Dr. Thompson's Blog

End of Life Decisions

Having cared for patients with progressive neuromuscular disorders for many years, I have always been very involved with their end-of-life decisions. As the end of the disease was approaching for each patient, children, teens, or young adults,  I have had a discussion with each patient about what  he or she would like me to do as time was running out. All of the patients, without exception said " If you can send me home from the hospital in the same condition  I was before, that is fine. I don't want any tubes, respirators, or tracheotomies." The other concern most of them had was "Would they have any pain?" Many of these were boys with Duchenne dystrophy and most of them were remarkable  patients.  Almost all of them  had great concerns about their mothers and how they would suffer.

There has been so many lies by individuals such as Sarah Palin and others about "death panels" and "Pulling the plug on Grandma" that I am appalled that more doctors have not spoken up. Part of the job of caring for patients with life-threatening diseases or very elderly patients is helping them make plans for what is ahead. This can be done in a very gentle, caring way and should be part of our job. it is sad that the Democrats felt they needed to add this to a bill for Medicare patients, so the doctors would be paid for their time. I can't imagine a physician being so greedy that he or she would even bill for this time. This is part of our job.

Yes, patients need counseling about end-of-life decisions. Do they have a Living Will and does their family understand what they want done as the end approaches? My children and doctors know that I will haunt them for the rest of their days if I am attached to any respirators, tubes or other life-saving equipment. To me the quality of life is important and if "Pain outweighs pleasure", than there is no quality of life. I certainly have no interest in "Living in the Valley of the Shadow of Death"  as someone said they would be glad to accept in a letter to the Editor of the New York Times.

Congress Playing Politics with People's Lives

I met Senator Hatch when I was the National Medical Advisor for a special Nestle program. He seemed like a caring man. Yet I read and hear on the news that he and his fellow Republicans and some Democrats in Congress say they are unwilling to vote for the much needed changes in our broken health care system. They all have wonderful health insurance and never have to worry about paying for medical care or growing old without care. How can they sanction the scare tactics they are using?

I am embarrassed when friends in other nations ask me what is wrong in our country that so many people are dying without medical care or losing their homes becasue of enormous medical bills. How can these Republicans and some Democrats sleep at night? Most Americans desperately want changes in our very bad health care system, yet these individuals in Congress are letting the medical complex line their pockets so they will fight any changes. They should be ashamed and embarrassed to let the health insurance, drug companies, and medical supply companies tell them what to do. They were not elected to Congress to be weak and spineless and put their greed ahead of people's lives.

Outrageous Lies About Health Care in England, Canada, and Europe

The health insurance and drug companies are pumping over one million dollars each day into the pockets of the politicians and lobbyists to ensure that the Democrats don't have even a slim chance of making real changes in our present broken health care system. Having worked at Hammersmith Hospital in London on several occasions I know that the British greatly value their health care system. I have been told that they would not like to be in the U.S. and know if they lose their job or have  major medical bills that they could lose their homes.

A doctor friend forwarded a long e-mail  she received from a Scottish friend  who had worked in the U.S. and then moved back to England. He could not believe what many people  in the U.S. are saying about British, Canadian, and European health care. He said that he was glad to be home so he would not have to worry about receiving health care for himself and his family. "Yes", he said, t"here are good things and bad things in our system, but no one would want the terrible medical problems you have in the U.S. where the insurance and drug companies are in charge of your health care".  He also said  he felt seventy percent of doctors in the U.S. were in medicine to make money, whereas in England and Europe, he felt the statistics were reversed with seventy percent in medicine to care for patients and only thirty percent in it for money. What a sad commentary on our present U.S. health care which appears will only get worse unless Congress passes a public option and legislates controls over the greedy drug and health insurance companies.

Dishonesty in Medical Journal Articles

In the fifty years I have practiced pediatrics I thought I had seen just about all the deep dark sides of medicine, but an article in today's New York Times taught me about another type of dishonesty in medicine. The article is entitled "A Call to Put a Halt to Medical Articles Drafted by Drug Companies". The reporter is Natasha Singer.  

I have had numerous articles published in prestigious medical journals and always found the review process to be very thorough. I did have to laugh at one reviewer who obviously didn't know much about neuromuscular disorders and questioned some of my facts. However, in general the reviewers knew that I was the sole author and that I certainly had no connection with any drug companies.

How can a professor in a medical school allow his or her name to be used on an article ghost-written for a drug company? What has happened to their ethics? One professor was quoted that it would take her too long to do the necessary research for the article and she wouldn't get paid! As a salaried medical school professor I can't imagine what she was thinking!

There is even a company called DesignWrite that writes articles for drug companies and then doctors are found who will put their names on the articles. How can  some medical schools be so lax to allow their doctors to do this?  The administrators can certainly do better. it is true that becoming a tenured professor in a medical school depends a lot on how much a doctor has pubished, but that doesn't make it right for these individuals to allow others to write their papers, particularly when there are connections with a drug company.

Bartering for Health Care

I found an interesting article in yesterday's San Francisco Chronicle by Tom Murphy. It was entitled "Health Care Bartering Just What the Doctor Ordered". As I read the article, I wondered what people in France, Canada, England and other countries with good health care would think if they read the article.

As a physician, I would be embarrassed to have my families "barter" for their children's health care. Either I reduced or elminated the charge if someone could not pay or had them  pay just a little each month. When I was in private pediatric practice in the wealthy community of La Jolla, I found that the rich were the worst about paying their bills, but those with little money always found a way to pay and were the least demanding.  There was at that time a small group of houses rented by Hispanic workers. They either paid a dollar or nothing  when I saw their children. Yet a partner who didn't last very long would charge them the full fee and  he was an Elder of his church! That has always bothered me.

Mr. Murphys's article stated that there are actually exchanges where bartering can be arranged. One of these is the ITEX Corporation. He also noted that a grandmother works' in a hospital kitchen and gift shop in order to pay off  her grandson's hospital bill of about $8000.

No wonder we have a health care crisis. I just hope the Democrats can stand up to the health insurance and  drug companies and put together a health plan that includes a public option. I am embarrassed that people have to barter for health care or work in a hospital kitchen in order to have good medical care for themselves and their families  We can do better as a nation.

Obesity a Significant Health Care Cost

Whenever I travel and sit in airports I am amazed at the number of people I see who are extremely obese. Many of these are young and often if the parents are obese, so too are the children. According to the Center for Disease Control and Prevention, 147 billion dollars was spent last year on obesity related medical care. Fifty-percent of the cost was paid by Medicaid and Medicare. In watching the town hall health care debates, I wonder if some of angry people I see who are obese are not receiving government support for their health care but just don't recognize that their medical care is a program paid for by the government.  

I believe that physicians are partly responsible for this problem. Many times I have been told by medical students and house staff that I am the only doctor they have ever heard ask a patient about their diet. Not one of the gastroenterologists I have seen over the years has  asked me what I eat and yet this is their speciality. We are what we eat, the saying goes.

I think schools and colleges are partly responsible, too, because of all the fast food available in the schools and on college campuses. Because many parents work two jobs, meals are often fast food which has many calories and is not always that healthy.  As a practicing physician, who was a single, divorced parent, I  planned meals on the weekend and did the necessary shopping. A live-in housekeeper was necessary becasue of night and weekend emergency calls, but my children and I ate breakfast and dinner together and I didn't keep snacks in the house except for some fruit. I think we can all make an effort to teach our children better ways of eating and hopefully reduce some of the obesity associated medical costs that include diabetes and hypertension.

Grandparenting Children with Medical Needs

Now that eleven million grandparents have either part or full-time care of their grandchilden, an up-to-date knowledge about their medical care is extremely important. Many of the children I saw in the Center for Handicapped Children that I founded and directed in San Francisco were brought to see me by their grandparents. Several of the grandaprents had medical problems themselves, but they were all exceptionally caring. It was becasue of the need for a book about grandchildren with special needs that I wrote the  book just released by Jessica Kingsley  Publishers of  London and Phildadelphia.

Fifteen years ago autism  occurred in 1:15,000 cases; now the statistics are sadly 1:150 cases. Many cases are genetic but others have no known cause and the idea that immunizations have anything to do with the disorder has been complely refuted by good medical studies.

Grandparents must learn how to navigate the complex medical maze and be aware of problems such as Malignant Hyperthermia for children with muscle disorders. If a child has spina bifida, a possible sensitivity to latex products must be understood. Babies now should not be placed on their abdomen to sleep and the list goes on and on.

I have just added a link on my Blog to the recent interview I did with Bobbi Conner of the excellent Parent's Journal. The link has been added so grandparents (and parents) are able to listen world-wide. I hope the information both in the interview and the book, "Grandparenting a Child with Special Needs" will be helpful and perhaps in some cases life-saving.

Big Money Behind Opposition to Health Plan Legislation

It is hard to beleive that so many Americans are buying the terrible lies being spread by the health insurance and drug companies, as well as rich Republicans who have ties to these campanies. A doctor friend recently sent me information about the amount of money that is being spent by the drug,  health product, and health insurance companies to keep health care in its present lucrative state. (For them).

According to the Center for Responsible Politics, health product companies spent $67,959,095 on lobbying, insurance companies $39,760,477, hospitals and nursing homes $25,552,0888. This is just for three months with a total of  $133,271,660. When your hear that 18,000 people die each year for lack of  medical care and one million homes are lost yearly due to medical bills, you wonder if any of these lobbyists have a conscience. How could you possibly be a lobbyist for one of these companies?

When I hear people like Sarah Palin say that President Obama plans to have a "death panel" to decide if  special needs and elderly people should live, I wonder how anyone could have elected her governor of Alaska. Don't people read newspapers and books or do they just look at Fox News or Facebook? Our country has sunk to new lows when I see individuals who receive Medicare screaming about not having any government control of medicine. Who do they think runs Medicare??

Different Reactions to a Serious Diagnosis

I am always amazed at the different ways that patients react to a serious diagnosis. Two different women show what to do and not to do. One woman has changed her life so that as much stress as possible has been eliminated. She is taking more time for her creative work, continuing with her exercise program, taking a special, long planned trip and receiving counseling. Her serious diagnosis has a good outlook at this time.

The other, younger woman is doing everything possible to make her condition worse. At the end of her work day, she is stressed and very tired. If she were my patient I would say "Either you make some drastic changes or I cannot care for you." I wonder if her doctor has even talked to her about what she does each day and how she is coping? Anyone who has a serious illness must take charge of his or her own life.  Most doctors today cannot be counted on to sit down and talk about how to make the best choices for survival.