Disqus - Latest Comments for valjonesmd

Re: RIP Hooper

valjonesmd — Thu, 11 Feb 2010 13:34:40 -0000

Wonderful thoughts, Evan.

“Somebody should tell us, right at the start of our lives, that we are dying. Then we might live life to the limit, every minute of every day. Do it! I say. Whatever you want to do, do it now! There are only so many tomorrows.”

--Pope Paul VI

Re: I Spy the Senate Bill

valjonesmd — Mon, 21 Dec 2009 17:59:25 -0000

Interesting point about the machinery being taken over. With over 2000 pages of gibberish to enjoy, it doesn't surprise me that the best that most of us can do is to pick one or two issues that we can get our arms around (say, abortion language, Medicare expansion, or public option) and fixate on that to the exclusion of the other stuff. However, I've spied enough redundancy and waste in the fine print to make me deeply concerned about this bill. Perhaps a better illustration (than the lovely Christmas do-dads above) would be a Petri dish of a swab from a Senate toilet seat? It would light up with thousands of organisms, each capable of creating some serious illness in a person if introduced to the right tissue.

The good news is that Best Doctors' future is assured: with 30M newly insured patients being triaged by homeopaths/naturopaths with online degrees from alternative medical schools - you'll have no end of work to do, teasing out wrong diagnosis after wrong diagnosis. "Total body candidiasis" is going to become an exceedingly common dx if Harkin's amendments survive till the end. And your taxes will pay for Christian Science Prayer treatment for such ills. And that's just one bacterial strain among thousands in this bill.

Fun times.

Re: The Nuclear Option

valjonesmd — Sat, 12 Dec 2009 18:33:02 -0000

I think most employers/insurers agree with your view, Evan. However, I think we may be close to a tipping point where financial realities will simply drive employers nuclear and employees really won't have a choice in it. It will be scary and there will be blowback - but with careful education ("hey guys, you're actually going to SAVE money") and a great team of primary care docs with pay-as-you-go practices to support consumerism, this HSA approach is actually a fine healthcare reform strategy.

Unfortunately we're in a chicken-egg point in history where there aren't enough HSA type patients to fuel pay-as-you-go practices on a large scale, and without those practices, switching to HSAs and high deductible plans feels scary for patients (and doesn't necessarily improve their HC experience).

However, I can tell you that I've personally witnessed a quiet revolution in my corner of Virginia where people are die hard fans of my practice model. Many have high deductible plans and HSAs from which they pay me cash for my time. I'm available 24/7 via phone/webcam/home visit/office visit/texting/email... It's really been great and I know that this could take off if given the chance. :) It may not, and that would be a crying shame. But I'm willing to "die trying."

Re: What Really Matters

valjonesmd — Fri, 30 Oct 2009 20:07:34 -0000

What really matters is that doctors would probably do this instinctively if they were paid the way lawyers are - for their time. Not to be flippant here - but it makes a big difference to social graces. Most of what we do is undervalued, over papered, and part of system that makes us miserable.

We are constantly pressured to work for free - that's why docs don't like to do email or phone calls with patients, even though it'd be in their best interest. We don't see our loved ones, kids, own families - because we're staying up late coding, buffing charts, and playing "mother may I?" with insurance companies.

Now, that doesn't excuse bad behavior - and doctors should spend more time with patients, getting them the answers they deserve, and treating them with kindness and reassurance. But asking them to do all that for free is something that all but the saintly-est will struggle against. That's the real problem here, IMO.

Re: If You Had to Fix Just One Thing

valjonesmd — Sat, 24 Oct 2009 08:49:40 -0000

Amen. I'm joining my PCP's practice for just this reason - people need help with care coordination, and they need more time with their doctors. When PCPs opt out of the excessive administrative burdens required by health insurance, they can refocus their time and attention on the patient.

The average PCP requires 4.5 support staff to deal with reimbursal and documentation. Our practice has reduced that to 0.5 - and we pass on that savings to our patients by spending more time with them, and charging an affordable hourly rate. We do house calls, office visits, phone calls, email - whatever's convenient and necessary. No fee/service with a complicated pricing structure. Just fee/time. No membership fees or hidden costs. Our average patient spends only $300 year on their primary care - and they have access to us 24/7. If they want to submit our invoices to their insurance companies they may do so... But when your care costs about the same as your copays - why bother?

This is healthcare set free...

Re: The Eyes Have It

valjonesmd — Tue, 11 Aug 2009 23:16:22 -0000

The butt twitching complaint is exactly how it was written. You're right that it's vague, and that's the point. The nurses are subtly saying that the patient is a poor historian, and that this is more likely to be psychogenic than anatomic. It also means that the nurse who triaged the patient does not believe that the person is "high acuity." Right or wrong, it suggests to the doctor (especially the x 3 months) that this is not an emergency and the patient can be prioritized lower than the others.

Re: The Eyes Have It

valjonesmd — Tue, 11 Aug 2009 20:39:45 -0000

My first priority is always patient safety - if everyone's safe and being taken care of, then the next priority is choosing to help someone in the time I have remaining on my shift. There is no overtime pay... and working overnights is exhausting and you really want to get out on time (I've almost had car accidents trying to get home after an extra long shift). However, if it's early in the shift and there's plenty of time I'm happy to take on complicated and challenging cases, with the most acute people first in line.

Re: Better Health Sponsors Blogger-Politician Healthcare Reform Discussion At National Press Club

valjonesmd — Tue, 14 Jul 2009 10:02:58 -0000

Just to be clear – the intent of the press conference was to give medical bloggers an opportunity to speak directly to politicians inside the beltway about their healthcare reform concerns. I invited medbloggers who have been the most outspoken about reform, and who have the largest reach – but sadly I couldn’t include as many people as I’d like due to budget constraints, etc.

The conference needed a name – so as I thought about what medbloggers really wanted to communicate, it seemed to me that we cared most about putting our patients first, and that this message often got lost in the “who’s going to pay” arguments.

The spirit of the conference is about expressing the need to preserve the patients’ right to choose (along with their providers’ advice and input) the best path for their care. It was never my intention to exclude patients from the conference in any way – patients and physicians/nurses are each others best allies, and we need to stick together!

Yours in the struggle for quality, affordable, healthcare for all,

Val

Re: Happy Canada Day From The Canadian Embassy In Washington DC

valjonesmd — Wed, 01 Jul 2009 20:07:20 -0000

It appears that I was more interested in the horse. :)

Re: Saturday Surgery: $150

valjonesmd — Tue, 02 Jun 2009 18:16:20 -0000

Cost to squeeze cyst repeatedly = 0 dollars

Understanding the pathophysiology behind cysts (that the walls of the cyst must be completely removed or else they'll just manufacture more gunk eternally): priceless

Re: Weird X-Ray Of The Week

valjonesmd — Tue, 19 May 2009 14:19:13 -0000

Thanks for all your smart comments - #1 Dino is the closest to the full story. Congrats, Dino! This is in fact a VP shunt tracking from the brain of a child with spina bifida into the peritoneal cavity, through an inguinal hernia and into the scrotum (which is distended with CSF). The shunt and hernia were repaired soon after the x-ray was taken.

Re: Is Chris Matthews Mean?

valjonesmd — Tue, 05 May 2009 09:33:26 -0000

Thanks for your input and insights folks. :) I think Chris is brusque and he knows it. The fact that people interpret this as "mean" really bothers him - which is why he's probably not truly mean. What I like about him is that he adores his wife. Any time she enters a room he introduces her to the crowd as if she's the most wonderful woman in the world. He even calls her "his queen" in public - which is endearing.

Chris likes to test his interviewees by playing hardball - it's like pushing a person around to check their balance. I personally prefer softball, so he does make me wince. It would also be nice if he could be a better listener, and more gracious to the "little guy." However you've gotta give him credit - he's tenacious and successful in what he does.

Re: It’s Not A Tumor: Dr. Val Lacks Veterinary Savvy

valjonesmd — Tue, 17 Mar 2009 17:13:33 -0000

Ona update: ok, this is going to sound kinda gross, but I have learned how to pop her patella back into place. It's really easy and she doesn't mind. Any time I see her pause with her leg lifted I just pop it back in. She's generally not uncomfortable. I suppose the inevitable outcome could be a grade 4 subluxation (where it stays dislocated permanently) or development of knee arthritis. I'll try some "watchful waiting" - what's the more modern term? "Active surveillance" and see if she needs ortho.

Re: It’s Not A Tumor: Dr. Val Lacks Veterinary Savvy

valjonesmd — Tue, 17 Mar 2009 08:32:36 -0000

I know, prices are crazy in this country. Maybe I should engage in veterinary tourism? If I flew to India could someone fix Ona's patella issue? Might cost a heck of lot less than doing it here. :)