Dr. Thompson's Blog

Bad News for Medicaid and Medicare "Advantage" Patients

The cost of health care seems to get higher and higher as the insurance companies lobbyists have seen to it that their companies make more and more money. Recently, it has been reported that the private Medicare plans that Bush and his administration have pushed cost more and do little extra for patients. This was reported by Robert Pear in the 11/24/08 New York Times. The government pays insurance companies more for these plans, even though they are not providing the promised care. The 10.1 million people enrolled in these plans thought they were going to get better coverage, but this has not turned out to be true.

Patients who are on Medicaid or welfare, (Medi-Cal in California) are going to most likely have to pay more in co-payments and premiums, since new Federal rules now allow the states to charge more.  I don't understand how people who are already suffering from having little money can be asked to pay more for their health care. What will happen, and is happening, is that people will not take care of their health problems, simply becasue they cannot afford to pay increased premiums and co-payments. When I cared for welfare patients, I refused to ask them to pay anything. I felt that was wrong, but  the wealthy people in the government, who have excellent health care, simply don't understand the plight of people who are trying to get by on minimal amounts of money.  Hopefully, with the new, more understanding administration, some of these laws will be changed.

The Debate about Attention Deficit Disorder

Attention Deficit Disorder can be helped greatly if it is diagnosed in the early years. Unfortunately, since schools are cutting down back on many of their services, a good work-up by an educational psychologist may not be done and the child may fall farther and farther behind in school. Many of these kids drop out, join gangs, and eventually may end up in prison unless they get adequate help. Seventy-five percent of dropouts end up in prison; a scary statistic.

With the success of Michael Phelps, the Olympic swimmer, some doctors are saying  that having A.D.H.D is an advantage. If you are a parent of one or more kids with this disorder, you may think differently. If a child is identified early and given special help, his or her self-esteem will not be  lessened, as it may be if they cannot succeed in school. If pediatricians did complete physical examinations including a few neurological tests, early diagnosis couold be made in the doctor's office and then documented by appropriate psychological testing. There are so-called minimal neurological signs that can be found  on even a fairly brief examination. However, the 8.5 minutes per patient that are alloted many doctors does not allow time for much of an examination. Thus, many  A.D.H.D. kids go through life feeling inadequate and unhappy. Parents are the experts with their kids and if there is any question about a child having this disorder, I would insist and demand, as a parent, that appropriate testing and treatment be given.  

Women Physicians and the Doctor Shortage

I just had an interesting conversation with a retired former professor of one of our best medical schools. He was talking about the great need now for more primay care physicians. His answer about why this has happened started me thinking. He said he was concerned that so many women doctors work just part-time, drop out for several  years, or take easy health department or administrative jobs. In  his time, he said, there were either no women in the classes or just one or two. Now many medical school classes have over fifty-percent women. If these women do not work full-time as he and I did, then yes, there will be a shortage.

I told him about the time a few years ago when I was talking with the chairman of a department in my old medical school. The man was asked to take a phone call by his secretary and when I started to leave, he motioned me to stay seated. I watched as he  got more and more agitated listening to the caller. At the end,  he almost banged down the phone and said, "I wish I never, ever, had to take another women resident."  Then he told me the caller was to start her residency in his program within a week or two and was demanding, not asking, that she have certain days and weeks off. I said, "If I had done that, I would have immediately been let go." "Yes", he said,  "many of these women doctors  don't have any hesitancy about doing exactly what they want and assume you will go along with it." I felt very sad and angry that woman physicians would take advantage of their peers and department heads.

Male residents have told me that often in their training  fellow women residents left early, took days off, and just assumed the men would cover for them. I remember, even in my day,  one very pretty and wealthy fellow resident would leave after lunch on Fridays and be flown in  her private  plane to her vacation home. How she managed that I will never  know. She wasn't a particularly good resident  and the rest of us always had to clean up after her. I suspect she probably did not practice or just worked part-time after her training. I hope our present  women medical students will show a little more dedication to medicine and not give people a bad taste in their mouths about women physicians.

Melamine Also Present In Some U.S. Foods

I was interested to hear on the news and also read in the newspaper that the F.D.A. has opened a branch in China. That sounds like a good idea, but I wonder just how much power the staff will  have.

After reading an article by James McWilliams in the 11/17/08 New York Times, it appears that we have our own melamine problem.  The author states that "Chemical plants throughout the United States produce millions of pounds of melamine a year." He goes on to say that melamine easily can get into food because the fertilizer companies add this substance to their products. Then, if food is grown in soil containing the fertilizer, we will get traces of melamine in our food. If chickens or other animals are fed on feed that contains melamine, that is another way for us to take in an unhealthy amount of melamine. Even organic foods may not be safe, the author notes, if melamine-containing fertilizer was used in the soil. So perhaps instead of establishing an office in China, the F.D.A. should examine their rules about fertilizer in the U.S. and the addition of melamine.

Dangerous Side-Effects of Risperdal and Zyprexa in Kids

Too many doctors these days find it much less time consuming to prescribe a drug rather than taking time to listen to patients, to obtain an adequate history, and do a complete physical examination. Of course, the greedy drug companies love this because they can sell more and more drugs.

Recently, there have reports about the serious side effects of the drugs, risperdal and zyprexa, as well as related drugs. These are being prescribed in children for attention-deficit disorder and bipolar problems. Thirty-one deaths have been reported in kids from 1993 to 2008. Other children had bad side-effects including excessive weight gain, muscle tics, and metabolic disorders. The drug company spokespeople say that the drugs have labels on them. That certainly isn't going to help a frantic parent when a drug is prescribed by a physician. If an adequate medical work-up has not been done, the diagnosis may not even be correct. I have seen children given drugs by physicians on their first visit when no work-up was done. No physician should ever be allowed do this and parents must demand that a good work-up, appropriate psychological testing, and lab work be done before one of these dangerous drugs is prescribed. The psychological testing must be done by a child psychologist who has wide experience in testing kids. Otherwise serious errors can occur.

Health Insurance Companies and Greed

I always think of the well known movie with Michael Douglas about Wall Street when I think about the health insurance industry. When his young protege asked  "When do you have enough money?" The answer was something like, "Never."

The health insurance company, UnitedHealth Group and AARP are under investigation by the former Vermont insurance commissoner, Elizabeth Rowe Costle, because many people thought they had comprehensive coverage and of course they didn't.  Big surprise?  I hope both of these groups will be penalized for what they have done to many elderly people. Robert Pear gives a good description of this investigation in the New York Times on 11/19/08.

Now the insurance industry has come up with another idea to increase their already enormous profits. They are apparently willing not to exclude anyone from coverage IF, and this is a big IF, everyone has to buy their expensive health insurance policies. Amazing! I surely hope the new administration does not allow these greedy insurance companies to push this plan through. Yes, we need coverage for all in the U.S., but not by putting more and more billions of dollars in the insurance companies' pockets. Regulation of these money hungry companies must be possible.  Not everyone can afford to buy expensive health insurance, so there has to be a better way.

Increase of Birth Defects Found with Fertility Assistance

Having cared for many, many  children with birth defects in my years of practicing pediatrics, I was not surprised to learn about the new report from the Journal of Human Reproduction that techniques such as in-vitro fertilization have been found to increase the risk of a baby being born with a cleft palate or cleft lip, rectal or esophageal defects. There was no report of an increase in spina bifida cases which is fortunate, since this is such a difficult multi-system problem. The spina bifida patients I have cared for have been some of my most heart-wrenching kids.

The good news is that all the reported birth defects have good surgical repairs even though there may be life-long side effects, such as speech, swallowing, or bowel problems.  I think that parents must consider the possible difficulties of in-vitro fertilization. When doctors take over what should be a normal process, then unexpected results are always possible. There are so many wonderful kids waiting to be adopted that I wish more parents would think about this possibility rather than spending great amounts of money in fertility clinics and possibly having a child born with a birth defect. 

Health Insurance for College Students Under Investigation

I was interested to read  in a 11/17/08 New York Times article by Jonathan Glater that the attorney general of New York was looking at some New York colleges to see why parents' had to pay for extra  health insurance for their kids even if the students were covered by their parents' health insurance. This is particularly puzzling when the health care provided by some colleges and universities leaves a great deal to be desired. I have always urged the parents of college students to find a doctor in the local community for their students because the student health service may be inadequate or not have board-certified physicians available to provide medical care. ( I devote a chapter to college health care in my book, 101 Ways To The Best Medical Care.)

I cared for many college students when I was in active practice because either they were not able to see a physician in the college health service or the treatment they received was inadequate or inappropriate. I had to make a house call to a dormitory one night to see a very ill student. She had been diagnosed as having tonsillitis and was critically ill. I thought she had mononcleosis and immediately had her hospitalized.  Her tonsils were so  large that they could easily have obstructed her airway.  The young lady was in serious danger and my diagnosis was correct.

Many college presidents are now receiving enormous salaries and benefits, so perhaps having parents pay for extra health insurance is a way to keep the college finances healthy. As the daughter of a college professor who was paid a very small salary, even though he was the  head of the department, the high finances of some colleges amaze me. Perhaps this new investigation will bring to light the colleges that abuse the trust parents place in them. 

Seeking Medical Care Overseas

I was amazed to read  in today's New York Times that 750,000 Americans sought medical care overseas last year. That certainly indicates how fragmented and expensive our medical care has become. South Korea has now joined India, Thailand, and Singapore in offering medical care to non-residents. Many of the doctors are American trained, but overseas care presents a problem. How can you check-out the doctors' success rate, if malpractice suits have been filed against the physician or what kind of reputation the doctor has? I would also want to know, if you are planning to have surgery, if you will have a board-certified anesthesiologist or a nurse anesthetist. This could be a life or death decision.

One of the things I always advise  patients to do is lots of networking when seeking medical care. First I would start with a doctor friend or family member who is a doctor or a friend who knows doctors or who has had excellent care from a physician. The next step is to check the Web site of your state medical board's listing of physicians to see if a doctor has one or more malpractice suits filed against him or her. You can also find out where the doctor received his or her medical degree and if the degree is a D.O., M.D. or other type of practitioner. Nurse practitioners who get a doctor' s degree in nursing are also calling themselves doctor, so you have to be very carefull about who you want to be your treating physician, anesthesiologist, or surgeon. You can never do too much investigating or ask too many questions.

Identifying Country of Origin of Food Products

The parent of three former patients sent me an important e-mail because she knew I was concerned about the news reports of foods coming from China  containing Melamine and another chemical. By looking at the bar code on the back of the product, we all should be able to identify the country of origin. Food products from China have the numbers 690 to 695 as the first three digits of the bar code. Other countries are as follows:

Taiwan-471                                                  Finland-64                   

USA-00 to 13                                                Switzerland-76

France-30 to 37                                            Saudi Arabia-628

Germany-40 to 44                                          United Arab Emirates-629

Japan-49                                                       Central America-740 to 745

UK-50                                                            Phillippines-480

Denmark-57

This is a good chart to take with you when shopping for food products. It is better to be safe than sorry.