I signed up for BIL:PIL not that clear on the concept, but that's a position I'm comfortable with. I had heard a little about "unconferences," but not enough to really get it, and I certainly have never been to any gathering structured like that. Or un-structured like that. Now that I've done a little more reading about the development of the unconference (I've only had time to do a little reading at this point, but believe me, I plan to read much more), I'm so happy to have discovered the format and the community around it.

If you are new to unconferences, let's just go with Wikipedia, which says it is a facilitated, participant-driven conference centered around a theme or purpose. From what I could tell, BIL:PIL 2009 in San Diego had a few more scheduled speakers than one would normally expect at an unconference, but the atmosphere was informal, all comments and ideas were open for debate, and everyone attending was inspired in many ways. I suspect many of us attendees are struggling to put some structure around the unconference unstructured experience at this point.

I'm relatively new to blogging, but happily, not very new to thinking. Hey, it's always been one of my favorite hobbies. Because I didn't have any idea what to expect at the unconference, I was very happy to connect with folks who seem to be thinking about the same things I have been thinking about lately. I was even happier to hear from folks who were thinking about things that had not even occurred to me yet. I guess that's entirely the point of an unconference. While pondering how to put enough structure around the experience to capture any of it in a blog, it occurred to me that some of the high points for me related directly to my recent blog entries, and of course that makes sense I suppose. 

I started my own small call to action to support primary care in my previous blog post. I asked for us all to pay more attention to the role of the primary care physician as we consider alternate models of healthcare delivery and payer systems. At the time, I had read a little about Care Practice but having the time to sit down and hear directly from its founder and Medical Director, Aaron Blackledge, really got the wheels turning more. Aaron speaks in a thoughtful deliberate way that does not mask his passion for delivering efficient patient-centered care by carving out waste to trim costs. His model has proven successful in San Francisco, and we were all wondering about the possibility of replication of the model.

Of course, it's always great to hear a success story. Dr. Blackledge had to make decisions -- big financially difficult decisions that were true to his gut, but completely counter to the trends the industry told him to focus on at the time. He is humble about it, but that takes courage and it's paying off.  However, the real power of his story comes from understanding just how broken primary care is in our country. It is the camel's back on which all the straws of healthcare and healthcare reform are being stacked, and we are at a critical crossroad; do we build up some kind of support system to keep that camel standing just a little bit longer, or put that last straw on its back and watch it collapse? Meanwhile, what are we doing to develop sustainable models of care?

Aaron gave a lot of credit to  L. Gordon Moore, MD, and his concept of Idealized Medical Practices as a major influence on Aaron’s practice. So of course that inspired me to find out more about Idealized Medical Practices and in so doing, I found a soldier who had long been fighting the fight I just began to mention on my last blog.  We need to pay attention -- now -- to the critical role of primary care as we reform healthcare and develop new models of healthcare delivery. As Dr. Gordon writes: "If we are ever going to see real healthcare reform in our professional lifetime we must help policy makers in D.C. understand there is a real constituency for change. We're going to keep working with you and as many folks as we can get signed up with us.  We're working hard to make it easy for folks like you to be heard."

If you are intrigued, read some more. If you agree, please sign up to support primary care.

OK, so that was one thread pulled. Just one of the many threads of ideas that began to unravel and re-weave themselves over the two days of BIL:PIL.  There’s so much more to say,  but I'm getting on a plane, and those stories will have to wait for another day. Thanks to everyone who conceptualized, actualized, and prosthelytized BIL:PIL. We are all looking forward to the next adventure in healthcare innovation-and setting healthcare free.