Jennifer Brokaw Class of ’93 and Lael Conway Duncan HS ’91-95:
A Remedy for Fragmented Care
Photo by: Jonathan Payne
Jennifer Brokaw and Lael Conway Duncan first met on the oncology ward at Dartmouth-Hitchcock Medical Center when Duncan was a resident and Brokaw was a medical student.
“You never forget your first experience with patients dying,” says Brokaw. “I still can hardly talk about it.” She became an emergency medicine doctor, in part, to avoid the emotional toll of losing patients whom she’d come to know well.
Duncan, however, felt drawn to specialties that demanded deep relationships with patients. On the oncology unit, she bonded intensely with a woman who was dying from the same form of breast cancer that had killed Duncan’s mother a year earlier. Duncan helped the woman overcome her fear of dying and facilitated her return home, where she died peacefully. Duncan later became an infectious disease specialist treating patients with HIV and Hepatitis, and then worked in a long-term acute care center caring for “the sickest of the sick,” she says.
Now, after many years in different fields, Brokaw and Duncan are together, again, with a shared desire—to help patients navigate today’s complex health-care system. In 2009, Brokaw, Duncan, and Sara Callander Stephens, a nurse, teamed up to build Good Medicine, a San Francisco-based company that provides advocacy, counseling, decision support, medication management, advance care planning, and care coordination for patients and their families.
“As an ER doctor, I saw a real need for people to get coordinated care, to better understand their illnesses, and to do more planning around chronic and serious illnesses,” says Brokaw. “People are often at a loss for guidance and support during critical illnesses because their primary care doctors are stretched to the limit.”
Good Medicine handled over 70 cases last year and expects to double that number this year. Most of their clients have the means to pay for the services, but about 15% of the company’s work has been pro bono.
“Our mission is to fill the gaps in health care,” says Brokaw. “And so much of what we are doing—shared medical decision making, end-of-life care, patient safety—has its roots in our experiences at Dartmouth.” Eventually, she hopes that the Good Medicine model will be replicated elsewhere and will be yet another example of alumni from the Geisel School of Medicine at Dartmouth shaping the future of healthcare.