Dr. Thompson's Blog

Do You Have A Living Will?

As medical care gets more and more fragmented, it is even more important now to have a Living Will that states what you do and do not want done at the end of your life. Even young people, who are at risk for a sudden accident, need a Living Will. The necessary form can be down loaded from the Internet. One  Web site is www.partnershipforcaring.org. Once you have filled out the form and had it notarized, you should give a copy to someone in your family or a close friend who will respect your wishes. Your primary doctor should also have a copy.

In the 2/24/09 New York Times, Jane Brody raises another important point. She notes that you want to be sure your primary doctor agrees with your wishes and will respect them. If a physician is Catholic or has other religious objections to not doing everything possible to keep a patient alive, then you might want to change doctors. I have seen physicians keep people alive who were very old, had no family and were blind, deaf, and on life support. Doctors are trained to save lives not to let patients die.

Your local medical society may also be able to send you a form or tell you were to find one. This is not something to be put off. Please take care of it as soon as possible if you have not already done so.

Medical Care for College Students

When parents send a child off to a college away from their home, there is always the question about what will happen if the young person becomes ill. The anxiety is warranted  because not all colleges and universities have student health services that offer adequate medical care. I have had to make long distance calls to get good care for college students, who were former patients, and have even had to make a "dorm call" for one seriously ill student. Fortunately, I got there in time and had the girl quickly admitted to the nearest hospital.

My advice to all parents who are sending a child off to college is to carefully check out the student health service and if possible find an internist in the local area who would be available if medical care is needed. Some student health services rely on nurse practitioners and have only an on-call doctor. This is not the care I would want for a child of mine.

The other thing to find out before a young person leaves for college is if they have to buy the college's health insurance or if the parents' insurance will still cover the college student. There has recently been a five million dollar settlement by the Aetna insurance company because of lack of reimbursement for out-of-network care. 85 million college students will receive some money. This was reported in a 2/3/09 article in the New York Times.

Of course, the final word for parents is to be sure all immunizations are up-to-date, particularly the meningococcal vaccine. If there is a pre-existing medical problem, a letter should be on file with the college student health service from the student's local doctor.

The Case for Daily Vitamins

I have always taken a diet history when I see a new patient or one with undiagnosed problems. Some of the diet histories I get are truly amazing. How people can live on fast food and eat little until the evening meal is beyond my imagination. Thus I was concerned about an article in the 2/17/09 New York Times by Tara Parker-Pope entitled "Vitamin Pills: A False Hope?"

The  focus of the article was not on the importance of daily vitamins because of the very bad diets that many people eat, but it discusses whether vitamins help prevent cancer or serious problems, such as heart disease. There is no discussion about the average individual's diet or the recent reports about the serious deficiency of Vit D,  even in small children. If a baby is on a formula that is fortified with vitamins, then the addition of any oral vitamins should be discussed with the baby's doctor.

If you look at all the processed and fried food that people eat with the addition of few fruits or vegetables, then the need for a multi-vitamin is very clear. There is simply no way that many of us can eat the quantity of fruits and vegetables that are recommended. I have never  taken my daily Theragran-M vitamin with minerals with the thought that it would prevent cancer or heart disease, but know that for me a vitamin supplement is needed because food is of little interest and I would not get the recommended daily dose of vitamins without a daily vitamin.

Pros and Cons of Patients Reviewing Doctors Online

The Zagat restaurant guide company has now teamed up with the Wellpoint insurance company to rate doctors online according to an article by Milt Freudenheim in today's New York Times. This certainly raises a lot of questions for me. I am remembering my parents' doctor who was greatly skilled in the art of medicine, but was a very bad doctor. My parents would have rated him as excellent, yet they ultimately paid for his bad medical care with their lives.

Many doctors have absolutely no bedside manner, but are the best in their particular fields. If I want a patient to see a particular doctor who tends to be a little gruff, I always warn the individual about this when I make the referral. I would never refer to a physician who was rude or uncaring, but if he had a particular skill that was needed, then I would chose that individual. The doctor would not get a glowing review for his or her personality. 

I can understand a review that rates things like the cleanliness of the office, the pleasantness  and efficiency of the office staff and the accessibility of the doctor for phone calls, appointments, and  after-hour calls. Rating doctors as to their ability and knowledge would probably be difficult for a non-medical person. Instead I think patients should do lots of networking before choosing a doctor by checking with doctor and nurse friends, and checking their state medical board's Web site about any past malpractice suits, which medical school  was attended, and qualifications as to  Board-certification.

Court Rules Against Link Between Autism and Vaccine

It is of great concern to me as a pediatrician that so many children are being denied immunizations by their parents because of the concern about the possible development of autism. Even though thimerosal was removed from vaccines in 2001, parents are still trying to blame their children's autism on immunizations. The recent court ruling reported in the 2/13/09 New York Times was that in three cases brought by parents no link could be found between the children's autism and the MMR vaccine.

The one case last year where the court did not have adequate medical testimony and ruled in favor of a  doctor's child was unfortunate. This child was later reported to have an underlying mitochondrial  myopathy by Dr. Salvatore DiMauro, one of the leading experts in the neuromuscular field. This neuromuscular disease can present in many different ways and some of the children I have seen had autistic-like symptoms. These can progress over a period of years.

The vaccine compensation program was not set up to deal with cases like this. I was asked to see a child some years ago who had developed severe polio-like symptoms following a vaccine. What the doctor had not found out before hand was that the parents were first cousins and the little child had a severe immune deficiency. She should not have been vacinated. The doctor was at fault, not the vaccine.  

Report Falsified on Link between Autism and Immunizations

Countless parents have not had their children immunized because of the report in 1998 by Dr. Andrew Wakefield that there was a link between Autism and the MMR vaccine. The London Sunday Times reported that Dr, Wakefield "fixed the data on autism." Only 12 children were included in his article published in The Lancet in 1998. Subsequently, investigation has shown that the claims Dr. Wakefield made were not true. Unfortunately, his article has caused not only a loss of children's lives, but a marked decrease in children who received immunizations. In England and Wales, it was reported that last year 1348 children had measles and two children died.

I realize that there are doctors in the medical profession who are as immoral and unethical as in other professions. However, I think everyone wants to believe that doctors are above falsifying data. However, in the fifty years that I have practiced pediatrics, I have encountered far too many doctors who were more interested in promotions, name recognition, and large incomes, rather than the welfare of patients.

I hope Dr. Wakefield will be stripped of his medical license and find employment in a field where he can no longer hurt children.

Pros and Cons of Online Medical Records

The proposed twenty billion dollars in the stimulus package destined for online medical records seem like a huge waste of money to me. I noted that in today's New York Times Letters to The Editors, two doctors agreed with me. Of course, the president of a software consulting and development company thought it was a grand idea. He has absolutely no idea of what would happen if practicing doctors were forced to put all their records online.

The privacy issue is of major importance because as one of the two doctors wrote "Competing insurers will always find ways to discover patients' health problems and exclude them from coverage." He is exactly right. The other problem is that once medical records are put online, it doesn't mean that doctors, nurses, or other medical personel will read them. If doctors won't take the time to pick up the telephone and talk to each other about patients, as so often happens, how are they going to take time to read voluminous records? They aren't.

I remember a child I saw for a consultation who had been examined in a good university  medical school hospital in another state. He was discharged with no diagnosis, but had continued deterioration. I asked the parents to send a medical release for all his records. They came and were  voluminous.  It took me a lot of work and a great deal of time, but the answer was right there. A laboratory finding came back after the child was discharged and it  gave the diagnosis. The child had a treatable condition which had been missed. No, I was not paid for the several hours it took for me to review the records. This is just an example of why I feel electronic records will just be one more problem for practicing physicians. No wonder so many good ones are leaving medicine.

CEOs' Income Versus Income of Physicians

Most Americans think all physicians are wealthy. Yes, there are the greedy doctors who demand payment up front for cosmetic surgery and the doctors who run patients through their offices like cattle getting ready for slaughter. However, the physicians who are the backbone of good medical care, such as family practice doctors, pediatricians, internists, and anesthesiologists make far less than the $500,000 cap President Obama has suggested for CEOs salaries. I can't imagine making that amount of money. If I did, I would love to set up a foundation to help kids in trouble or find worthy kids who needed college scholarships.

An interesting article in the 2/6/09 New York Times by Reed Hastings, the CEO of Netflix, suggests a different approach to capping the enormous amount of money that  CEOs can make. Mr. Hastings says that it would make better sense to put a fifty percent tax on the income of all wealthy people. This would include not only CEOs, but hedge fund managers, athletes, movie stars, and venture capitalists. He notes that capping income won't help, because the CEOs would just find other ways to get extra money. He suggests a fifty percent tax on all income above one million dollars per year. A CEO who makes twenty or thirty million should be able to get along on half that amount. Of course, he or she might have to sell one of their many houses, cars, or boats!

More Problems for the Federal Drug Administration

I don't envy the man or woman who is nominated to take Senator Daschle's  place as head of Health and Human Services.  Almost daily there is a report of a new health care problem.  Just in the last few days there was an article about  scientists at the F.D.A who were forced to approve inadequate medical deivices and now are being investigated as  "whistle blowers."

The next medical concern I noted was that some big drug companies are moving their plants outside the U.S. This not only hurts U.S. workers, but the article stated concerns that medicines may not be available if there is a major emergency. Also there is a concern about regulation. With inadequate controls, there could be counterfeit drugs and possible tampering with the medications.

The peanut problem is still not resolved. Now it appears that by law the F.D.A had to get the approval of the Peanut Corporation (who sent out the contaminated products) to even announce a recall of the contaminated products. That is truly incredible. What if the Peanut Corporation didn't want to give their approval? You really wonder who thinks up these regulations and why they are allowed to stand. We hope the new director will be able to stand up to the powerful lobbyists and do more to take care of America's citizens.

Senator Daschle and UnitedHealth Insurance Company

I am sure that Senator Daschle would be a fine Secretary of Health and Human Resources. However, I have some real concerns about how he would handle the UnitedHealth insurance company with whom he has acted in an "advisory" capacity. UnitedHealth is my least favorite of all the health insurance companies and their only interest is making a very large profit.  Their relationship with AARP is under investigation, I have read, and they have made billions of dollars in profit over the years. Their profit last year was 81 billion dollars. One-third of this profit came from "federally regulated sales of Medicare Advantage and Medicare supplements and prescription drug plans."  (This quote is from an article in the 2/2/09 New York Times.) These Medicare  programs need to be dropped, as well as the drug plans. Multiple studies have shown that they frequently cost more than other plans.

If Senator Daschle is going to be in charge of making drastic changes in our health care system then I hope the Congress asks him details questions about how he would handle his previous relationship with UnitedHealth. We need to put strong controls in place over these greedy health insurance companies. How this can happen must be discuused in detail. Otherwise no health plan that includes everyone is going to succeed.