Dr. Thompson's Blog

When General Doctors Don't Refer to Specialists

I am always surprised when supposedly good doctors don't refer to a specialist if  they encounter a problem for which they don't have an answer. i think one of the signs of an excellent doctor is when he or she says, "I 'm not sure what this means" or "This is something that needs further investigation by a specialist." Of course, in the HMOs, referrals cost a doctor money because the referral dollars are taken from his or her paycheck. How any doctor can allow this to influence a decision about a patient is beyond my comprehension.

I was talking recently to a woman in her late seventies who just had a complete physical. She was pleased that the doctor spend almost an hour with her which is unusual because the woman  belongs to an HMO and the doctor is a G.P. The woman mentioned that the doctor found no feeling in her feet and that this was an on-going problem. The M.D. didn't seem bothered by the finding but did get a blood sugar to look for diabetes. "Didn't he refer you to a neurologist", I asked?  "No", she said. I was appalled. Numbness of the feet could mean several things but certainly a neurologist should see the woman and at a minimum do nerve conduction times. If this doctor doesn't have an answer then hopefully a neurosurgeon or orthopedic surgeon will  be consulted to see if the numbness is due to nerve compression since the patient has had two bad back injuries because of being rear-ended.

Medical Care and the Republicans

I get shivers down my back when I hear Mr. Romney and Paul Ryan tell what they would do to medical care in the United States. Mr. Romney says that "He doesn't care about the very poor because they have safety nets" and yet the Ryan budget, which he supports, would take away the safety net. Mr. Romney says he will get rid of Planned Parenthood which allows poor women to have mammograms, Pap smears, and general health care. What is the man thinking? I realize that he has never been poor, hungry, and not sure where his next meal is coming from or what to do if he becomes ill.  He also says that he would make changes to Medicare, which means that many older and disabled individuals would be without health care. Of course, both he and Paul Ryan would get rid of the Affordable Health Care Act. I wish these two men could have seen some of the problems I have seen where famlies did not have the means to buy health insurance and if they did have coverage the insurance companies kept raising their premiums or cancelled their policies, if the cost was too high.

With the Affordable Health Care Act, insurance companies could not do this. They would also have to charge women and men the same amount for health insurance. At this time, women pay a great deal more than men.  Children now can stay on their parents' health insurance until they are 26 and kids cannot be denied coverage if they have pre-exisiting conditions. All this would change under Mr. Romney. I hope all Americans will realize what a disaster it would be for this country if the Republicans win in Novemeber,

When a Cardiologist (Heart Doctor) Should Be Seen

I was talking with a woman in her mid-seventies the other day and was amazed at what she told me. After a day of considerable hard  exercise, the woman suddenly had chest pain radiating down her right arm. This is a classical sign of a heart attack. She was a widow who was alone in her house, so she wisely called 911.  An ambulance  came and took her to the nearest hospital where tests were run. The woman was told there was a "blip" on her EKG or electrocardiogram. She spent the night in the hospital and the next day saw her famuly doctor. The doctor apparently wasn't impressed with the findings and said to come back in a month. I was appallled.

Didn't the doctor realize that her patient should be immediately referred to a cardiologist? What kind of medicine was she practicing? A cardiologist has several more  years of training than the usual family doctor and certainly should be the one to say everything was all right. The next episode of chest pain could be fatal! I am hoping that the woman really listened to my advice and would do what she promised, which was to get a referral to a cardiologist. I didn't understand why she would have any hesitation. It wasn't a matter of money becasue she had excellent insurance and plenty of money. I just hope she listened to my advice.

I have never understood why many doctors try to be all things to all patients and are loath to make referrals. When I heard a murmur in a child or teenager that I didn't like, the patient was immediately  referred to a cardiologist. Several times I was told that I probably saved the patient's life.

 

Be Aware that Regular Measles (Rubeola) is Spreading

A new article in the current Pediatric News caught my eye with a picture of a child with a wide spread rash on his face. I had no question that it was the measles having seen my own children and patients with the disease. (This was before a vaccination was available.) The child who was pictured had traveled to France with his parents for a vacation. Ten days after he returned home, the boy became quite ill with a fever, cough, and wide spread rash. His parents had not had the boy vaccinated.

The article states that in 2011, there were about 14,000 cases of measles just in France. This included cases of measles encephalitis and even deaths. In the United States, 217 cases were reported in 2011. If you have seen a child with measles that goes on to encephalitis, you would have, as I do, a hard time understanding why any parent would risk this serious illness happening to one of their children. They are also risking a possible death.

Now that we have many visitors coming from other countries and American citizens traveling all over the world, the risk of  exposure to an infectious disease or having one brought to the U.S. is very high. Dr. Wakefield's destructive article about immunizations causing autism has been completely refuted and he has lost his license to practice medicine in Britain.

I hope any parent who has not allowed their child or children to be immunized will realize that they could be causing their child's death or permanent disability.  

 

 

Eating Disorders in Children

I was talking with a father a few days ago who was concerned about the eating habits of his little six-year-old. The child would not eat meat or chicken and just wanted fruits and vegetables. The family were not vegetarians. The father said  his daughter would eat a hamburger at McDonald's and loved chicken nuggets and other fast foods. He also said his wife was a very picky eater and would smell food before she would eat it. I asked if the father liked to cook and he said that he did. "Why don't you buy a children's cook book", I suggested, "and cook some of the dishes with your daughter. "That's a great idea" the father said. "I'll go to Barnes and Noble this afternoon and get one." I also suggested he should ask the family doctor or pediatrician  to talk with his wife and if necessary a dietician could talk with the woman.  My concern was that the child was being set up for a possible eating disorder. Children usually mimic what their parents eat. For example, when I see a greatly obese child, I look at the parents and usually one or both of the parents are quite obese. I think parents have to be careful about the eating patterns  they establish.

If you have had to be the doctor for a child with anorexia or bulemia or other eating disorders, you want to nip any problems in the bud before a serious eating disorder occurs.

When Coaches Push Too Hard

Not too long ago I was talking with two brothers, who are both college students. Their lives are completely controlled by two different coaches, as both spend five or more hours a day weight lifting, working out, or in practice. When I asked when they had time to study or have fun, both laughed. I then asked what they planned to do after college and neither young man was sure. One brother was having considerable back pain and the other was having pain in a knee, which concerned me. I didn't understand why the parents seemed so complacent about what was happening to their sons. Did they have any idea  what the future might hold for them?  Yes, one or both of the young men could get to play professional sports, but that might not happen, so then what would they do if they were constantly in pain from all their injuries?

Then there is the New Orleans football coach, who hopefully will never be able to coach another team. He  paid his players to injure members of the other teams. What has happened in the country that we take sports so seriously and put young peoples' lives and health at risk?  Not too long ago I met a young man who was a quadriplegic, as the result of a college football injury. How glad I am that my son, who did play varsity football for a year, decided to change to acting his junior year in high school, even though the coach tried to shame him into continuing with his team. I think parents need to be vigilant and watch their childrens' coaches very carefully.

Questionable Sources of Medical Information for Parents

I was looking through parenting magazines in the library recently and was concerned about some of the medical information I saw. I have long worried that parents are going to the Internet, magazines, books, and now apps to find out what to do about a problem instead of talking to their family doctor or pediatrician. There is a great deal of misinformation and also incomplete information available today.  An example of this is an article I saw recently about what to do when a child is slow in speaking. Various diagnoses were offered, but no place in the article was a hearing test suggested. There was also an incorrect statement that all babies are tested at birth in the hospital. That is not true and the test can also be unreliable depending on how it was done and who did it. Hearing should always be tested in a pediatric hearing center if there is any question.

Another example is colic. One article talked about the "Rule of 3" that I have seen mentioned elsewhere. In my experience, some babies, who have colic, don't just cry for three days a week, but may cry every night. No where in the article was there a suggestion about other causes for the crying. Everything parents think is colic may not be colic. It could be allergy to milk or even soy milk, gastrointestinal refux, and some have problems with  bowel movements. I remember two babies with tight congenital bands just above the rectal sphincter. When I inserted my small gloved finger, a great burst of gas and stool came out and the babies never had "colic" again!

Will the Affordable Health Care Act Be Saved?

As the Supreme Court starts three days of hearings and arguments about the Affordable Health Care Act, I am wondering why they are even bothering? I doubt that they will consider the law, but just vote along party lines. Justice Clarence Thomas should certainly not have a vote since his wife has a firm that has lobbied against the act since it was passed. I would be greatly embarrassed if I were Justice Thomas, but I suspect that little bothers him.

As a physician who has seen many people without health care and known how much they have suffered, I know how much we need this bill to be enforced. I still don't understand why many of the provisions don't go into effect until 2014, but perhaps that was the only way they could get it passed. The things that have already been accomplished are: College age young people can stay on their parents' health insurance until they are twenty-six and the insurance companies cannot deny coverage for pre-existing conditions. This is a particularly important provision. Also, an individual's insurance cannot be cancelled if he or she has very expensive medical care. Preventive health care services are covered which will save much money in the long-term. Of great importance is that women will have their health care covered for things such as breast X-rays, contraceptives, and Pap smears. This will save tremendous amounts of money and lives.

What Parents Can Do About Today's Dangerous Chemicals

When I read the article in the March 15th New YorkTimes about all the chemicals to whch babies and chidlren are exposed, I  can understand parents' concerns. However, instead of spending time making their own cleaning agents, soaps, and many other things, I would suggest that parents organize and put pressure on the FDA and other Federal  agencies  responsible for checking on dangerous ingredients.  Yes, we have far too many chemicals in use today, but are parents making themselves and their children neurotic by not allowing them to sleep in a bed that hasn't been especially made or checking on the contents of every single thing a child contacts? 

The article notes that one to three thousand new chemicals are introduced each year. This is certainly scary, but there is just no way a parent can check every single thing they use in their homes or that a child touches. What about when a child is in school, at a friend's house,  or out in the community? Certainly contacting news services, federal agencies and legislators could accomplish much more than reading labels and becoming upset. Parent groups can exert tremendous pressire on manufactures and the government if they use their energies that way.

Preventable Medical Tragedies

It is heartbreaking to have a child or teenager severely hurt or even die because of a preventable accident. Recently I have been told of two different teenagers who were tragically hurt when they pulled over to the side of the road to get something out of their car trunks or to check something on their car. One teen was killed immediately by a driver who slammed into him and the other may lose one or both of his legs. If the teens had put out flares indicating they were stopped, these tragedies might not have happened.

I was driving a grandchild to the aiport recently on the freeway and came around a blind curve. I was in the right lane, so I could exit. A car was stopped in the right lane and two men were behind the car looking in the trunk of their car. If there had not been an opening in the next lane, I could easily have slammed into the men. I was fortunate that there was an opening, so I could swerve into the next lane. If the occupants had put out flares, I would have immediately moved into the next lane. How lucky we were.

Another very preventable tragedy is when little children get into the medicine cabinet, grandmother's purse, under the sink, ashtrays, alcohol, or bottles in the garage or outside that contain poisons. Valerie Noonan kindly sent me a Web site, www.upandaway.org to remind all parents and grandparents what to keep out of the way of kids.