Dr. Thompson's Blog

Tanning Salons and Skin Cancer

I have long been concerned about tanning salons and the possiblity of skin cancers. Having picked up two malignant melanomas in children and having had two good friends who developed these, I think people are unwise to expose their skins to excessive, harmful UV rays. Whether it is prolonged exposure at the beach or under the tanning lights at a salon, I think moderation is the best choice. Several friends who have had prolonged exposure to sun have had surgical removal of  cancers from their faces. These  have not resulted in the best cosmetic outcomes.

In these days of such emphasis on looking young and beautiful, I don't know why anyone would want to try to overcome the odds and expose themselves to excessive UV rays. Having spent most of my adult life working in hospitals and caring for patients in my office, I have found staying out of the sun has served me in good stead. Yes, as a child I spent summers swimming in our local college pool, but paid for this by having two small skin cancers removed.

A troubling article in this week's Time magazine notes that according to the World Health Organization "The risk of cutaneous melanoma is increased 75% when use of tanning devices starts before 30 years of age." The FDA has some guidelines about the use of tanning salons, but according to the article these are ignored by  many tanning salons. As a physician and parent, I will continue to discourage the use of tanning salons or excessive exposure to sunlight.  

Gleeful Health Insurance Executives

I am sure that the health insurance excutives are delighted about the probable failure of a public option. What a marvelous Christmas gift this will be for them. They will reap millions and millions of dollars in new members' insurance payments if everyone is required to buy health insurance.

I am embarrassed that most of our members of Congress seem so spineless. Yes, many of them have received enormous contributions from not only the health insurance companies but also the drug and medical equipment companies. I hope that the spineless members of Congress suffer in the next election and are replaced by individuals with more backbone and no relationships with the insurance, drug and medical equipment companies.

I was talking last week to an American woman who lives in Paris. She told me of the wonderful care her children have had by Paris doctors and in the hospitals when hospitalization was needed. I advised her not to come back to the U.S. if she wanted the best medical care, but to stay in France. This certainly is a sad comment for an American physician to have to make.

Choosing Medical care By Cost Not Quality

It seems that the quality of medical care in the U.S. is getting more and more like a business and not about providing the best medical care to patients. There are now two Web sites where you can look for a doctor by how much he or she charges. You will have no idea of the quality of care, if the office is  clean, and you are going to see a board-certified doctor or a nurse practitioner or physician's assistant. You can look up the physician on a state medical board Web site but that will only list malpractice suits and not give you any idea about the quality of care. Of course, if you belong to an HMO and are assigned to a physician you also have no control over the quality of care.

I am always amazed about how even intelligent people chose to spend their money. Many pay as little as possible for medical care and yet take long expensive trips, buy expensive clothes, or expensive "toys". I would rather pay more for medical care and save on trips, clothes, etc. The choices we make about how we spend our money can have a major impact on our lives. An inadequate physician or one who should not be practicing medicine at all could mean a difference in your immediate or long-term survival.

The two Web sites are PriceDoc.com and OutofPocket.com. These Web sites also list the cost of various procedures. Remember that an X-ray of poor quality or one that is misread can lead to a bad or even tragic outcome, as can lab work that is not properly done. If a procedure is not done by a well trained individual the results will be both invalid and misleading. Your health is in your hands and the choices you make about medical care could change or even end your life.

When and How To Change Doctors

It always surprises me that people will keep going to a doctor that they don't really like or just  feel he or she  isn't very good. If a doctor is greatly skilled in the art of medicine his or her patients may stick with the doctor through thick and thin. My own parents did this despite the doctor being grossly incompetent.  They were not medical people and didn't realize that his great bedside manner covered up a major lack of medical knowledge. My mother paid for this with her life.

If you have even the slightest concern that your doctor or a specialist isn't the best, you can first get a second opnion or you can just find a new doctor. I would first check the state medical board Web site to see if there have been any malpractice charges against the doctor. Then do lots of networking to see if you can out about find his or her reputation. If you have a doctor friend to ask, this  could help but remember the doctor you are asking about could be a neighbor or a friend and how he or she practices medicine may not really be known. Please don't ever put up with a lack of interest, a poorly run office,  bad billing practices or  a really incompetent physician. There are some wonderful doctors in the U.S. but you may have to do a lot of research to find just the right one for you. Of course the HMOs and PPOs make it difficult to change doctors, but your life is in your hands.

Controversy about Cancer Screening Guidelines

I just had a phone call from a man I know asking my thoughts about the new cancer screening guidelines. I said that my advice would be to ignore them. Then he made a very interesting statement that could certainly be true with the amazing power the health insurance companies have over our legislators and our country. The man remarked that if the new cancer guidelines were in place the health insurance companies would not have to pay out so much for cancer screening examinations.

We then discussed the pending health care legislation and he said that he had called his congressman saying "Please don't vote for it." I agreed that unless strict controls were put on the health insurance and drug companies, as well as the medical equipment companies, that we would all be losers. The idea of a public option that would have an "opt out" provision makes no sense at all. The only way a public option will work is if it was made as powerful as the greedy health insurance companies.

I have great fears for the future of health care in this country and think anyone going into medicine these days may be in for some most unpleasant surprises. I loved practicing medicine, but that was in the days when doctors were in control, not the health insurance, medical equipment, and drug companies.

Genetics Testing-Pros and Cons

Many pediatricians and family practice doctors refer a child to a geneticist if they are unable to decide on a diagnosis. This is particularly unfortunate with pediatric neuromuscular disorders. Unless a geneticist has had neuromuscular training, the referral can result in numerous unnecessary and unpleasant tests, as well as misdiagnosis. If the geneticist is connected with a neuromuscular center as was Dr. Margaret Thompson, co-author of the genetics textbook, Thompson and Thompson, or Dr. Alan Emery in the UK, then the referral is usually a waste of time and money and can cause unnecessary distress.

Now I have read in an 11/16/09  article in the New York Times by Steven Greenhouse that a new law has been passed to prevent employers and health insurance companies from requiring genetic testing or obtaining family histories of an employee. The fact that this has been going on is new to me. I am delighted that some good legislation is coming out of Congress. It makes no sense that an employer had a right to ask for this kind of information. Even if genetic testing is done there are many variables in how the results can be  interpreted. Thus very dangerous information may be obtained that should only be interpreted by an expert in the field, not an employer or a health insurance company.

Ear Infections in Infants and Children

I hear frequently from parents across the United States that their family doctors and pediatricians don't seem to know much about the treatment of ear infections. Some of the older doctors were trained to do lancing or myringotomies for bulging middle ear infections but now that seemed to be a thing of the past. With the otoscopes or instruments that are now mostly used by doctors, there is no way that an ear canal can be cleaned or a myringotomy done under direct visualization. I have done a myringotomy even on a six-week-old baby who came in for a well baby check, but who I found had a bulging, bright red ear drum. I was amazed at the amount of pus that came out. This was a baby who could easily have developed meningitis or mastoiditis.

The signs of ear infections are variable and depend somewhat on the age of the child. Babies may just be irritable or cry a lot. Also they may or may not have a fever. Some will cut down on their milk or food intake. Older children may pull at the affected ear or keep their head turned to the side where the ear is painful. If there is a thick, pus-containing discharge coming from the ear then the ear drum has probably broken because of an ear infection. I then would see a pediatric ear-nose-and throat doctor and probably not bother to see a pediatrician or family practice doctor unless they have had wide experience treating ear infections.

With the increase in hearing loss among children and teens in the U.S., ear infections must  be taken very seriously. Sometimes doctors put children on many courses of antibiotics without referring them to an ENT specialist. Thus parents must be agressive and take their child to see a pediatric ENT doctor. Nurse practitioners and physician assistants should not treat infants or children with ear infections. If the doctors are not doing a very good job with ear infections, it is not fair to expect someone with half as much training and often little pediatric training to treat ear infections.

Attitude, Words, and Serious Medical Problems

Several individuals with breast cancer and other potentially fatal disorders have talked to me recently about the noted author Barbara Ehrenreich's latest book. Their understanding is that she is saying, "Being positive is not going to help you".  The author has written some excellent books in the past so I don't understand why she would write such a negative book. Having cared for countless patients with progressive or potentially fatal diseases, I think hope is a very, very important  emotion. I have always told patients that a new discovery or medicine could make all the difference to them and we never know which researcher will have an answer. When I was a pediatric resident, leukemia in children was almost always fatal in the early years. Now most patients are living good lives after their early treatments. If patients lose hope and become depressed, their lives usually go from bad to worse. Some even try to commit suicide.

I wonder if the author is angry about her own diagnosis and sees no hope? There are some amazing medical accounts of patients who have done exceptionally well despite an early diagnosis of a potentially fatal disorder or disease. I think we all need to be both hopeful and realistic about life. Otherwise the day to day struggles seem hardly worthwhile.

I think, too, that we all need to be careful about how we view people with a medical diagnosis such as breast cancer or for example, a muscle disease. The words "victim", "battling a disease", "you are sick", and the very limiting word, "wheelchair bound", should be eliminated from everyone's vocabularly. Hope and the right words can make a great difference in the life of anyone with a serious medical condition.

Mortality Rates Are Higher in Some Hospitals

A physician friend kindly sent me the results of a survey done by Health Grade. Their Web site is available at www.healthgrades.com.

This organization studied 5,000 nonfederal hospitals and found a great difference in the mortality rate of the hospitals. The study noted that hospitals in Ohio and Florida had the highest mortality rates. I am surprised about Ohio because the Cleveland Clinic has an excellent reputation as does Ohio University Medical School. The group graded the hospitals on twenty-eight different procedures and treatments. They noted that "The fact is, patients are twice as likely to die at low-rated hospitals than at highly rated hospitals for the same diagnoses and procedures." In general, the study showed that the "risk-adjusted mortality at the nations' hospitals improved on average 10.99% from 2006 through 2008". This is good news, but there should not be such a discrepancy between the top-rated hospitals and other hospitals across the U.S.

it was noted that the four main causes of preventable deaths were: pneumonia, heart failure, sepsis (infection), and respiratory failure. Of course, it is not stated if some hospitals saw more patients who were critcally ill or had life-threatening disorders. I know even in the area where I live two of the hospitals see most of the major problems while other hospitals may turn them away. My son told me of a case he had as an anesthesiologist, where a patient with good insurance  was brought by ambulance to his hospital  because nine other hospitals turned him away. The man was critically ill, so  I wonder if the other hospitals didn't want the case to show up on their records?

Febrile Seizures in Children

I had a recent frantic call from a grandmother saying her three-year-old granddaughter, who lived in another state, had just been taken to an ER after a probable seizure. The child's mother later sent me an e-mail detailing not one but apparently a past history of three other seizures. I couldn't understand why the child's pediatrician had not sent the child to a pediatric neurologist prior to the last seizure whch sounded as though it was a grand mal or tonic-clonic seizure. The child was unresponsive and lost both bladder and bowel control. Apparently all four seizures had been accompanied with a slight fever. I advised the mother that a pediatric neurologist whould be seen as soon as possible. Certainly an EEG should be done and the possibility of an apnea monitor considered.

When a child has a seizure, immediate measures should be not to use any restrains  but put the child on a flat surface and remove any sharp objects that might cause harm. Calling 911 and a child's doctor are both important. The big risk is meningitis and if there is a fever and stiff neck then a spinal tap must be done. This is a simple procedure and one I have done many times. Meningitis is very treatable if it is diagnosed early.

When there is no family hisory of seizures, no trauma or fall, and the child is under five, most children  outgrown these seizures. There are other types of seizures that may occur later on, particularly if there is a family history of seizures. A seizure is a very scary thing for parents and others to observe. I was walking on the streets of Munich, Germany with a friend and a policeman fell to the ground at my feet and had a seizure. There were no other medical people around, so my friend said, "He is all yours to take care of!"  Fortunately, the man quickly responded to my care and an ambulance soon arrived. Not my favorite overseas day!

Overseeing Care of a Nursing Home Patient

Those of us who have had family members or close friends in a nursing home can give many accounts of less than adequate care. No matter how carefully you check out a nursing home there are many things that could be greatly improved. One of the main problems is that most nursing homes are run for profit, so any way the management can skimp on services, the more money they make.

Medical care, too, can be less than desirable or sometimes just plain bad. An article written by Jane Brody in the October 6, 2009 New York Times suggests hiring a geriatric case manager. That sounds fine but it has two problems. Most people don't have the funds to do this and these case managers are few and far between. Ms Brody  cites the Web site of the National Association of Professional Geriatric Case Managers at www.casemanager.org. It would be important to do a detailed background check on a case manager's credentials if you plan to hire one.  I have  known cases where someone took over the care of an elderly individual with dementia and convinced him or her to sign a will leaving everything to the individual.

Unfortunately, the doctors who will visit nursing homes often just make a quick in and out visit and spend little time going over the patient's chart and sometimes don't even bother to actually see the patient. If they make a note in the chart, then they can charge for the visit. Also states such as California require only a monthly visit which is just plain wrong. You cannot care for a patient in a nursing home by visiting just once a month. I have had teenage patients with terminal illnesses in nursing homes and made daily visits. Sometimes even two visits a day were necessary.

As a family member or even a good friend you can insist that better care be received if it is inadequate. The "squeaky wheel does get the grease" and if the nursing home personnel know you are watching, your loved one or close friend will get better care.