Pediatric cardiologist James Johns, M.D., relishes being a physician who wears many hats.
On any given day, he might see a newborn with an irregular heartbeat, think about drug costs for millions of patients, help train the next generation of cardiologists or see a patient he has followed for more than 30 years for a congenital heart defect.
Of all of his roles though, the “long-term relationships — with patients and with colleagues — are what I get up for in the morning,” says Johns, professor of Pediatrics.
Johns is a towering presence — in stature and decades of service — in pediatric cardiology at Vanderbilt. A 1980 graduate of Vanderbilt University School of Medicine, Johns completed his residency in Pediatrics at the University of Wisconsin, then returned to Vanderbilt as a pediatric cardiology fellow in 1984. He joined the faculty in 1987.
In his 33 years as part of the division, now named the Thomas P. Graham Jr. Division of Cardiology in honor of its first director and Johns’ mentor, Johns has seen a sea change in the practice of pediatric cardiology.
“When I was a fellow, babies who had hypoplastic left heart syndrome (a congenital heart defect that affects normal blood flow through the heart) almost all died within the first week of life,” Johns says. “Now, with treatment advances, we have teenagers who have hypoplastic left heart syndrome and are thriving.”
Advances have been especially striking in cardiac catheterization, Johns says, which is now used for many different treatments including closing holes in the heart, opening holes, putting in stents and implanting valves without the need for open-heart surgery.
It’s been really exciting to see the evolution of pediatric cardiology over the years.
“It’s been really exciting to see the evolution of pediatric cardiology over the years,” he says.
Although he’s a self-described “geek,” it wasn’t the rapidly advancing technology that drew Johns to pediatric cardiology. For him, the specialty offered an ideal blend of caring for critically ill patients in the acute setting and then having the opportunity to care for those patients for many years.
“I have a young man I still follow that I remember doing CPR on for about 45 minutes in 1985 when he was a toddler,” Johns recalls. “He plays golf now and is a funny guy. I really enjoy getting to know patients and their families over a very long time.
“It’s an amazing privilege to be involved with a family at a time that is almost always the worst time in their life — finding out their child has serious heart defects. Most of the children do well, and we’re fortunate to be able to continue to follow them for a long time.”
Johns grew up in Baltimore, the eldest child of two physicians at Johns Hopkins University.
“I grew up with dinner table conversations about medicine,” he says. He went to Yale University with the idea of going on to medical school, but he “hated the pre-med grind” and ended up majoring in engineering and applied science — though he took enough pre-med courses to apply to medical school.
His engineering and computer science background has served him well, Johns says. “A lot of congenital heart disease can be understood in terms of flows, which relates to engineering.”
He also has helped over the years with computer programming needs for the division, including developing an app for the Palm system for drug dosing. And he’s serving on the national pediatric cardiology steering board for Epic Systems Corp., whose clinical, administrative and billing software went live across Vanderbilt Medical Center on Nov. 2. Johns is one of several Vanderbilt physicians who completed training at Epic’s Wisconsin headquarters to become a Certified Epic Physician Builder.
“It has been exciting to be involved both in Vanderbilt’s Epic implementation as well as at a national level,” Johns says. “I am looking forward to seeing the ways we can improve the quality, safety and efficiency of the care we provide our patients.”
In another role, Johns spends a lot of time thinking about medications and their costs, he says. He has served on the pharmacy and therapeutics committee for Vanderbilt since 1992 and has chaired the related committee for Monroe Carell Jr. Children’s Hospital at Vanderbilt since it opened in 2004. These committees are tasked with deciding which drugs will be available in the hospitals, and how to use them appropriately.
Johns also serves on the TennCare Pharmacy Advisory Committee and on the Pharmacy and Therapeutics Committee for Navitus, which manages pharmacy benefits for about 5 million individuals, including Vanderbilt employees.
“I never thought I would know so much about drugs and drug costs, but it’s really important to carefully consider the best evidence-based practices for medication use,” Johns says.
Donning yet another hat, Johns also directed the fellowship program in pediatric cardiology from 2002 until late last year.
“Being involved in training young physicians has been another incredibly satisfying part of my career,” he says, noting that he’s had a hand in guiding about 60 of the 70 total fellows who have trained in the division (he was the seventh fellow in pediatric cardiology at Vanderbilt).
When Johns isn’t seeing patients or thinking about drug costs, fellowship training or IT improvements, he can be found hiking the trails at Radnor Lake, located just behind the home he shares with his wife, Karla Johns, M.D., associate professor of Clinical Ophthalmology and Visual Sciences. The two met as medical students at Vanderbilt.
“Karla’s maiden name was Jansen, and we were paired alphabetically for lots of things during our first year of medical school,” he says with a chuckle. “We started dating at the end of that year, and married after we graduated.”
They have a son, Will, who majored in Neuroscience but decided not to follow his parents into medicine. He lives in Chicago and does fleeting and scheduling for United Airlines.
