ROUNDS

Issue 05 — October 2026

Before You Pick a Plan.

A monthly check-in from Dr. Brian — practice news, something to cook, and what's on my mind.

From the Practice

Before you pick a plan

Open enrollment starts November 1. For the next couple of months a lot of you will be staring at a benefits portal, deciding what to do about 2027.

Here’s what nobody in that portal will tell you: the plan you pick and the doctor you have are two different decisions, and most people only make the first one.

A B2 Direct Care membership isn’t insurance, and it doesn’t replace it. It sits alongside the plan — usually a high-deductible one — and handles the part insurance does worst: the everyday. The visit that lasts as long as it needs to. The text that gets answered. The blood panel that costs $15 instead of $200.

If you’re going to make a decision about next year anyway, make it with a doctor in the room. Fifteen minutes, no pitch. I’ll tell you if it isn’t a fit — and sometimes it isn’t

Field Notes

Where the series lands

In June I told you the painting in my exam room — Sir Luke Fildes’ The Doctor, 1891 — wasn’t decoration. It was a thesis. This month’s post is the last in the series, and it’s the one where I stop describing the problem.

The four posts before it, in a sentence: medicine left the home, became a hospital, became a science, became an industry, became a billing apparatus, became a screen. Every step delivered real gains and charged a small, unmeasured tax on the relationship between one doctor and one patient. The taxes compounded.

This post is about what one small practice in Denver can do about that — plainly, including what it can’t. It’s the clearest thing I’ve written about why this practice exists, and it ends with a sentence doctors still quote at each other in residency, and what I think it costs to put it back.

Read “Patients Matter. People Matter.”

Currently Reading

Finished yesterday morning: I See You’ve Called in Dead, John Kenney — an audiobook I stretched over two months on purpose, for walks and downtime. It made me laugh out loud on a conference treadmill, took a turn I didn’t see coming (Harold and Maude flashbacks), and landed somewhere poignant about compassion and reinventing yourself. Exactly where I am heading into fall. My first Kenney. Not my last.

Also finished: Wreck by Catherine Newman. It gets its own space next month.

On the Calendar

• Open enrollment opens November 1. If you’re choosing a plan, see the top of this email — choose the doctor first.

• Ask Dr. Brian, Episode 3 — “What is a hospitalist, and why does it matter for your care outside the hospital?” Landing on the channel later this month.

• On the blog mid-month: “Why I Don’t Call It Direct Primary Care.” Short, and a little opinionated.

• Hospital-to-Home is open. If someone in your life is heading home from a hospital stay, reply to this email — that’s the fastest path.

• Culinary medicine sessions — still in development for early 2027.

And as always: reply to this email — I read every one.

October Office Hours: By appointment only. Suite 412, 1776 S Jackson St. Telemedicine statewide.

Reader Challenge 

The report: nothing new, and it worked

Last month I set no new goal, and I liked it. The job was to reinforce two things — a device-free morning and a walk — and both came back, mostly because I stopped measuring them. No distance, no minimum. I went when it felt right, and once the weather turned, it felt right a lot. The thing I didn’t expect: I started walking errands I would have driven.

Fall is my favorite time of year, and it pulls me toward the kitchen. I cook regularly, but the last couple of months it trailed off. So November’s challenge is one new recipe a week — real ingredients, under 30 minutes, something anyone could make, and no ultra-processed shortcuts. The hard part isn’t the cooking. It’s the structure: pick the recipe, and have the ingredients in the house before Tuesday.

Here’s where you come in. Send me yours. Reply to this email with a recipe that fits those three rules — real ingredients, under 30 minutes, anyone could make it. The ones I cook go up on my Instagram and Facebook, with your first name on them if you want it there. Four weeks, four recipes. Some of them should be yours.

Know someone who needs this?

Rounds goes to people who are curious about a different kind of doctor’s office — members and not-yet-members alike. If someone you know has been saying “I can never get in to see my doctor,” forward this. The level of care I give my members doesn’t scale past 150 people, which is the point.