you setting this up?
Dr. Jeffrey Kaibin Lin: [11:22] Yeah so, the concept of reentry program or main streaming program out of corrections is essentially you have individuals who have been in prison, could be in jail for a couple of days, or they could be in prison for years, and they are released. And like all humans, they should be getting some kind of healthcare interface with doctors, some sort of preventive medicine. And so most prisons do have primary care. They may have an affirmary, they sometimes only have an urgent care setting, but they do have medical need.
There's a high degree of chronic medical conditions, just overall, high blood pressure, cholesterol, diabetes, there's often a lot of substance use there's maybe injury. And so all of these things happen within the walls of corrections. And sometimes when they get released, all of a sudden, that's lost. And so part of the goal of the Transitions Clinic is to make sure that the medical care is continued. But really, it's an excuse to kind of really interface with the inmates who have been patients and get them the social services and kind of comprehensive wraparound services that they it needs.
So, for instance, somebody all of a sudden has to take a new medication, but once they leave, they need to find a job in order to afford this medication. And so part of the transitions clinic is social workers and community health workers who have shared experience, who have lived experience and may have been incarcerated themselves, who are able to work with our patients or what they call our clients and help them ease back into kind of mainstream society. Someone who's been in for 20 years is coming out and now has to use the computer in order to apply for a job and has no idea how to do that.
And so our clinic is based on healthcare needs and regular visits and annual visits and all that. But it really is also about setting them up with maybe housing services, employment services. There may be social services or benefits that are available. We have substance use counselors, and all of it is really trying to ease and help prevent recidivism, but also to just make the transition back to, I guess, like mainstream society as easy as possible under the guise of a doctor's clinic. And I think it's our way of sneaking people back in through the doctor's office.
Bisi Williams: [13:57] I love that. So as a recent medical school grad, let's talk about medical education and how it can be updated or redesigned from your perspective.
Dr. Jeffrey Kaibin Lin: [14:07] Yeah. I graduated from the University of Miami and I was enrolled in a dual degree program. And so I earned a Master's in Public Health at the same time. And I think the trend in medical education is about tracks. It's about kind of interests and focus. And so you can also get Master's in Genetics during your med school. You can also get a Law Degree. You could do bench research, hardcore research and get a PhD in Biochemistry. The word producing itself is problematic, but it is about producing physicians with different toolsets. And I think that's what makes things interesting.
The trend at the time was talking about medical education, which is in the US a four year degree, four years of schooling, kind of shifting between book medicine and clinical medicine. Do you need to spend that much time studying, like books? Or do you need to spend more time interacting with humans? And so the kind of push and pull between what they call clinical medicine and preclinical medicine is trending towards more clinical medicine, meaning more interactions with patients, earlier interaction with patients.
Another chunk is when we talk about a four year education, can it be a three year education? Whereas medical school in the US is kind of something you apply for after college and so it's like four plus four. But then you go to other countries where you apply to medical school as a high school student. And so you have essentially the same amount of time. You may spend six years, seven years, and your college isn't filled with non medical things. Your college is med school for six, seven years. It's just a different model.
I feel like medical school was really good for me because I was in this other track. And so I had a different perspective. We learned about public health. We learned about health systems. We learned about kind of the social determinants of health. All these are not necessarily part of a traditional medical program that's kind of focused only on the science. I think there's a lot of value with the MDJD programs because you're learning medicine, but you're also learning about legal ramifications. There's just so many different ways you can do medicine that I think the medical school should offer those kind of choices.
Bisi Williams: [16:30] So when you talk about a comprehensive program where you can explore all of these differences or use all different parts and sides of yourself, do you think that that creates better physicians?
Dr. Jeffrey Kaibin Lin: [16:42] I think you have to have everything available. I think the face of medicine is something we can talk about. Who gets into medical school when you say the word doctor or physician, what comes to mind? And I think that's changing. And I think that's acknowledged that it's not just like a patrician Caucasian guy in, like, a long white coat with glasses and curly hair or whatever. That's kind of like your TV doctor. But I think physicians are just another person who has a specific role. But you shouldn't have expectations about who they are or what they should be or what they could be.
You have to have a body of knowledge, but you do have to learn basic science. But again, what you end up doing in medicine is so different. There's so many different things you could do in medicine, and you have to be exposed to that. Maybe your med school is very kind of traditional hospital medicine with your cardiologists and your GI doctors and it's a very, just kind of straightforward, but it's not outside of the hospital setting or the clinic setting. Then you don't know that there's other doctors who are flying around the country into war zones, and you don't know that there are doctors who are practicing homeless street clinics on their bicycle, or they are in the jail setting, or they're maybe doing home visits as a Hospice doctor.
These are all very different things that unless your medical education can offer you that you're not going to know about it. So I think it's really like changing the definition and expectations of what a career in medicine is and saying, hey, you don't have to do that traditional thing because there's a lot of need outside of that in many different places.
Bisi Williams: [18:32] So it's 2049 and you're sitting at the kitchen table with your son or daughter, and they're about to apply to medical school. What advice would you give them?
Dr. Jeffrey Kaibin Lin: [18:43] You have to have a driving force in order to just do well. I think you have to have a motivating factor, because med school can be hard and everyone has their own reasons. But you have to have reasons. I don't want to judge people's reasons. Let's just say someone had, I don't know, a ton of college student loans, and they thought, Well, if I become a doctor, I can make a bunch of money, and then I can pay off my college loans. That may be true, but I think the work you have to do as a physician, I would have to ask my kid, they don't have to justify it to me, but they need something to carry them through it, I think, and beyond because once you finish med school, okay, cool. You have to do residency, which is hard and difficult. And then after you do the residency, then you actually have to work. And that's hard, too. So something has to be driving you.
Bisi Williams: [19:37] I love that. And so from your perspective, Doctor Lin, talk to me about the healthcare workforce and its qualifications.
Dr. Jeffrey Kaibin Lin: [19:44] Currently, I would say it's in transition, but it used to be this concept of best and brightest, and so only the highest scores could somehow translate to becoming a compassionate physician and, of course, that makes no sense. I think there's a lot of gates or thresholds or you have to get a certain score to do this. And it's really hard. And I think it's unfair. The concept now of a holistic review, which seems common sense, is basically okay. It's not just these six numbers and a transcript. It's the whole package. And so the whole package is now becoming important.
I would say across the country, people are kind of embracing this concept of okay, we can't just focus on these numbers. So I used to do admissions, I was on the admissions committee at University of Miami for our medical school, and it was a very complex process of multiple chart reviews, multiple interviews, multiple committee meetings, multiple rankings. It was always this debate between, oh, well, this person's got a really great score, but someone said they're a terrible human being. Oh, but they have a great score versus well, this person failed all these classes but is, like, incredibly compassionate and had really good patient experiences maybe while they were in some kind of clinical setting in preparation for medical school.
Who do you think is going to be the better doctor. Who's going to succeed? And you had a cadre of individuals who would say, oh, well, we're going to go with the high score. And then you had another group was like, that high score is going to be a terrible person.
So I think it's hard to know because you're also saying, okay, let's take this person in four years. What are they going to do? And now global pandemic wise you kind of lose the interview process. That was some way of gauging human interaction and who they are and kind of all the subtleties of just like how an applicant might interact with somebody. You can capture it on video. But that interview day and the interview visit, all that kind of stuff just gives you, like a preview of who somebody is.
Now not to say you're also kind of on your best behavior. But to go back to hard qualifications, I feel like the transcript should demonstrate not necessarily high numbers, but good exposure, because if you haven't seen what a doctor does or have any idea or no clue or you've only seen a certain thing, then that's very limiting. And that goes back to what kind of doctor you're going to end up being. So some people have their exposure because that's what their parents did, or maybe they had their exposure because they were very sick as a child. And so they went to the doctor every month or something, who knows, eventually become pediatricians.
Some people have these stories about what motivates them. But I think you really have to have and be able to talk about the things you've seen and maybe how they've affected you and then how they've influenced you. But also diligence and resilience and so, oh, wow they did fail that class, but they took it again, and they did well. That's more important than I don't know, straight A's to me. I'm in the minority opinion, but that's just for me.
Bisi Williams: [23:20] But I wonder the conundrum, could you not have somebody who has amazing grades and is compassionate? Is that such an attention or is that a possibility?
Dr. Jeffrey Kaibin Lin: [23:33] Yeah, those are great applicants, but I think the emphasis would be on the exposure and not necessarily on the grades. And so the grades would be a bonus for an applicant who was able to talk about, oh, I spent the summer doing this and I spent a whole year doing that and was able to learn something from that and talk about it and maybe be able to express a vision for what they want to do with that experience. And by the way, also did well, that's really good.
And it wasn't always that kind of tension of these polar opposites. But when you have the kind of perfect applicant, let's just say that applicant may have their choice of places to go because everybody would love to have that applicant. And I think that there may be another applicant who's not fawned over by everybody else, maybe didn't have all the chances that somebody else had and really struggled but still tried to apply and has a motivation coming out of adversity, a motivation coming out of I didn't grow up in a two doctor household, but I have an idea of what I want to do and I was able to work really hard to get some exposure.
Maybe I was the first college graduate and maybe nobody else is doing what I'm trying to do, which is apply to medical school. That applicant, to me, is very valuable, not a cookie cutter person, but somebody who has struggled and therefore will do well when they struggle in medical school. Those are my kind of applicants that I really always fought for.
Bisi Williams: [25:25] I love that. And to conclude, I think that you're really talking about what's core to caring is compassion, for the system, for the people within the whole medical industrial complex, which you're kind of breaking down a little bit, which I think is interesting. Is there a question or a thought that I didn't ask you that you'd like to say to our audience in closing.
Dr. Jeffrey Kaibin Lin: [25:54] I think that change is difficult. People are used to doing a certain thing. People have expectations, good or bad about what something is. People are used to paying health insurance premium on their paycheck that some exorbitant amount of money, or they're used to paying $10,000 when they go to the emergency room. These are all things that are our current reality and it takes a lot to say, you know, what it's been like this, it's been entrenched like this, everybody else is doing it like this, but this is inappropriate, and this has to go. I think, a big shift towards just a unified system instead of our patchwork of insurance companies who act as gatekeepers, a patchwork of different hospital systems, none of which talked to one another, a system of pharmacies and pharmaceuticals that are really profit driven. These are things that people know and expect.
Advertising budgets became part of pharmaceutical budgets that diverts from, let's just say, even research and development or distribution or costs. So a drug may cost a lot because you have to watch a commercial for that and not because the medication is better. But that's what we know and expect now, for the last 30 years. Oh, yeah, these are drug ads. Why are there drug ads at all? So what we all are familiar with, and I think it's hard, but these are things that people talk about right now.
There was a state bill in California to have a unified California system, at least not just a US system that didn't pass because an insurance company wants to exist and wants to kind of be the middle man. And so they would hate to lose that role. And they have a lot of political power. Just have to have a little faith. I think that we may be shifting all your expenditures into a new system, but that new system is meant to take care of an entire community or nation or country. I think it's scary to think about a kind of universal healthcare, but I think it's necessary.
Bisi Williams: [28:08] That's a wonderful vision. Thank you for joining me today, Dr. Lin.
Dr. Jeffrey Kaibin Lin: [28:12] Thank you very much for having me.
Bisi Williams: [28:14] I've been speaking with family physician Dr. Jeffrey Kaibin Lin, clinical faculty with Harbor-UCLA Family Medicine Residency Program and until next time I'm your host, Bisi Williams.
