Post Author: Kohar Jones, MD

A positive view of health reform, no thanks to the HITECH Act

Tech
June 3, 2015

Recently I completed the Commonwealth Fund’s 2015 International Survey of Primary Care Doctors. They wanted to know what I thought about our health system; if fundamentally it worked or needed to be better. They asked questions about my satisfaction with practicing medicine, the quality of care my patients receive, and my experiences with electronic medical records. (You can click here to read through the 2012 survey, to get an idea of …

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The gun violence epidemic is a traumatic injury epidemic

Physician
March 16, 2015

“What brings you in today?” I asked my new patient, a healthy appearing clean cut 35-year-old married man with kids.

“Check me out, doc.” (STD check? chronic disease screen?) “My brother was just diagnosed with diabetes; I want to make sure I’m OK.” (OK, easy — sugar and cholesterol check)

No prior medical problems for him.

Prior surgeries? At this question, he paused.

“I was shot in the leg last summer leaving work,” he said. “I lost …

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Blessed to be alive after a gunshot wound

Physician
January 11, 2015

“Blessed. I’m so blessed.”

She kept repeating this, from her seat on the examining table.

“I’m so blessed.” I unwrapped the bandage holding on the splint that had covered her arm for the three weeks since the bullet went in above her elbow and came out through her forearm, hitting no bone, touching no major artery.

“Blessed.”

Homeless. With diabetes that needed insulin, which needed a refrigerator, that she didn’t have.

Vulnerable. A few years earlier, …

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State legislatures should not enter the exam room

Physician
May 26, 2014

The doctor-patient relationship is under threat from state laws that try to shape what we can and can’t do for our patients. Many state legislatures are proposing laws that limit the questions doctors can ask patients in our confidential clinic visits. Do you smoke? Drink soda? Exercise? Do drugs? Is there a gun in the home?* Do you want to be pregnant? Is there fracking near your home?*

The questions followed …

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How to stop losing primary care physicians to burnout

Physician
May 13, 2014

Here’s a central difficulty of the Affordable Care Act: If everyone has access to health insurance, then everyone has access to all the medical care they need. Curing sickness and preventing death costs a lot, and society can go broke providing costly medical care to everyone. Society saves money and lives when everyone sees a primary care doctor who works to keep people well.

But we don’t and won’t have enough …

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Shadowing physicians continues the cycle of paying forward

Education
January 8, 2014

Is Physician “Shadowing” a Shady Practice? asks Dr. Elisabeth Kitsis in a post at the Doctor’s Tablet, a blog run through the Albert Einstein College of Medicine. She concludes that yes, it is, and invites readers to share their opinions on having high school and college students shadow physicians.

I was reminded of my fantastic 8 week shadowing opportunity as a college student through the Project AHEAD program at the Charles B. …

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Reform creates new incentives in health care

Policy
July 24, 2013

I advocated for the Affordable Care Act, and celebrated when it was passed.

It’s good to have everyone covered, I thought.

Insurance for everyone is the first step to health care for all.

Alas, access to health insurance isn’t the same as access to health care.

First there is the niggling detail of providers. We already have a primary care provider shortage.  Internists, pediatricians, family physicians are already working at full capacity in caring for …

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While doctors disagree, every physician wants to fix health care

Policy
April 27, 2012

Three out of four dentists recommend this tooth brightening toothpaste — make your smile sparkle like never before! Six out of seven plumbers recommend this drain opening de-clogger — make your bathtub drain like never before! Nine out of ten doctors recommend improving the medical system in the United States — make your health care system heal like never before!

But how do we do that?


Do doctors think the Affordable Care Act is the soothing balm …

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Why doctors should drive health reform

Policy
April 17, 2012

Who better knows how to fix a leak than a plumber?
Who better knows how to repair a cracked doorway than a carpenter?
Who better knows how to solve the conundrum of our leaking cracked health care system than a doctor?

Doctors are an important part of public discussions about health care reform.  Our prescriptions drive healthcare costs.  We are the crucial middlemen between the biomedical industry and patient health. Sharing our first hand experiences in health care …

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What should be the stated aim of health care in America?

Policy
January 20, 2012

The triple aim of health care, as defined by the Center for Medicare and Medicaid Services (CMS) is: improving the experience of care, bettering the health of populations, and reducing the per capita costs of health care.

This struck me as odd when I first read it.  Why should the stated aim of any system become to decrease the costs associated with that system?

Which led to the next logical questions: What should be the stated aim of …

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The positive effects of palliative care on quality of life

Physician
December 30, 2011

“I’ve been a fighter all my life,” said my new patient, a middle aged man with thinning hair, a worried wife, and a dismal prognosis. He had  worked all his life as a plumber with no health insurance.  When he was healthy, it was okay.  But now he was sick.

I was meeting him for the first time in the community health center where I work as a family physician, tending …

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How Medicare undermines primary care

Policy
August 23, 2011

When I was a family medicine intern, I met a diabetic patient in the hospital who had stopped seeing his regular doctor after he lost his job and his health insurance.  His untreated diabetes made his feet go numb.  He stepped on a nail and didn’t realize it until he noticed a smell that cost him his foot.

He spent thousands of dollars on the surgery and subsequent hospital stay—far …

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Pay for performance doesn’t work in difficult patient populations

Physician
August 2, 2011

Pay for performance.  It’s a lovely sounding concept. If you’re a good doctor, defined by having healthy patients who meet predetermined quality indicators, then you get paid more.

What could be simpler, right?

Wrong.

Not all patients are created equal.  Some are highly educated, highly literate, highly motivated to prioritize health.  They have good jobs with health insurance, so critical medical care isn’t prohibitively expensive. They don’t need to choose between paying …

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The National Health Service Corps impact on primary care doctors

Physician
March 17, 2011

Before I had even begun medical school, I already knew that I would enter primary care when I finished.  I had successfully applied for and received a scholarship from the National Health Service Corps Scholars program.  By the time I graduated, I knew that after my three years of residency training, I would practice in an underserved area for at least four years, one year of service to America for …

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Legal tobacco and illegal marijuana are historical accidents costing billions

Policy
January 13, 2011

“What do you think of medical marijuana?” my mother, who has never smoked a thing in her life, of the tobacco or cannabis variety, asked me one day as we drove through beautiful upstate New York woods.  We had just passed a sign saying “We will destroy your crops,” with a marijuana leaf beneath. “It has its place,” I said.  “No reason to be against it.” “But isn’t marijuana a …

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Doctors who order tests for their own financial gain

Physician
November 15, 2010

“What a shame,” said my eighty eight year old Armenian grandmother, shaking her head with sorrow, and I had to agree. “US officials charge 73 people, mostly Armenians, over a massive fraud against the country’s medical insurance system,” read the BBC headline.

A (mostly) Armenian crime syndicate set up 115 sham clinics in the United States, using real doctors’ names and real patient information, stolen from different systems, to generate false …

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