Dr. Thompson's Blog

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.

Researching a Physician's Credentials

A good friend was having some urinary problems and said she was seeing a new urologist. The treatment she told me about didn't make any sense and I asked  if the doctor was board-certified. "How do I find that out", she asked? I said there are three ways: the first is to check the Web site of the Medical Board of California  (or your state) that lists doctors. It  gives  a doctor's  date of graduation from medical school and  training. The second way is to look at the doctor's card and the third way is to call the doctor's office and ask the secretary.

When my friend looked at the doctor's card she said it read "Board-certified in obstetrics and gynecology." It added female urology problems.  When I explained that the doctor was not a urologist, my friend was angry and upset. Obviously she had been badly misled was not getting the treatment she needed. Another friend did not know what the initials D.O. meant and didn't realize that the doctor who was about to do a D and C on her was not an M.D. Both of these women are older and intelligent, so I was amazed at their lack of knowledge about medical personnel.

There are now many initials that people in "health-care" fields are using after their names, so you have to be very careful. You should always know what a doctor's training has been and if he or she is an M.D., D.O., nurse practitioner or physician's assistant. If a nurse gets a Ph.D in nursing, she may call herself a doctor. She is not an M.D. and does not have the training that a board-certified physician has.

So never be afraid to ask questions and do research. It could mean the diffrence between unnecessary treatment or surgery or it could be life-saving!

Controls Must Be Placed on Health Insurance, Drug, and Equipment Companies

I am greatly concerned that any healthcare bill which is passed will  give the greedy health insurance, drug, and medical equipment companies just that much more money. If there is no Public Option and if no controls are placed on what health insurance, drug, and medical equipment companies can charge, every American, except for the rich and members of Congress, is in for BIG trouble. I cannot emphasis this too much.

As a practicing physician for fifty years who has worked in both rich and poor parts of the U.S., taught in three medical schools, and cared for kids with special needs for more than forty years, I have seen the best and worst of medicine.

The rich Republican members of Congress who have not had my experience watching the terrble deterioration of U.S. healthcare should not be allowed to even have a voice in healthcare legislation as far as I am concerned. They have the very best possible health insurance and receive the best possible medical care for any medical problem that they or their families may have. How can they possibly understand what it is to lose a child,  beloved family member, or friend to inadequate  or NO medical care?  How can they understand losing a home because of unpaid medical bills?

There are some wonderful doctors in the United States who work against the overwhelming odds of mounds of paper work which the insurance companies require and result more often than not in denial of treatment for a patient. Denying care for a patient is the way to increase  insurance companies'  profit and they do it every time they can. Our present medical system is an embarrassment.

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.