Resign from the AMA

The American Medical Association endorsed the nomination of Dr. Tom Price for Secretary of Health and Human Services. This is the wrong position for physicians and for the organization that claims to represent us. Despite more than ten years of membership starting with active leadership in the Medical Student Section long ago, I can no longer support the organization.

The AMA does not have a clear way to cancel membership on its web site, so I telephoned them at 800-621-8335. I spoke with a very nice woman who listened to my concerns and processed my cancellation. To obtain a refund of dues, she asked that I email a letter to her requesting this and asked that I include my opposition to Dr. Price’s nomination in my letter. I’ve redacted her name and email address, but otherwise included the letter in its entirety below.

[Update, 20161206: The day after my original post, the AMA released a clarifying statement of their position regarding the nomination. Not long thereafter, I received a response from AMA Member Relations, and replied to them confirming my membership cancellation. Both emails are copied beneath the original one below. I also edited the original very slightly to add the date in the header.]

Date: Wed, 30 Nov 2016 09:41:54 -0500
Subject: Membership Cancellation
From: Christian Jones <on-call@christianjones.md>
To: [redacted]
Cc: Jack.Deutsch@ama-assn.org

Ms. [Redacted]:

Thank you for your assistance by phone this morning in cancelling my
longstanding American Medical Association membership. I am disappointed
that an organization ostensibly advocating for physicians is instead
actively working against the interest of myself, my colleagues, and my
patients, and must therefore withdraw my support for the AMA. As you
requested, I’m writing this email to explain my reasons and request formal
cancellation and a refund of my membership dues. As this is directly a
result of the press release of 29 November (
https://www.ama-assn.org/ama-statement-nomination-rep-tom-price-be-hhs-secretary),
I am additionally copying AMA’s media contact, Jack Deutch, listed on that
press release, and will be posting this letter on social media and on my
personal blog, http://jonessurgery.com/.

Recent elections and the long period leading to them have demonstrated the
divisiveness in our political culture, and I’m sorry to add more to that.
Physicians, like all members of our society, have a responsibility to
advocate for their beliefs, but we additionally have the responsibility of
advocating for our patients. This, unfortunately, has not been the
consistent message of the AMA. The vocal endorsement of Dr. Tom Price’s
upcoming nomination as Secretary of Health and Human Services clearly
demonstrates advocacy for some physicians at the expense of patients,
rather than in concert with their needs.

Those of us who treat patients with debilitating disease, patients
seriously ill or injured, patients who had difficulty obtaining insurance
coverage prior to the implementation of the Affordable Care Act, patients
who are routinely ignored by politicians, the patients who need us
most—we are not served by Dr. Price’s nomination nor by those who endorse
him. AMA’s voice no longer speaks for us, no longer represents the
physicians who are working to improve patients’ lives, who are struggling
to provide care to patients who have already suffered from, as the AMA’s press
release called them, “market-based solutions” and reduction of “excessive
regulatory burdens”. AMA’s voice is no longer that of the American
physician.

I hereby request cancellation of my AMA membership and refund of any
appropriate AMA membership dues. I will additionally be recommending to my
colleagues and contacts that they do the same.

Sincerely,

Christian Jones, MD, MS, FACS

Date: Thu, 1 Dec 2016 14:32:07 -0600 (CST)
From: membership <membership@ama-assn.org>
To: on-call@christianjones.md
Subject: Your Inquiry: Tom Price, MD, Nomination

Dear Dr. Jones:

Thank you for contacting the American Medical Association (AMA) to share your thoughts and concerns regarding the Health and Human Services Secretary nomination. We take seriously the concerns expressed by those who do not support the nomination, and our support for it is not an endorsement of every policy position Dr. Price has advocated.

However, as a physician, Dr. Price has had a relationship with the AMA, and with organized medicine generally, for decades. Over these years, there have been important policy issues on which we agreed, and others on which we disagreed. One thing that has been consistent through the years is his understanding of the many challenges facing patients and physicians, and his willingness to listen directly to concerns expressed by the AMA and other physician organizations.

If confirmed by the Senate, Dr. Price will be charged with pursuing the policy goals of the President he will serve. Similarly, as a non-partisan organization committed to improving the health of the nation, the AMA is charged with advancing a robust set of policies established by its House of Delegates, highlighted in the AMA Vision on Health Reform, which can be found at https://www.ama-assn.org/sites/default/files/media-browser/public/washington/ama-vision-on-health-reform.pdf.

The AMA appreciates your involvement and urges you to continue to be included as a member in the organization that brings together physicians across all states, medical specialties, life stages, and practice environments. Having members with diverse views and experiences as physicians makes the AMA highly effective in upholding our mission, which is “to promote the art and science of medicine and the betterment of public health.”

Through your continued membership in the AMA you have the opportunity to speak up about the issues that are most important to you, which shapes the future of medicine from the inside out. We hope that you will continue to be part of the AMA and share your voice.

We value your feedback and encourage you to stay informed about the AMA’s legislative advocacy activities, which can be found at https://www.ama-assn.org/about-us/national-advocacy. The AMA welcomes diversity of thought and opinion. We value your membership and hope you will reconsider. However, should you wish to change your AMA membership status, we ask that you send a confirming email to member.feedback@ama-assn.org. Please be sure to include your full name, preferred telephone number, and email address. Kindly note our refund policy shown below.

AMA refund policy:
The AMA membership cycle is based on a calendar year. Full refunds are issued upon written request within 35 days of membership activation. Refunds requested after 35 days are prorated for the remaining months in the calendar year. Refunds will not be issued for the current year if requested after September 30.

If you have any questions, please call AMA Member Relations at (800) 262-3211 or direct an email to msc@ama-assn.org.

Sincerely,

Malynda Steward
Member Relations
American Medical Association

CONFIDENTIALITY NOTICE
This email and attachments contain material for the exclusive use by the intended recipient and may contain confidential information that is protected from use or disclosure under applicable law. If you are not the intended recipient, please notify the sender and delete the original message and attachments without making copies.

Date: Tue, 6 Dec 2016 11:19:23 -0500
Subject: Re: Your Inquiry: Tom Price, MD, Nomination
From: Christian Jones <on-call@christianjones.md>
To: membership <membership@ama-assn.org>, msc@ama-assn.org, member.feedback@ama-assn.org

Ms. Steward:

Thank you for your thoughtful response. I appreciate the more nuanced
position in your reply, as well as that in the AMA’s follow-up post. I
similarly understand the AMA’s pragmatic desire to “be in the room” and
advocate for physicians. However, I also note that the original statement
from the AMA still stands at
https://www.ama-assn.org/ama-statement-nomination-rep-tom-price-be-hhs-secretary,
still makes no mention of the AMA’s stated objections to Dr. Price’s
policies, and still “strongly endorses” his nomination and his attempts to
implement “market-based solutions as well as reduce excessive regulatory
burdens” thus hurting our patients.

The AMA’s decision to attempt to placate its members without without
withdrawing its support of Dr. Price is unfortunate. The organization’s
decision to strongly endorse the nominee rather than to take a stand
against the administration nominating him will likely allow it to remain in
the room, but demonstrates that while in the room it will remain toothless
and advocating neither for physicians nor for patients. It will stand by
echoing its support for those in power fearing loss of its own influence
rather than acting as our voice. As I stated before, I can not and will
not support this position.

I once again formally request and confirm the request to cancel my
membership and issue me a refund of any applicable membership dues so that
they do not fund these activities. As requested, my full name is Christian
Daniel Jones, my preferred (office) telephone number is 410-955-2244, and
my email address is on-call@christianjones.md.

Sincerely,
CDJ

A Few New Things

I’ve had some wonderful projects come to light this week, and despite the obvious shameless self-promotion, I’m gonna write a bit about each of them here. This isn’t a list for bragging, and is far from a simple CV addition, but I’d like to talk a little about each, including some of the struggles, joys, and thoughts that led to them.

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“Simplified” E&M Coding

Billing & coding isn’t the most exciting process in health care, but it’s a necessary part of most practices, and is hardly ever taught in residency or fellowship. I’ve had the opportunity to learn from many outstanding professional coders over the years, and for some reason found the topic fascinating. (To be fair, I’m still not the best at keeping up with the day-to-day process, but I really appreciate the idea.)

As part of a talk I gave our new Acute Care Surgery fellows (and a few faculty), I developed a brief guide to choosing the proper billing code for evaluation & management (i.e., non-procedural) services. Surgery coding is (relatively) easy: find the code for the surgery you did. (Yes, there are intricacies, but still….) E&M, even in my “brief” guide, is cumbersome and confusing. I haven’t previously been able to find a useful 1-page reference sheet for E&M, so I made one, then added a couple of pages of explanation & instructions. If it’s the sort of thing you’re interested in (or just find useful), feel free to share and enjoy. And please, send me feedback by email (on-call@christianjones.md) or on Twitter.

“Simplified” E&M Coding Quick Sheet, version 20160906

One Sheet Surgery: Dealing with Surgical Emergencies

Last updated 30 June 2016

Just a reminder of the steps to take in any surgical emergency. These are not evidence-based.

The attached files are nicely formatted, and additionally include contact info and a reading list. Share and enjoy.

  1. Call for help
  2. Airway
  3. Breathing
  4. Circulation
  5. Disability
  6. Exposure
  7. Foley
  8. Gastric decompression
  9. Hertz
  10. Imaging

PDF: OSS – Surgical Emergencies

Microsoft Word: OSS – Surgical Emergencies

As always, these files that are the sole work of Christian Jones are hereby released into the public domain, with no rights reserved.

Waiting for the Light

I wait for the light to change. Every time. I hit the scuffed but still reflective silvery button and then stare at the other traffic light waiting for it to go from green to yellow to red and then for the hand to turn into the little walking avatar. Every morning. Every evening. Every time I’m walking across the street from the parking garage to the hospital or back.

This is not really a normal thing to do in Baltimore. I’m in no way accustomed to seeing, well, anyone else do this. I occasionally get little looks while I’m standing there on the corner and others are crossing the street. “I guess he’s waiting for someone,” I imagine they’re thinking. In most cases, I doubt it even occurs to them that I’m standing there waiting for the proper crossing signal before I step into the street.
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Indispensable Medical Texts

Amazon has made it much harder over the last few years to find “Listmania!” lists, and there was one I made long ago to which I keep trying to refer students and residents. Therefore, I’ve reincarnated (or at least resuscitated) below my list of “indispensable medical texts”. I’ve only updated to newer versions of books where available, and otherwise just copied my prior content from Amazon. [Edit: I’ve now added more!] It also still links to the Amazon listing for the books, but I don’t receive any affiliate credit for your using the links. Hope it helps!

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ABSITE Statistics: The Absolute Basics

The Behind the Knife team put together a great last-minute ABSITE review podcast to cover those annoying issues asked every year which require memorization. However, they noted that statistics wasn’t their strong point; I’m happy (and only mildly embarrassed) that it’s one of mine.

Long, long ago, I put together a brief “concepts” review for ABSITE statistics. It includes no calculations, tables, or graphs, and is a set of the absolute basics. If you just want to remember what a few of the important terms mean, feel free to download. It’s available as a PDF or the original PowerPoint