My Kind of Medicine: Real Lives of Practicing Internists: Bill Johnson, MD
Fifteen years ago, Dr. Bill Johnson set a goal: 100,000 miles by 2012. He chose the year 2012 because it would be the 20th anniversary of when he began cycling. As of August, he has finished 75,000 miles. He has another goal: to keep his patients out of the hospital.
In 22 years of practice, he has done a pretty good job of accomplishing it. According to insurance records, Dr. Johnson’s hospitalization rate is one tenth that of the average internist. Out of a patient base of roughly 3,000, not one of them is currently in the hospital. A figure like that is something many physicians strive for; Dr. Johnson has made it a reality.
It was during his last semester of high school that Dr. Johnson, a Lubbock, Texas native, was having difficulty deciding on a career. At first, he considered missionary work and ministry, but after a discussion with a friend of his father’s, he considered another choice. “He was frustrated by my decision because he felt I was strong in my studies and that I should put them to good use. I remember he said, ‘Well if you are going to do missionary work, at least be a medical missionary!’” Dr. Johnson took his mentor’s advice. After graduating college in just three years, he was off to medical school at Texas Tech University.
In medical school he quickly identified with the ideology and approach to internal medicine. “I admired the way the professors taught and the thought processes that went into it,” he says. “I chose internal medicine primarily because of their influence and I knew I would want to have ongoing relationships with my patients.” He took his learning experience very seriously. “I learned how to do a proper physical exam from the head of cardiology,” recalls Dr. Johnson. “He was the first person to get through my thick head the importance of evidence-based medicine and data. Now of course, it is a practice that is prominent and widely taught, but back then we were still warming to the idea.”
At the urging of others, Dr. Johnson found his calling. Once he did, he ran with it, soon becoming a wizard at diagnosing. In the 1980s, he explains, the skill was valued even more than it is today. “Managed care has changed the environment a bit, but internists are still the most skilled at diagnosing a common disease or a condition that is presenting uncommon symptoms.”
A few years ago, Dr. Johnson had a patient case that put these exact skills to the test. A young woman who was pregnant was referred to Dr. Johnson by an Obstetrician/Gynecologist for a swollen leg. The gynecologist had suspected deep vein thrombosis. Dr. Johnson performed an ultrasound and found no clots, but did eventually figure out that the patient had developed factor VIII deficiency which was causing a compartment syndrome. If Dr. Johnson had not recognized the condition immediately, the patient would have likely lost the leg. “That referring gynecologist sent me patients for the next five years!” he says. “That is a testament to how internists are valued in our system.”
A Pure Progressive
Dr. Johnson was a busy man in medical school and during residency training. While studying to become an internist, he met and married his wife, Rhonda, and had two children. Shortly after he finished, he opted to work in a private practice outpatient facility. It fit his professional needs, allowed him the opportunity to work with colleagues he admired, and gave him the time he needed to spend with a growing family. “It was 1985 and my wife and I were in the bathroom as I remember,” he says. “We made the decision right there that I would take a job which would allow me to be with my family; to know my children. That meant working as an internist.”
Dr. Johnson has been practicing in a private practice setting for his entire career. His practice is named “Prevention First,” and the name is not rhetoric; Dr. Johnson has always touted preventive care, long before it became a catch phrase. “My goal has always been to keep patients out of the hospital, that’s my job,” he explains. “There’s an art to it. You have to be able to know when they’re on the edge of running into trouble. As doctors, we’re scientists, but what I do I see more as an art. As much as 70 per cent can be taught, but the rest has to be inherent.” As a devoted religious man, Dr. Johnson has a naturally positive attitude that lends itself well to the business of healing. But the seasoned doctor is also aware of his own limitations, as he was following an unforeseen and sad event involving a longtime patient.
The patient, a woman in her late 50s, had been involved in a car accident, in which she had broken her tibia and was sent to a local hospital. Because it was not the hospital that Dr. Johnson was affiliated with, he did not treat her. Nonetheless, everything appeared fine and afterwards she returned to Dr. Johnson wearing a cast. Four months passed, and her husband died. On the day of the funeral, she contacted Dr. Johnson and told him she was not feeling well, which was to be expected under the circumstances. She came to the office and he measured her blood pressure. It was low, which was odd since she had never been hypotensive. An exam produced normal results and she was not out of breath. The only thing worth noting was the fact that she was on warfarin. The next morning, when she returned to his office, he decided to admit her. While at the office, she threw a massive clot (despite having been on warfarin) and Dr. Johnson rushed her to the emergency room. She died that day. “That has been my biggest disappointment,” he says. “She was one of my favorite patients. I did everything by the book, but it was still too late. If only I had been a little bit better; a little bit faster.”
The Goal Keeper
In 2001, after their adult children had moved out of the area, Dr. Johnson and his wife knew it was unlikely the kids would return to the Lubbock area to work. The decision they had made back in 1985 in their bathroom suddenly resurfaced. They wanted to be a family again. They decided to relocate to the Dallas-Fort Worth area to be closer to their son William and their daughter Meredith, and that Meredith would work as the new office manager once they relocated. The move would mean a major upheaval for Dr. Johnson—after spending decades building a career as a trusted internist, a department chairman overseeing a staff of hundreds, and an internal medicine section chief, he would have to start completely over. The idea would terrify many, but for Dr. Johnson, it was not terrifying at all, but rather something that was already familiar to him: a goal. “It was challenging, starting over,” he admits. “Opening an office—it’s a skill set I had not used in a long time, but ultimately it was very rewarding. My practice is very successful now and we’re planning on opening a second office soon.” In 2001 when the decision to relocate was made, Dr. Johnson had yet to reach his 75,000-mile mark. But he was well on his way, and he had also by this time maintained his enviable hospitalization record for many years. And so he just took to his new goal the only way he knew how: with hard work, seasoned skills, and a little bit of faith.
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