Dr. Thompson's Blog

Choosing Medical care By Cost Not Quality

It seems that the quality of medical care in the U.S. is getting more and more like a business and not about providing the best medical care to patients. There are now two Web sites where you can look for a doctor by how much he or she charges. You will have no idea of the quality of care, if the office is  clean, and you are going to see a board-certified doctor or a nurse practitioner or physician's assistant. You can look up the physician on a state medical board Web site but that will only list malpractice suits and not give you any idea about the quality of care. Of course, if you belong to an HMO and are assigned to a physician you also have no control over the quality of care.

I am always amazed about how even intelligent people chose to spend their money. Many pay as little as possible for medical care and yet take long expensive trips, buy expensive clothes, or expensive "toys". I would rather pay more for medical care and save on trips, clothes, etc. The choices we make about how we spend our money can have a major impact on our lives. An inadequate physician or one who should not be practicing medicine at all could mean a difference in your immediate or long-term survival.

The two Web sites are PriceDoc.com and OutofPocket.com. These Web sites also list the cost of various procedures. Remember that an X-ray of poor quality or one that is misread can lead to a bad or even tragic outcome, as can lab work that is not properly done. If a procedure is not done by a well trained individual the results will be both invalid and misleading. Your health is in your hands and the choices you make about medical care could change or even end your life.

When and How To Change Doctors

It always surprises me that people will keep going to a doctor that they don't really like or just  feel he or she  isn't very good. If a doctor is greatly skilled in the art of medicine his or her patients may stick with the doctor through thick and thin. My own parents did this despite the doctor being grossly incompetent.  They were not medical people and didn't realize that his great bedside manner covered up a major lack of medical knowledge. My mother paid for this with her life.

If you have even the slightest concern that your doctor or a specialist isn't the best, you can first get a second opnion or you can just find a new doctor. I would first check the state medical board Web site to see if there have been any malpractice charges against the doctor. Then do lots of networking to see if you can out about find his or her reputation. If you have a doctor friend to ask, this  could help but remember the doctor you are asking about could be a neighbor or a friend and how he or she practices medicine may not really be known. Please don't ever put up with a lack of interest, a poorly run office,  bad billing practices or  a really incompetent physician. There are some wonderful doctors in the U.S. but you may have to do a lot of research to find just the right one for you. Of course the HMOs and PPOs make it difficult to change doctors, but your life is in your hands.

Controversy about Cancer Screening Guidelines

I just had a phone call from a man I know asking my thoughts about the new cancer screening guidelines. I said that my advice would be to ignore them. Then he made a very interesting statement that could certainly be true with the amazing power the health insurance companies have over our legislators and our country. The man remarked that if the new cancer guidelines were in place the health insurance companies would not have to pay out so much for cancer screening examinations.

We then discussed the pending health care legislation and he said that he had called his congressman saying "Please don't vote for it." I agreed that unless strict controls were put on the health insurance and drug companies, as well as the medical equipment companies, that we would all be losers. The idea of a public option that would have an "opt out" provision makes no sense at all. The only way a public option will work is if it was made as powerful as the greedy health insurance companies.

I have great fears for the future of health care in this country and think anyone going into medicine these days may be in for some most unpleasant surprises. I loved practicing medicine, but that was in the days when doctors were in control, not the health insurance, medical equipment, and drug companies.

Genetics Testing-Pros and Cons

Many pediatricians and family practice doctors refer a child to a geneticist if they are unable to decide on a diagnosis. This is particularly unfortunate with pediatric neuromuscular disorders. Unless a geneticist has had neuromuscular training, the referral can result in numerous unnecessary and unpleasant tests, as well as misdiagnosis. If the geneticist is connected with a neuromuscular center as was Dr. Margaret Thompson, co-author of the genetics textbook, Thompson and Thompson, or Dr. Alan Emery in the UK, then the referral is usually a waste of time and money and can cause unnecessary distress.

Now I have read in an 11/16/09  article in the New York Times by Steven Greenhouse that a new law has been passed to prevent employers and health insurance companies from requiring genetic testing or obtaining family histories of an employee. The fact that this has been going on is new to me. I am delighted that some good legislation is coming out of Congress. It makes no sense that an employer had a right to ask for this kind of information. Even if genetic testing is done there are many variables in how the results can be  interpreted. Thus very dangerous information may be obtained that should only be interpreted by an expert in the field, not an employer or a health insurance company.

Ear Infections in Infants and Children

I hear frequently from parents across the United States that their family doctors and pediatricians don't seem to know much about the treatment of ear infections. Some of the older doctors were trained to do lancing or myringotomies for bulging middle ear infections but now that seemed to be a thing of the past. With the otoscopes or instruments that are now mostly used by doctors, there is no way that an ear canal can be cleaned or a myringotomy done under direct visualization. I have done a myringotomy even on a six-week-old baby who came in for a well baby check, but who I found had a bulging, bright red ear drum. I was amazed at the amount of pus that came out. This was a baby who could easily have developed meningitis or mastoiditis.

The signs of ear infections are variable and depend somewhat on the age of the child. Babies may just be irritable or cry a lot. Also they may or may not have a fever. Some will cut down on their milk or food intake. Older children may pull at the affected ear or keep their head turned to the side where the ear is painful. If there is a thick, pus-containing discharge coming from the ear then the ear drum has probably broken because of an ear infection. I then would see a pediatric ear-nose-and throat doctor and probably not bother to see a pediatrician or family practice doctor unless they have had wide experience treating ear infections.

With the increase in hearing loss among children and teens in the U.S., ear infections must  be taken very seriously. Sometimes doctors put children on many courses of antibiotics without referring them to an ENT specialist. Thus parents must be agressive and take their child to see a pediatric ENT doctor. Nurse practitioners and physician assistants should not treat infants or children with ear infections. If the doctors are not doing a very good job with ear infections, it is not fair to expect someone with half as much training and often little pediatric training to treat ear infections.