Episode 71: Dr. Erika Bliss (She/Her) of Equinox Primary Care - Seattle, WA

DPC Doctor


Dr. Erika Bliss & Shaytun
Dr. Erika Bliss with soon to be clinic therapy pup Shaytun

Dr. Erika Bliss is a graduate of the University of California, San Diego School of Medicine. She received her undergraduate degree in History from San Francisco State University and a Master’s degree in Latin American Studies from Stanford.


She completed her medical training at the Swedish Family Medicine Residency Program in Seattle in 2003. After residency she worked at Carolyn Downs Family Medical Center in Seattle, an FQHC, where she served as a staff physician, Clinical Site Director, and Director of Clinical Quality


Dr. Bliss has traveled extensively in Mexico and Central America. There she collaborated with a local women’s health and human rights group to do research, including a video project, on domestic violence. In addition, she developed and implemented a medical education exchange program with a rural hospital in Honduras. While in medical school, Dr. Bliss was a founding member of the Free Clinic Project of San Diego, a student-run project that delivers primary care to homeless and indigent people. Not only has Dr. Bliss focused on direct patient care, she has also been involved in organized medicine and health policy through her work with the American Academy of Family Physicians. Additionally, she served on the education task force for the Future of Family Medicine Project, a national effort to chart the direction of Family Medicine for future decades.


Dr. Bliss served on the boards of the Washington Academy of Family Physicians, and the American Board of Family Medicine.


Dr. Bliss helped found and later served as CEO of Qliance, the first large-scale DPC organization in the US, started in 2007. After Qliance closed in 2017, she established Equinox Primary Care where she is a solo practitioner. She also volunteers for End of Life Washington, helping people who want to take medications to aid in dying to avail themselves of the Washington Death With Dignity Law. She has conducted volunteer forensic medical exams for asylum seekers since 2005. And since the beginning of COVID, with access to abortion severely curtailed, she has been providing telemedicine medication abortion services.

Outside of medicine, she is busy lately helping take care of her granddaughter and spending time with family, as well as raising her 1 year old miniature poodle, Shaytun, who she hopes will become a therapy dog in her clinic soon.



 

Dr. Bliss speaks about virtual DPC options at Equinox Primary Care - Hint Health Blog 2020




 

Dr. Bliss talks about DPC as a driver of innovation a the 2019 Hint Summit



Dr. Bliss talks about the Qliance experience at the 2018 DPC Summit


Dr. Bliss Interviewed by Concierge Medicine Radio



 


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TRANSCRIPT*


Welcome to the podcast Dr. Bliss.


Hi, nice to be here. Thank you so much for joining us. I just am so honored to have you as our first interview of the season.


And when I say that, what I think about is that you've really been there and done that and seen it all. You have gone from residency to enough QHC to working at clients, being CEO there, and then opening your own direct primary care at Equinox. So thank you so much for joining us today.


Now in the past . You had said a quote that I really loved and I wanted to start our conversation with that. And the quote was, and that's what primary care is. It's meant to adapt, to figure out and help the communities at serves. And so I was wondering if you could share with us what that quote means to you when you show up for your patients every day.


So that quote was really from my, some of my most important mentors going into family medicine. So really more specific to the specialty of family medicine, but talking about the name of the primary care doctor for your future. And to me it represents some of the best of the specialty, some of the best of primary care and reflects actually data from the rest of the world in other healthcare systems are primary care is the foundation that the health care system, fanatic community.


So that always really appealed to me. And then in family medicine, the training is so fabulous for walking into any community and adapting to it. That's really what it's all about. So for me, family medicine, and as a system and approach for doing primary care, which is a function in a healthcare system was the ideal So from early I was talking to my mentors and that's what I was hearing over and over again. And examples of that are, I work in a large metropolitan city in Seattle, so it's not like I'm going to learn how to do colonoscopies. We have a ton of people here who can do them. They do them all the time.


They're excellent at them. So I'm not going to do that, but what if I was a doctor in a very small community and the only way that people could get colonoscopies consistently would be, if I learned how to do it well, it's a procedure.


It's something that, as a physician or any well-trained healthcare provider, you can learn to do any procedure. It's, it takes some time and focus and all that, but if that's what your community needs to do, if your community needs you to do we've all learned about contact racing now, right?


Public health and epidemiology type of work, then that's what you do. If you have a heavy load of substance abuse disorders in your community, and you learn to work with people who have that. So to me, that's that wasn't specific to Deakin C. It was really about what are we supposed to be doing as primary care providers, whatever type in any community.


So then translate that to DPC. I felt frustrated with the system before I started doing direct primary care and realized that direct primary care by creating a rational business model would allow me and the folks that did this assumption in a way where we could adapt what we do for the community.


So you could, whoever signed up for your practice, whatever populations you ended up serving, you study that and observe and research it and figure out what to those folks. It's just, it's a hundred times easier for the proceed because you have control over how you spend your time and resources.


Absolutely. And I think that it's such a Testament as to why this movement is growing and continuing to grow like wildfire because we're not cookie cutter doctors and we are not working with cookie cutter patients. And so the ability, like you said, so eloquently to learn and to, you know, study about your patients and then to deliver that personalized care every day to your patients, it really is so different from every 15 minutes you have a new appointment.


Yeah. Now I would really love to also have you touch on your experience overseas because clearly you were so involved working overseas in a health setting. what of your experience there, have you also been been able to bring back to your practice at keylines, but also, especially at Equinox now.


Yeah. So probably the most influential experience for me. And this was a big part of what made me decide I wanted to go into medicine, was working with the women's domestic violence and human rights organization in Southern Mexico Javis. I went there as a graduate student doing Latin American studies or the background in history, looking to volunteer with them and write my thesis about their group and their movement, because it was so striking that such a progressive and incredibly well thought out program had developed in this pretty remote part of Mexico, or, it's a big travel destination, but it's a very conservative part of the country.


So I interviewed all the people working for the organization, all incredible women and activists. And funny enough, the doctors ended up capturing my imagination more than anything. And I. Healthcare was a really interesting way to access a community and sight out what was going on. You have this very privileged view into the private lives of people in the community that are, it's hard to get.


You have to be like the priesthood adopter and hear those kinds of stories. What really struck me about the doctors too, is two things. One was there really very well developed concept of public health, community health, and empowering communities to take control of their health. The other was their incredible humanity in dealing with patients.


They would see women who had never been to a doctor before who had been sexually and physically abused. Many of them had terrible reproductive health problems that were never getting dressed. So this was their first time and I just sat in the room with them while they did these interviews with these women.


And I was so impressed with their, they were so relaxed first of all, and it was we can take all the time with me and when you want to stop the stuff and you can always do another appointment. So there wasn't this concept of, I have to meet my metrics. This woman needs a pap smear. She might have, cervical cancer.


I got to get it done. Now it was more like, I need to gain your trust to review this at your pace. And they were very well informed about, they were doing the Thomas, focused approach to women's healthcare and, general mental health care long before. And this was 1992, basically that I was down there working with them.


So way ahead of where we were. So that really struck me and it planted a seed. So when I went back to school and I realized I wanted to get involved in health care and I told people, here's what I'm interested in doing. They started suggesting to me, why do you become a doctor? And literally that was how I started to percolate wow, doctor, and started that whole path.


So that had a huge influence on me. I was just so impressed with what they were doing and I felt like they were so far ahead of so much of what we were doing to do that.


For the people who are listening to this podcast, especially if you're in medical school or in residency, and you do have the opportunity, or even if you're a physician who is able to um, you know, have the time to take a trip overseas, to work with organizations.


I mean, Yes, it's a little harder with COVID, but at the same time, there's so many ways to support overseas organizations. And I truly believe having done overseas work myself. When you speak to. Your experience and how the setting was, where people really have the trust in you, because you're a physician because, you know, you're there with the understanding that you're there to take care of them.


When you talk about the relaxed visits, it's like, when, while you're talking, I can envision myself in those same visits in the Dominican Republic or in Ghana. And other physicians have talked on this podcast, Dr. Jack Ford, Bush, Dr. Christina Gonzalez about time overseas.


And so I encourage people to, if you haven't and you have the ability to definitely, think about having that on your horizon in terms of checking out a way to serve another country and another, another community, because it really it really brings a different perspective to your life, into your way of practicing medicine.


Two comments about that. I, to add. I think it's really important when you go overseas to see the healthcare workers that you're going to be working with and observing and all that, seeing them as colleagues and really approaching it as what a great opportunity to connect with colleagues in another country.


I think that is much appreciated by them when we did our exchange program with this community hospital in Honduras. It was really cool because we set up, we wanted it to be an exchange program. So we were going to send students and residents down there, but we wanted to, we were adamant with UC San Diego, that we had to have the opportunity to bring up their doctors and nurses.


And so we got funding for it and all that. We managed one trip for them to come up here. It was so you're Craddick and difficult to just get them into any facility to even observe. It's just crazy. But we managed to do them. Week one was a surgeon. We paired him up with some surgeons and he was so delighted to be able to connect to his colleagues here and vice versa.


They loved it too, because we always have stuff to talk about oh, what are you doing? He asked me for that, oh, it's this gadgets, same with the nurses. That was really neat. The other thing I'll say about it more related directly to DPC is that it's so important. I think, to recognize what can be done in less resource intensive environments, because so much of what we think we need to provide health care is completely unnecessary.


And especially if you're going into DPC and setting up your own practice or working with people to set up. It's easy to get overwhelmed and think you'd have to have a whole lot of complex stuff and a lot of machines and like sakes in every room and all this stuff when you really don't. And I always remind people that talk, I heard of with doc in them new Orleans after hurricane Katrina, and she was saying, look, we had to do medicine on the street corner.


That's all there was. People need to care. So I always read that. Remind myself of that. And obviously if you hang out a shingle on a street corner to come to you here, but it bonds you that realizing, okay, what is it that people really want to need again? How do I respond to my community?


What's going to resonate for them. And that's going to be time, very poorly compensated in that.


Definitely. And I love that. I love that. And it really again, just going back to the fact, this is the opening podcast for the season. It really challenges people to think about that, especially if they haven't yet purchased their first and a meds purchase or at least a space.


So definitely things to think about. Now. I want to ask this question cause I love asking everybody, but and you alluded to it earlier that you knew that there was a better way to do health care after you finished residency. But how did you come to learn about DPC?


So I actually had the privilege of being related to somebody's PC.


So my cousin Garrison bliss, the granddaddy, his direct primary care was practicing in Seattle. And I just happened to pick a residency in Seattle. So it was just gives me, cause I really didn't. I had never really spent any time with Garrison. We've lived in completely different states growing up.


You know, A generation older than me. So even though we're cousins he had, much further along in his medical career. So he was practicing with his it was called concierge at that point before the name was invented. But it was so great because all throughout residency, periodically we would get together and I'd come over and shadow him in the clinic or we'd go out dinner and I'll never forget.


Anyone who knows Garrison knows he's like Mr. Happy all the time. So there's a reason for that. He quickly, he got out of the increasingly stressful rewarding world, thinks of service and leader in general silo kind of hair and moves into doing this McKinsey model and found such joy in his practice that he just, it kept him the, bubbly, happy guy that can cause that.


So imagine you're a resident, you're kind of like, oh, well, I'm tired, they're having a bad mood and everything has way too much to the year. And then you're following around this doctor who didn't last. So how does it feel to be this kind of macros? And he says, oh, every time I walk into a patient exam room, I feel like I've been invited to a party.


And I was like, oh God, this is one of the crazy blesses. But you know, He really, he just would drop these pearls of wisdom all the time that I go running back to the residency and meet, our balance sessions with the other residents. And it's a Harrison told me this time, he said, he feels like he's been invited to a party.


Isn't that amazing? And or just little bits of really great advice, people going into DPC we'll hear things like how are you going to deal with the worried well or super anxious patients and all that kind of thing. And he said things like, if someone.