July 1, 2025 • 26 mins
In this heartfelt episode, Dr. Kara Foster shares powerful stories from her recent mission trip to Guatemala—and what they reveal about the brokenness of our own healthcare system. With honesty, humility, and hope, she reflects on the kind of care that truly transforms lives: care that’s human-centered, relationship-driven, and grounded in compassion—not paperwork.
Whether you're a provider feeling burned out or a patient tired of feeling like a number, this episode will inspire you to imagine a better way—and maybe even be part of building it.
Topics Include:
What serving in rural Guatemala taught me about dignity and access
Why empathy is more powerful than any diagnostic test
How Direct Care can bring mission-style compassion to your own community
A call to action: from global outreach to local reform
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:02):
Hey friends, it's Kara. I was planning to give you my
lessons on customer service for direct care, but today I'm
currently in Guatemala giving eye exams and glasses to those
with the biggest need. This trip is more than just a
clinic week. It's a soul reset, a deep
remembering, and a jolt back to the why behind all the work that
(00:22):
I do in healthcare and the work that I believe we all can do if
we just dare to do it differently.
Because this episode is not about numbers.
It's not about policy. It's not even about optometry in
the usual sense. It's about what happens when you
strip down healthcare to its barest, most beautiful form.
(00:44):
When there are no Emrs, no portals, no prior
authorizations, no production quotas, No 7 minute visits, no
wondering which code gets reimbursed best.
It's just people in need, glasses and hope, hands and
heart. And I'll be honest with you,
this week in Guatemala always hits me in the best way.
(01:06):
It reminds me of what care is supposed to feel like.
Not rushed, not robotic, and nottransactional.
Real, personal and transformational.
And yes, we are still going to talk about direct care.
You know me, I always bring it back.
But today we're going to talk about it through the lens of
something deeper. Through the story of the woman
who walked five hours, five hours just to get a pair of
(01:28):
$2.00 readers so she could see her Bible again.
Through the eyes of my daughter who handed out toys to kids and
then use Google Translate to play with them.
Through the truth that most of the world lives without access
even to basic care, and yet somehow manages to hold on to
joy, dignity and resilience. This episode is part travelogue
(01:50):
and part therapy session for allof us navigating this broken
system, and really, also part manifesto.
It's a gentle rebellion against the way things are, A loving
call to reimagine something different.
A reminder that we don't need more text or tools, we need more
heart. So whether your provider on the
edge of burnout, a patient who feels more like a number than a
(02:12):
person, or just someone who wants to believe that medicine
can still be human, settle in. This is your episode.
We're going from rural Guatemalato modern day medicine, from
dusty clinic floors to sterile US offices, from hope to healing
and back again. Because everything I see this
week, everything I feel in my heart and my gut and my bones,
(02:34):
it all circles back to what I'm trying to build with direct care
and what you can be a part of, too.
Let me set the scene for you. We're in rural Guatemala.
The roads aren't paved. They're dusty, bumpy and winding
through hills and coffee trees. Chickens cross casually in front
of tuk tuks. Kids kick around 1/2 inflated
soccer ball in bare feet. Everything is weathered but
(02:57):
alive, beautiful, resilient, full of color and contrast.
And tucked into this landscape is our clinic.
Now when I say it's inside a hospital, I need to pause and
clarify. This isn't what we think of as a
normal hospital in the United States.
No gleaming floors, no fancy waiting room with a coffee bar,
no MRI machines humming behind thick glass, No air
(03:18):
conditioning. This was more like a concrete
outpost, an open air facility with a few small rooms, some
plastic chairs lined up in an open room, and a shared
bathroom. The exam rooms were simple,
mostly just a folding table, maybe a mirror.
Plastic chairs we used, our headlamps, our handheld lenses
and portable equipment that we carried in our luggage.
(03:40):
No Emrs, no prior auths, and no printer toner to worry about.
And still this humble space becomes a place of healing.
People began lining up before sunrise.
Our social worker had spread theword in the community that we
were there and got the neediest patients to come see us.
Many had walked for hours. A mother with a baby on her
(04:01):
back, an older man with a cane and no shoes.
A line of children each holding on to each other's backpacks.
Many had never had an eye exam. Some didn't even know they
needed one. And then we got to work.
We set up stations, triage, refraction, glasses, fitting.
We moved as a team. No billing codes, no portals.
(04:22):
Just care. And it's real.
And it's exactly what I needed to remember what medicine is
supposed to feel like. And being in Guatemala reminded
me of something powerful, something I didn't even realize
I was grieving. It reminds me of something we
don't miss when we step outside the US healthcare system.
There are no CPT codes that justify what we did, no
(04:45):
insurance companies to fight with, and no one asking is this
vision complaint under your VSP or your medical plan?
No portals or check boxes. No clicking through screen while
someone tells you about their headaches.
It's just care. You can look patients in the
eyes and you can help them, and there's a purity to that, a
clarity and a simplicity. This somehow makes me feel so
(05:06):
much more meaningful. I wasn't standing behind a desk
explaining why an anti reflective coating wasn't
covered. I wasn't spending time double
documenting, once for the chart,once for insurance.
And I wasn't deciding how thoroughly I could examine
someone's eyes based on what plan they had.
I was simply doing what I was trained to do.
Look, listen and help. And the whole time, the stock
(05:29):
kept running through my head. Why can't Healthcare at Home
feel like this? And let me be clear, I'm not
saying I want the US to become adeveloping country.
And I'm not romanticizing poverty or wishing away our
tools or technology. But I am saying that with all
the resources that we have, withall the software, scheduling,
and new pharmaceuticals, we've lost something important.
(05:51):
We've lost the humanity in medicine.
We've let the business of care take precedence over the act of
caring. And in Guatemala, I get to taste
what it feels like to have time again, to be fully present and
to make the connection with priority instead of coding.
And I thought, this is what medicine is supposed to feel
like. This is what it feels like to
(06:13):
come home at the end of day feeling emotionally full, not
depleted. And I realized I don't need to
cross a border to find that feeling again.
That's what direct care is. It's the closest thing we have
here in the United States to that kind of clarity.
Like when people hear that I dropped insurance, they
sometimes assume I did it to make a statement, like I wanted
(06:34):
to be rebellious or exclusive orthat I was turning my back on
accessibility. But the truth, I didn't drop
insurance to be edgy. I did it to save my sanity and
healthcare. I did it to actually care for
people the way that I believe they deserve.
I don't want doctors to lose thespark.
And I know that if we don't makea change, doctors are going to
want to leave the profession altogether, or worse, become a
(06:58):
doctor that just goes through the motions.
So for me personally, I sat downand looked at the numbers.
I looked at the hours I was working after hours, and I
looked at how many people I was rushing through, not making the
personal connection. And not because I didn't care,
but because I was forced to if Iwanted to stay afloat.
(07:18):
And I realized the system isn't just stealing my time, it's
stealing my purpose. Direct care gave me that purpose
back. And it's not perfect.
There's no one-size-fits-all andit takes courage, planning, and
some rethinking. But it works.
It works because it cuts out thenoise.
(07:38):
There are no middle men dictating how long I can spend
with a patient, no paperwork jungle just to get a basic
service approved, and no hours lost trying to justify why
someone needs a pair of glasses or dilation.
It's just me, the patient, and the goal of getting them.
Well. If you've ever sat in an exam
room, looked into someone's eyesand thought, I wish I had a few
(08:00):
more minutes to be really to be able to connect with them.
If you've ever had to stop explaining A diagnosis because
you know your next appointment is already 10 minutes behind, or
if you've ever looked at your schedule and felt that sinking
feeling in your stomach, you know what I'm talking about.
And if you've never practiced medicine in any other way, you
might not even realize what you're missing until you step
(08:21):
outside of that system and have time to breathe again.
So no, I don't miss the billing codes.
I don't miss the prior authorizations.
I don't miss fighting with insurance reps who've never seen
a retina but are somehow deciding what care I can offer.
But what I do miss when I'm inside the US system is the soul
of the work, the time, the silence, the ability to pause
(08:44):
and say, tell me more. And in Guatemala, I can find it
again. But more importantly, I realize
that we can build it here too. Not in theory, in practice.
One visit at a time, one patientat a time, one exam room at a
time, and one practice at a time.
That's what direct care allows us to do.
(09:05):
That's why I'll never go back. Let's talk about burnout.
It's not the cute kind of I needa self-care day kind of burnout.
I'm talking about the kind that leaves you sitting inside your
car in the clinic parking lot, dreading going inside.
The kind that makes you questionwhy you ever went into medicine
in the 1st place. The kind where you get home and
can't remember a single patient you saw because you were just
(09:27):
surviving the day. And my colleagues are exhausted.
And I was too. Before I transitioned to direct
care, I was seeing almost 25 patients a day.
That's every 10 minutes on the dot if nothing runs behind.
And of course, everything runs behind because they're real
patients who have real problems and came there for you to help.
(09:49):
I'd be staring at my computer more than my patients, clicking
boxes, writing within normal limits more times than I can
count, trying to document everything in a way that would
justify getting paid because Godforbid you forget to mention
medical necessity in exactly theright way.
And then after a full day of care, I'd be up at night
(10:09):
charting, trying to catch up, trying to stay afloat, and
trying to remember why I even started this.
But here's what I realized. Burnout doesn't just steal our
energy. It steals our presence.
It steals our curiosity, and it steals our ability to be human.
You feel like a vending machine with a white coat on.
You put in your insurance card, push a few buttons, and outcomes
(10:32):
a prescription next. No time to pause, no time to
teach, no margin for asking the real questions.
Like, how's your sleep? What's your stress like right
now? What matters to you about your
vision? Because those questions aren't
billable. But when I go to Guatemala, I
remember what real care feels like.
(10:53):
No Ehrs, no insurance approval, and no one hovering over my
shoulder asking if I hit my goals for the day.
I wasn't watching the clock. I was watching a grandmother see
her granddaughter clearly for the first time in years.
I was watching a boy put on his first pair of glasses and gasp
as he saw the world come into focus.
(11:13):
And in those moments, I feel it again, the flicker in my chest
that says, oh, this is what it'ssupposed to feel like.
You feel your soul stretch. I remember that it's my job not
to move patients through a system, but to help them and to
heal. And that's the kind of a moment
you can't bill for, but it's thekind that fills your soul.
(11:35):
And here's what breaks my heart.We shouldn't have to go to
another country to experience that.
We shouldn't have to escape our own system to feel like doctors
again, like caregivers and healers.
We shouldn't have to choose between taking care of people
and making a living. But right now, for so many
providers, that's exactly what it feels like.
(11:56):
So we numb, we detach, we automate, We cope with humor,
whine, or endless podcasts aboutproductivity hacks.
But deep down, we know we were meant for more than this.
That's why we went into healthcare in the 1st place.
And direct care gives us that more.
It gives us permission to slow down, to sit with patients, to
(12:18):
ask real questions, to follow our instincts.
Not an algorithm. It brings us back to the reason
we got into this in the 1st place.
To help, to connect, to make someone's life just a little bit
better. And honestly, it brings the joy
back. Not in a fake toxic positivity
way, but in the quiet, sacred way where you finish your day
(12:39):
and think that mattered. So if your provider listening to
this and you're tired, I want you to hear me.
You're not broken, you're not weak, you're not a failure.
You are practicing in a system that was designed for profit,
not for people. And the fact that you still care
after everything, that says everything about you.
(13:02):
But you don't have to stay stuck.
You don't have to give up the parts of you that made you want
to do this work. You just have to find a new
model. And if you're a patient
listening, this effects you too,because when your doctor is
burned out, they can't show up for you the way you need them
to. But when we shift the system,
when we build practices around people instead of policies,
(13:25):
everybody wins. We can't pour from empty cups,
but with direct care, we can refill them, and then we can
pour again from a place of purpose, not exhaustion.
So let's talk about what it really meant to bring my
daughter on this trip, because it wasn't just powerful for me
as a mom, I personally feel thatit's transformative for her as a
(13:49):
growing young woman. So she's 11, and she's the kind
of kid that still loves stuffed animals but also wants to go to
Harvard and work at NASA. She's curious and kind and brave
even when she's nervous. And this is the third time I've
taken her to Guatemala, obviously not just for a
vacation but to serve to work. And she doesn't hesitate.
(14:11):
She packs her in a suitcase, brings crayons and stickers to
hand out and toys and wants to help out the patients and make
the kids have fun. She jumps in with both feet,
uses Google Translate to make friends, and made a friend who
was the exact same age as her. But everything else about their
lives was so different they didn't even speak the same
language. But that didn't stop them.
(14:31):
Every day they came back and Amelia pulled out her phone and
opened up Google Translate. And just like that, like the
modern version of passing notes in class, they were chatting,
sharing favorite colors, what they wanted to be when they grew
up, and what their houses were like.
Later that afternoon, they invited us to our house for
dinner, and I'll be honest, I had the immediate mom moment of
(14:53):
wait, what are we doing? But when we walked with a few
locals to her neighborhood, we looked around quietly, taking it
all in. Their home was a small concrete
structure, no running water. They cooked over a fire in the
backyard, chickens wandering through the kitchen.
My daughter didn't say much in the moment, but I could see her
eyes scanning everything. The wheels were turning.
(15:15):
And later that night as we got ready for bed, she said to me,
Mom, they were so happy and theyhad so little.
And we have so much that I didn't realize.
And right there, I knew this trip had done more than help
people. It cracked open a whole new
level of perspective. Healthcare isn't just about
(15:36):
tools or degrees. It's about connection, about
seeing people for who they are, listening to them, and learning
from them. She saw what most of the world
lives like with resilience, creativity, and strength and
simplicity. She saw how broken and bloated
our system can be at home because for all our technology,
(15:59):
many American kids never get that kind of heart to heart
experience. How many of us even slow down
enough to sit in someone else's world and just observe?
We came home and she didn't ask for anything new.
No souvenirs or treats. Just understanding how she wants
to go back again and help. And here's what I've realized.
(16:20):
This trip didn't just make her grateful, it made her curious,
compassionate and aware. And Amelia gets now, maybe more
than many adults, that Healthcare is not a transaction,
not a box to check or a visit torush through.
It's service, community, and humility.
We weren't just giving people glasses, we were giving them the
(16:42):
ability to read, to work, to seetheir grandkids faces again.
And in return, they were giving us stories, perspective, and
yes, a deep appreciation for what we so often take for
granted. When I talk about direct care
and ditching insurance and slowing down, I'm not just
talking as a doctor. I'm talking as a mom.
(17:04):
Because I want that kind of medicine to exist when our girls
grow up. The kind that sees the whole
person. The kind that listens.
The kind that reaches across language barriers with a smile
and a translation app and says you matter.
That's the world that I want ourgirls to live in.
And it starts with how we chooseto care for one another here,
(17:27):
there and everywhere in between.So let's bring it back home for
a minute. People ask me all the time,
Kara, how does going on a mission trip in Guatemala relate
to the work you're doing in yourpractice in North Carolina?
What do pop up clinics in rural villages have to do with running
a modern eye care practice? And my answer is everything.
(17:48):
Because what we do in Guatemala,the off the grid, no insurance
one-on-one kind of care, is the blueprint for what direct care
looks like in its purest form. In Guatemala, I don't have to
log into a portal. I don't have to check someone's
deductible or wonder if V or wonder if VSP considers A-250
(18:08):
reader a covered benefit. I don't have to chart for
billing and I don't have to document a diagnosis code, just
justify the fact that I helped someone see.
But I do get to listen, to ask questions, to educate, and to
serve and spend time focusing onthe human being in front of me.
(18:28):
And guess what? Direct care lets us do that at
home. Let's talk about how they mirror
each other. Transparent pricing in
Guatemala. Of course, we hand out our
glasses and carefreely, but the value of what we're doing is
immeasurable. In direct care, we can't always
give things away, but we can be clear.
No surprise bill. No codes to decipher.
(18:49):
Just here's what the visit costs.
Here's what's included. Let's focus on your eyes, not
your wallet. It restores trust and you stop
being a billing entity and startbeing your human resource again.
In Guatemala, we don't double book.
We don't rush. Of course, we see as many as we
can, but never at the cost of connection.
(19:10):
In direct care, I don't have to cram 18 patients into a day.
I can actually sit with someone,talk about their vision and
their nutrition. I can hear about their family
history, their concerns, their barriers.
And here's the magic Patients start telling you things that
matter because they finally havethe time and space to feel
heard. In Guatemala, I don't just hand
(19:32):
someone a pair of glasses and send them off.
We explain how to wear them and how their eyes are aging.
And I talk about diet, about sugar and inflammation.
And in direct care, I do the exact same thing.
When I'm not racing through insurance mandated checklists, I
can say, let's talk about your diet, your blood sugar, your
stress. Because guess what?
(19:53):
It all shows up in your eyes. The next one gets me a little
bit emotional because dignity doesn't come from fancy
equipment or shiny clinics. It comes from eye contact, from
listening without interruption, from presence.
In Guatemala, a patient looks you in the eye and says Gracias
doctora. And it's not because you did
something flashy, it's because you cared.
(20:15):
In indirect care, I can look a patient in the eye and say this
is your time, I'm here for you. I'm not behind, I'm not
distracted, and I'm not typing through your tears.
So when someone says isn't direct care kind of idealistic,
I just smile because it's not idealistic.
It's not a pie in the sky dream.It's basic humanity.
(20:35):
It's what medicine used to be before we sold it to the highest
bidder. And we don't need to go to
Guatemala to find that kind of care.
We just need to get insurance companies and billing codes and
the hamster wheel of productivity out of the way.
Because here's the truth. What we're doing in those
makeshift clinics with a foldingchair and a flashlight and a
suitcase full of donated frames is more real, more healing and
(20:59):
more impactful than the most $500 specialist visits.
And what if we can create a model that does that in the
United States with structure, support, and sustainability?
Then why wouldn't we? Why wouldn't we want care that
makes sense, that honors time, that leads with prevention,
education and respect? Direct care isn't a rebellion.
(21:22):
It's a return. A return to common sense, to
compassion, to being a doctor. And you know what?
It's not just better for patients, it's better for us
too. Because when I go home from
Guatemala, I'm tired but not burned out.
I come home emotionally full andremember why I love being a
doctor. And I want every provider
(21:43):
listening right now to know you don't have to travel to remember
that feeling. You can build it right where you
are. And next, I want to speak
directly to the patients listening now.
And I want to say something thatmight feel hard to hear, but I
promise it's coming from a placeof love.
If you've ever left your doctor's office feeling like a
number, feeling rushed, dismissed, or barely listened
(22:06):
to, you're not crazy. You're just caught in a system
that wasn't designed for you. When doctors seem rushed, it's
not because they don't care, it's because the system doesn't
allow them to. Doctor likely went to school for
a decade, took on massive debt, worked grueling hours, and
sacrificed sleep and family because they do care.
But then they get stuck in a machine that's turning faster
(22:28):
and faster, measuring in volume,not connections.
But the good news is you have more power than you think.
And you can choose the kind of care that you want.
You can ask about cash pricing, look for direct care providers
and support the clinics that prioritize time, education,
humanity. Because here's the bottom line.
(22:50):
You deserve more than 7 minutes and a prescription pad.
You deserve someone who knows your name, who remembers your
story, who says let's talk abouthow you're really doing.
Someone who sees you not just asa diagnosis or deductible, but
as a whole person. This is about access.
That makes sense. It's not a concierge or boutique
(23:11):
medicine for the wealthy. It's about clinics who are run
by people that believe that everyone deserves dignity, not
those just with platinum. PP OS about making healthcare
affordable, predictable, and human again.
Because right now, we're all living inside a healthcare
system that's wildly expensive, massively inefficient, deeply
(23:32):
impersonal, and not actually making us healthier.
But if what? What if we could change that?
Not with a massive political reform, but one patient, one
doctor, and one clinic at a time.
That's what direct care is. So if this resonated with you,
if you've been craving somethingdifferent, I want you to know
(23:54):
that it's out there. And if you don't know where to
start, message me and I'll help you find someone in your area.
Because that's what community isfor.
Because this movement, this shift in care, it's not just
about doctors burning out. It's about patients waking up to
what's possible, to what they deserve, and to what we don't
have to tolerate anymore. Because we're not numbers,
(24:17):
you're not a case, and you're not a line on an insurance form.
You are a human being and you deserve to be seen, heard, and
cared for. So here's the heart of it,
friends. Whether you're in a remote
village in Guatemala or a busy town in North Carolina, the need
is the same. People want to feel better, they
(24:38):
want to be understood, and they want to trust their doctor more
than anything. And they want to believe that
the system designed to care for them actually will.
And I truly believe that we can build that kind of system, not
all at once, not with a government mandate or a billion
dollar tech fix, but one patientat a time, one clinic at a time,
(24:59):
one story at a time. This episode stirred something
in you. If you felt your heart tug a
little and thought, why can't itwork this way at home?
Here's what you can do next. Share this episode with a friend
who's feeling burned out, with apatient who's frustrated.
Let this story be the spark. Visit carafosterod.com if you're
(25:20):
new to direct care or just curious.
I've got free resources to help you understand what this
movement is really about. In spoiler.
It's not about cash, only snobbery.
It's about care. That makes sense.
And if you want to donate glasses funds or join a future
vostrip, you don't have to be anoptometrist to make a
difference. You just need a harp for people
(25:41):
and a belief that vision changeslives.
We'd love to have you in the circle.
You can reach out. And one last thing, if you're
still listening, thank you. Thank you for your time, your
energy, and your open mind. Thank you for caring about
people. Really caring because we don't
just need a better system, we need a more human 11 rooted in
dignity, service and heart. I'll see you next week where we
(26:05):
get back into the practical toolkit for building your direct
care practice. This one will be a two-part
episode about the way I treat customer service and my practice
and how you can do the same. And also, another upcoming
episode will be a detailed rundown for patients about what
direct care really is and how itcan heal our country.
(26:25):
Thank you again for listening. This is Kara Foster opting out.
Hey friends, it's Kara. I was planning to give you my
lessons on customer service for direct care, but today I'm
currently in Guatemala giving eye exams and glasses to those
with the biggest need. This trip is more than just a
clinic week. It's a soul reset, a deep
remembering, and a jolt back to the why behind all the work that
(00:22):
I do in healthcare and the work that I believe we all can do if
we just dare to do it differently.
Because this episode is not about numbers.
It's not about policy. It's not even about optometry in
the usual sense. It's about what happens when you
strip down healthcare to its barest, most beautiful form.
(00:44):
When there are no Emrs, no portals, no prior
authorizations, no production quotas, No 7 minute visits, no
wondering which code gets reimbursed best.
It's just people in need, glasses and hope, hands and
heart. And I'll be honest with you,
this week in Guatemala always hits me in the best way.
(01:06):
It reminds me of what care is supposed to feel like.
Not rushed, not robotic, and nottransactional.
Real, personal and transformational.
And yes, we are still going to talk about direct care.
You know me, I always bring it back.
But today we're going to talk about it through the lens of
something deeper. Through the story of the woman
who walked five hours, five hours just to get a pair of
(01:28):
$2.00 readers so she could see her Bible again.
Through the eyes of my daughter who handed out toys to kids and
then use Google Translate to play with them.
Through the truth that most of the world lives without access
even to basic care, and yet somehow manages to hold on to
joy, dignity and resilience. This episode is part travelogue
(01:50):
and part therapy session for allof us navigating this broken
system, and really, also part manifesto.
It's a gentle rebellion against the way things are, A loving
call to reimagine something different.
A reminder that we don't need more text or tools, we need more
heart. So whether your provider on the
edge of burnout, a patient who feels more like a number than a
(02:12):
person, or just someone who wants to believe that medicine
can still be human, settle in. This is your episode.
We're going from rural Guatemalato modern day medicine, from
dusty clinic floors to sterile US offices, from hope to healing
and back again. Because everything I see this
week, everything I feel in my heart and my gut and my bones,
(02:34):
it all circles back to what I'm trying to build with direct care
and what you can be a part of, too.
Let me set the scene for you. We're in rural Guatemala.
The roads aren't paved. They're dusty, bumpy and winding
through hills and coffee trees. Chickens cross casually in front
of tuk tuks. Kids kick around 1/2 inflated
soccer ball in bare feet. Everything is weathered but
(02:57):
alive, beautiful, resilient, full of color and contrast.
And tucked into this landscape is our clinic.
Now when I say it's inside a hospital, I need to pause and
clarify. This isn't what we think of as a
normal hospital in the United States.
No gleaming floors, no fancy waiting room with a coffee bar,
no MRI machines humming behind thick glass, No air
(03:18):
conditioning. This was more like a concrete
outpost, an open air facility with a few small rooms, some
plastic chairs lined up in an open room, and a shared
bathroom. The exam rooms were simple,
mostly just a folding table, maybe a mirror.
Plastic chairs we used, our headlamps, our handheld lenses
and portable equipment that we carried in our luggage.
(03:40):
No Emrs, no prior auths, and no printer toner to worry about.
And still this humble space becomes a place of healing.
People began lining up before sunrise.
Our social worker had spread theword in the community that we
were there and got the neediest patients to come see us.
Many had walked for hours. A mother with a baby on her
(04:01):
back, an older man with a cane and no shoes.
A line of children each holding on to each other's backpacks.
Many had never had an eye exam. Some didn't even know they
needed one. And then we got to work.
We set up stations, triage, refraction, glasses, fitting.
We moved as a team. No billing codes, no portals.
(04:22):
Just care. And it's real.
And it's exactly what I needed to remember what medicine is
supposed to feel like. And being in Guatemala reminded
me of something powerful, something I didn't even realize
I was grieving. It reminds me of something we
don't miss when we step outside the US healthcare system.
There are no CPT codes that justify what we did, no
(04:45):
insurance companies to fight with, and no one asking is this
vision complaint under your VSP or your medical plan?
No portals or check boxes. No clicking through screen while
someone tells you about their headaches.
It's just care. You can look patients in the
eyes and you can help them, and there's a purity to that, a
clarity and a simplicity. This somehow makes me feel so
(05:06):
much more meaningful. I wasn't standing behind a desk
explaining why an anti reflective coating wasn't
covered. I wasn't spending time double
documenting, once for the chart,once for insurance.
And I wasn't deciding how thoroughly I could examine
someone's eyes based on what plan they had.
I was simply doing what I was trained to do.
Look, listen and help. And the whole time, the stock
(05:29):
kept running through my head. Why can't Healthcare at Home
feel like this? And let me be clear, I'm not
saying I want the US to become adeveloping country.
And I'm not romanticizing poverty or wishing away our
tools or technology. But I am saying that with all
the resources that we have, withall the software, scheduling,
and new pharmaceuticals, we've lost something important.
(05:51):
We've lost the humanity in medicine.
We've let the business of care take precedence over the act of
caring. And in Guatemala, I get to taste
what it feels like to have time again, to be fully present and
to make the connection with priority instead of coding.
And I thought, this is what medicine is supposed to feel
like. This is what it feels like to
(06:13):
come home at the end of day feeling emotionally full, not
depleted. And I realized I don't need to
cross a border to find that feeling again.
That's what direct care is. It's the closest thing we have
here in the United States to that kind of clarity.
Like when people hear that I dropped insurance, they
sometimes assume I did it to make a statement, like I wanted
(06:34):
to be rebellious or exclusive orthat I was turning my back on
accessibility. But the truth, I didn't drop
insurance to be edgy. I did it to save my sanity and
healthcare. I did it to actually care for
people the way that I believe they deserve.
I don't want doctors to lose thespark.
And I know that if we don't makea change, doctors are going to
want to leave the profession altogether, or worse, become a
(06:58):
doctor that just goes through the motions.
So for me personally, I sat downand looked at the numbers.
I looked at the hours I was working after hours, and I
looked at how many people I was rushing through, not making the
personal connection. And not because I didn't care,
but because I was forced to if Iwanted to stay afloat.
(07:18):
And I realized the system isn't just stealing my time, it's
stealing my purpose. Direct care gave me that purpose
back. And it's not perfect.
There's no one-size-fits-all andit takes courage, planning, and
some rethinking. But it works.
It works because it cuts out thenoise.
(07:38):
There are no middle men dictating how long I can spend
with a patient, no paperwork jungle just to get a basic
service approved, and no hours lost trying to justify why
someone needs a pair of glasses or dilation.
It's just me, the patient, and the goal of getting them.
Well. If you've ever sat in an exam
room, looked into someone's eyesand thought, I wish I had a few
(08:00):
more minutes to be really to be able to connect with them.
If you've ever had to stop explaining A diagnosis because
you know your next appointment is already 10 minutes behind, or
if you've ever looked at your schedule and felt that sinking
feeling in your stomach, you know what I'm talking about.
And if you've never practiced medicine in any other way, you
might not even realize what you're missing until you step
(08:21):
outside of that system and have time to breathe again.
So no, I don't miss the billing codes.
I don't miss the prior authorizations.
I don't miss fighting with insurance reps who've never seen
a retina but are somehow deciding what care I can offer.
But what I do miss when I'm inside the US system is the soul
of the work, the time, the silence, the ability to pause
(08:44):
and say, tell me more. And in Guatemala, I can find it
again. But more importantly, I realize
that we can build it here too. Not in theory, in practice.
One visit at a time, one patientat a time, one exam room at a
time, and one practice at a time.
That's what direct care allows us to do.
(09:05):
That's why I'll never go back. Let's talk about burnout.
It's not the cute kind of I needa self-care day kind of burnout.
I'm talking about the kind that leaves you sitting inside your
car in the clinic parking lot, dreading going inside.
The kind that makes you questionwhy you ever went into medicine
in the 1st place. The kind where you get home and
can't remember a single patient you saw because you were just
(09:27):
surviving the day. And my colleagues are exhausted.
And I was too. Before I transitioned to direct
care, I was seeing almost 25 patients a day.
That's every 10 minutes on the dot if nothing runs behind.
And of course, everything runs behind because they're real
patients who have real problems and came there for you to help.
(09:49):
I'd be staring at my computer more than my patients, clicking
boxes, writing within normal limits more times than I can
count, trying to document everything in a way that would
justify getting paid because Godforbid you forget to mention
medical necessity in exactly theright way.
And then after a full day of care, I'd be up at night
(10:09):
charting, trying to catch up, trying to stay afloat, and
trying to remember why I even started this.
But here's what I realized. Burnout doesn't just steal our
energy. It steals our presence.
It steals our curiosity, and it steals our ability to be human.
You feel like a vending machine with a white coat on.
You put in your insurance card, push a few buttons, and outcomes
(10:32):
a prescription next. No time to pause, no time to
teach, no margin for asking the real questions.
Like, how's your sleep? What's your stress like right
now? What matters to you about your
vision? Because those questions aren't
billable. But when I go to Guatemala, I
remember what real care feels like.
(10:53):
No Ehrs, no insurance approval, and no one hovering over my
shoulder asking if I hit my goals for the day.
I wasn't watching the clock. I was watching a grandmother see
her granddaughter clearly for the first time in years.
I was watching a boy put on his first pair of glasses and gasp
as he saw the world come into focus.
(11:13):
And in those moments, I feel it again, the flicker in my chest
that says, oh, this is what it'ssupposed to feel like.
You feel your soul stretch. I remember that it's my job not
to move patients through a system, but to help them and to
heal. And that's the kind of a moment
you can't bill for, but it's thekind that fills your soul.
(11:35):
And here's what breaks my heart.We shouldn't have to go to
another country to experience that.
We shouldn't have to escape our own system to feel like doctors
again, like caregivers and healers.
We shouldn't have to choose between taking care of people
and making a living. But right now, for so many
providers, that's exactly what it feels like.
(11:56):
So we numb, we detach, we automate, We cope with humor,
whine, or endless podcasts aboutproductivity hacks.
But deep down, we know we were meant for more than this.
That's why we went into healthcare in the 1st place.
And direct care gives us that more.
It gives us permission to slow down, to sit with patients, to
(12:18):
ask real questions, to follow our instincts.
Not an algorithm. It brings us back to the reason
we got into this in the 1st place.
To help, to connect, to make someone's life just a little bit
better. And honestly, it brings the joy
back. Not in a fake toxic positivity
way, but in the quiet, sacred way where you finish your day
(12:39):
and think that mattered. So if your provider listening to
this and you're tired, I want you to hear me.
You're not broken, you're not weak, you're not a failure.
You are practicing in a system that was designed for profit,
not for people. And the fact that you still care
after everything, that says everything about you.
(13:02):
But you don't have to stay stuck.
You don't have to give up the parts of you that made you want
to do this work. You just have to find a new
model. And if you're a patient
listening, this effects you too,because when your doctor is
burned out, they can't show up for you the way you need them
to. But when we shift the system,
when we build practices around people instead of policies,
(13:25):
everybody wins. We can't pour from empty cups,
but with direct care, we can refill them, and then we can
pour again from a place of purpose, not exhaustion.
So let's talk about what it really meant to bring my
daughter on this trip, because it wasn't just powerful for me
as a mom, I personally feel thatit's transformative for her as a
(13:49):
growing young woman. So she's 11, and she's the kind
of kid that still loves stuffed animals but also wants to go to
Harvard and work at NASA. She's curious and kind and brave
even when she's nervous. And this is the third time I've
taken her to Guatemala, obviously not just for a
vacation but to serve to work. And she doesn't hesitate.
(14:11):
She packs her in a suitcase, brings crayons and stickers to
hand out and toys and wants to help out the patients and make
the kids have fun. She jumps in with both feet,
uses Google Translate to make friends, and made a friend who
was the exact same age as her. But everything else about their
lives was so different they didn't even speak the same
language. But that didn't stop them.
(14:31):
Every day they came back and Amelia pulled out her phone and
opened up Google Translate. And just like that, like the
modern version of passing notes in class, they were chatting,
sharing favorite colors, what they wanted to be when they grew
up, and what their houses were like.
Later that afternoon, they invited us to our house for
dinner, and I'll be honest, I had the immediate mom moment of
(14:53):
wait, what are we doing? But when we walked with a few
locals to her neighborhood, we looked around quietly, taking it
all in. Their home was a small concrete
structure, no running water. They cooked over a fire in the
backyard, chickens wandering through the kitchen.
My daughter didn't say much in the moment, but I could see her
eyes scanning everything. The wheels were turning.
(15:15):
And later that night as we got ready for bed, she said to me,
Mom, they were so happy and theyhad so little.
And we have so much that I didn't realize.
And right there, I knew this trip had done more than help
people. It cracked open a whole new
level of perspective. Healthcare isn't just about
(15:36):
tools or degrees. It's about connection, about
seeing people for who they are, listening to them, and learning
from them. She saw what most of the world
lives like with resilience, creativity, and strength and
simplicity. She saw how broken and bloated
our system can be at home because for all our technology,
(15:59):
many American kids never get that kind of heart to heart
experience. How many of us even slow down
enough to sit in someone else's world and just observe?
We came home and she didn't ask for anything new.
No souvenirs or treats. Just understanding how she wants
to go back again and help. And here's what I've realized.
(16:20):
This trip didn't just make her grateful, it made her curious,
compassionate and aware. And Amelia gets now, maybe more
than many adults, that Healthcare is not a transaction,
not a box to check or a visit torush through.
It's service, community, and humility.
We weren't just giving people glasses, we were giving them the
(16:42):
ability to read, to work, to seetheir grandkids faces again.
And in return, they were giving us stories, perspective, and
yes, a deep appreciation for what we so often take for
granted. When I talk about direct care
and ditching insurance and slowing down, I'm not just
talking as a doctor. I'm talking as a mom.
(17:04):
Because I want that kind of medicine to exist when our girls
grow up. The kind that sees the whole
person. The kind that listens.
The kind that reaches across language barriers with a smile
and a translation app and says you matter.
That's the world that I want ourgirls to live in.
And it starts with how we chooseto care for one another here,
(17:27):
there and everywhere in between.So let's bring it back home for
a minute. People ask me all the time,
Kara, how does going on a mission trip in Guatemala relate
to the work you're doing in yourpractice in North Carolina?
What do pop up clinics in rural villages have to do with running
a modern eye care practice? And my answer is everything.
(17:48):
Because what we do in Guatemala,the off the grid, no insurance
one-on-one kind of care, is the blueprint for what direct care
looks like in its purest form. In Guatemala, I don't have to
log into a portal. I don't have to check someone's
deductible or wonder if V or wonder if VSP considers A-250
(18:08):
reader a covered benefit. I don't have to chart for
billing and I don't have to document a diagnosis code, just
justify the fact that I helped someone see.
But I do get to listen, to ask questions, to educate, and to
serve and spend time focusing onthe human being in front of me.
(18:28):
And guess what? Direct care lets us do that at
home. Let's talk about how they mirror
each other. Transparent pricing in
Guatemala. Of course, we hand out our
glasses and carefreely, but the value of what we're doing is
immeasurable. In direct care, we can't always
give things away, but we can be clear.
No surprise bill. No codes to decipher.
(18:49):
Just here's what the visit costs.
Here's what's included. Let's focus on your eyes, not
your wallet. It restores trust and you stop
being a billing entity and startbeing your human resource again.
In Guatemala, we don't double book.
We don't rush. Of course, we see as many as we
can, but never at the cost of connection.
(19:10):
In direct care, I don't have to cram 18 patients into a day.
I can actually sit with someone,talk about their vision and
their nutrition. I can hear about their family
history, their concerns, their barriers.
And here's the magic Patients start telling you things that
matter because they finally havethe time and space to feel
heard. In Guatemala, I don't just hand
(19:32):
someone a pair of glasses and send them off.
We explain how to wear them and how their eyes are aging.
And I talk about diet, about sugar and inflammation.
And in direct care, I do the exact same thing.
When I'm not racing through insurance mandated checklists, I
can say, let's talk about your diet, your blood sugar, your
stress. Because guess what?
(19:53):
It all shows up in your eyes. The next one gets me a little
bit emotional because dignity doesn't come from fancy
equipment or shiny clinics. It comes from eye contact, from
listening without interruption, from presence.
In Guatemala, a patient looks you in the eye and says Gracias
doctora. And it's not because you did
something flashy, it's because you cared.
(20:15):
In indirect care, I can look a patient in the eye and say this
is your time, I'm here for you. I'm not behind, I'm not
distracted, and I'm not typing through your tears.
So when someone says isn't direct care kind of idealistic,
I just smile because it's not idealistic.
It's not a pie in the sky dream.It's basic humanity.
(20:35):
It's what medicine used to be before we sold it to the highest
bidder. And we don't need to go to
Guatemala to find that kind of care.
We just need to get insurance companies and billing codes and
the hamster wheel of productivity out of the way.
Because here's the truth. What we're doing in those
makeshift clinics with a foldingchair and a flashlight and a
suitcase full of donated frames is more real, more healing and
(20:59):
more impactful than the most $500 specialist visits.
And what if we can create a model that does that in the
United States with structure, support, and sustainability?
Then why wouldn't we? Why wouldn't we want care that
makes sense, that honors time, that leads with prevention,
education and respect? Direct care isn't a rebellion.
(21:22):
It's a return. A return to common sense, to
compassion, to being a doctor. And you know what?
It's not just better for patients, it's better for us
too. Because when I go home from
Guatemala, I'm tired but not burned out.
I come home emotionally full andremember why I love being a
doctor. And I want every provider
(21:43):
listening right now to know you don't have to travel to remember
that feeling. You can build it right where you
are. And next, I want to speak
directly to the patients listening now.
And I want to say something thatmight feel hard to hear, but I
promise it's coming from a placeof love.
If you've ever left your doctor's office feeling like a
number, feeling rushed, dismissed, or barely listened
(22:06):
to, you're not crazy. You're just caught in a system
that wasn't designed for you. When doctors seem rushed, it's
not because they don't care, it's because the system doesn't
allow them to. Doctor likely went to school for
a decade, took on massive debt, worked grueling hours, and
sacrificed sleep and family because they do care.
But then they get stuck in a machine that's turning faster
(22:28):
and faster, measuring in volume,not connections.
But the good news is you have more power than you think.
And you can choose the kind of care that you want.
You can ask about cash pricing, look for direct care providers
and support the clinics that prioritize time, education,
humanity. Because here's the bottom line.
(22:50):
You deserve more than 7 minutes and a prescription pad.
You deserve someone who knows your name, who remembers your
story, who says let's talk abouthow you're really doing.
Someone who sees you not just asa diagnosis or deductible, but
as a whole person. This is about access.
That makes sense. It's not a concierge or boutique
(23:11):
medicine for the wealthy. It's about clinics who are run
by people that believe that everyone deserves dignity, not
those just with platinum. PP OS about making healthcare
affordable, predictable, and human again.
Because right now, we're all living inside a healthcare
system that's wildly expensive, massively inefficient, deeply
(23:32):
impersonal, and not actually making us healthier.
But if what? What if we could change that?
Not with a massive political reform, but one patient, one
doctor, and one clinic at a time.
That's what direct care is. So if this resonated with you,
if you've been craving somethingdifferent, I want you to know
(23:54):
that it's out there. And if you don't know where to
start, message me and I'll help you find someone in your area.
Because that's what community isfor.
Because this movement, this shift in care, it's not just
about doctors burning out. It's about patients waking up to
what's possible, to what they deserve, and to what we don't
have to tolerate anymore. Because we're not numbers,
(24:17):
you're not a case, and you're not a line on an insurance form.
You are a human being and you deserve to be seen, heard, and
cared for. So here's the heart of it,
friends. Whether you're in a remote
village in Guatemala or a busy town in North Carolina, the need
is the same. People want to feel better, they
(24:38):
want to be understood, and they want to trust their doctor more
than anything. And they want to believe that
the system designed to care for them actually will.
And I truly believe that we can build that kind of system, not
all at once, not with a government mandate or a billion
dollar tech fix, but one patientat a time, one clinic at a time,
(24:59):
one story at a time. This episode stirred something
in you. If you felt your heart tug a
little and thought, why can't itwork this way at home?
Here's what you can do next. Share this episode with a friend
who's feeling burned out, with apatient who's frustrated.
Let this story be the spark. Visit carafosterod.com if you're
(25:20):
new to direct care or just curious.
I've got free resources to help you understand what this
movement is really about. In spoiler.
It's not about cash, only snobbery.
It's about care. That makes sense.
And if you want to donate glasses funds or join a future
vostrip, you don't have to be anoptometrist to make a
difference. You just need a harp for people
(25:41):
and a belief that vision changeslives.
We'd love to have you in the circle.
You can reach out. And one last thing, if you're
still listening, thank you. Thank you for your time, your
energy, and your open mind. Thank you for caring about
people. Really caring because we don't
just need a better system, we need a more human 11 rooted in
dignity, service and heart. I'll see you next week where we
(26:05):
get back into the practical toolkit for building your direct
care practice. This one will be a two-part
episode about the way I treat customer service and my practice
and how you can do the same. And also, another upcoming
episode will be a detailed rundown for patients about what
direct care really is and how itcan heal our country.
(26:25):
Thank you again for listening. This is Kara Foster opting out.
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