Dr. Thompson's Blog

The Importance of Home Health Aides

I was talking with a good friend recently who was soon to have major surgery. She and her husband are both in their seventies and I was concerned about what plans were being made for her care after the surgery. I knew her husband was a good cook and usually did most of the shopping and errands, but who would be there to look after his wife when he was out of the house?  I suggested they insist their surgeon write orders for Home Health Aides to come in after her discharge. The couple had not been told that these could be paid for by Medicare or that they were even available. In the past, we always had a discharge conference when a patient was ready to leave the hosptial. That way everyone involved who was caring for the patient could have input.  This sadly seems to have gone by the wayside.

I explained to my friend that Home Health Agencies can provide RNs, physical therapists, individuals to cook, clean, or grocery shop. These aides can also be paid for by Medicare, many health insurance plans, and even Medicaid. However, in this day and age, a patient or their family have to push the doctors to be sure an Rx is written and faxed to the Home health Agency in the area where the patient lives. I have done this many times for my older neuromuscular patients, many of whom had little in the way of a support system. I kept checking about aides with my friend and her husband and when she was discharged, the woman said the surgeon finally wrote the prescription but he wasn't happy about it.  How is that possible? Does the doctor really want his patient to land back in the hosptial because of complications? I was astounded!

Small Children and Tragic Accidents

As a physician who has cared for many post-accident chidlren and seen parents devastated by the loss of a child because of an accident or drowning, I cannot understand something I witnessed today. I had been doing some errands and started for my car in a big parking lot. As  I started to cross the busy entrance roadway , I saw a beautiful little, probably two-year-old boy come around the car adjacent to his mother's and start out into the road. His mother was paying no attention to the child as she was heatedly talking on her cell phone and looking for something in her car. There was no way she could see him, as her back was turned to us. I turned my back to the road to keep the child from entering it and told him he needed to go back to his mommy. He gave me a puzzled look obviously wanting to explore the busy roadway. I stood between him and the road and tried to get his mother's attention. However, her cell phone call and whatever she was looking for in her car were taking all of her attention and she was oblivious to both her little boy and me. Finally, the child headed back toward his mother and the woman backed out of her car and saw him. She had absolutely no idea that he had been about to go into the busy roadway or the part I had played. I shook my head wanting to say something but decided against it. Repeatedly, I have seen parents that I wanted to shake when I saw them absorbed in a cell phone call or some other activity and paying so attention to their small children. Little ones can slip away very quickly and a fatal accident can occur in the blink of an eye.

 

When General M.D.s Try To Act Like Specialists

I was talking with a seventy-year-old woman the other day who told me of the urinary problems she was having. Her doctor is a general practitioner who says she "specializes in kidney diseases."  Training  in nephrology or kidney problems takes several more years than that of a general doctor who may practice medicine after a one year internship. The woman told me that she got up in the morning and urinated a great amount of bright red blood. The doctor did check a urine and said that it was probably a bladder infection. A CT scan was done showing no apparent abnomalities and an antibiotic was ordered. It was questionable if a urine culture was done and there was no follow-up urinalysis or urine culture, At no time was it suggested that a urologist be seen.

General practitioners may be outstanding doctors but when a serious problem occurs a specialist needs to be called in. No doctor can be an expert on everything. Of course in many HMOs, of a patient is referred to a specialist that decreases the referring doctor's salary. Money does come far too often into what is the  best care for a patient. Far too many women have chronic bladder infections that are not adequately treated by their general doctors. A good urologist needs to do an examination, order any necessary tests, and follow these patients. Unfortunately, a good urologist seems to be hard to find these days. My own experience tells me that!

Anorexia and Bulemia Today

I have been reading a good novel about a divorced mother who discovered that her teenage daughter had bulemia. I was surprised to read that the author had the mother first contact the school guidance counselor. As it turned out the mother discovered this was a very bad thing to do. Yes, it certainly was because the girl was pulled out of the lunch room and the word quickly spread about her problem. Guidance counselors in most schools are not trained clinical psychologists. Instead,  their main function is to keep track of attendance and find students who miss school. The next thing the mother did was look on the Internet and find a counselor's name that she "liked." Choosing a counselor by the sound of his or her name and not ckecking credentials makes no sense. The mother at no point called the girl's pediatrician or general practitioner. Don't parents trust their children's doctors any more?

When I was in private pediatric practice, I cared for many girls with anorexia and bulemia. I cannot remember more than one time that I had to hospitalize a patient. Instead, I worked hand-in-hand with a superb female psychiatrist and we got the girls back to fairly normal weight while they and their parents received on-going psychotherapy. I remember at a state conference when the director or a Eating Disorder Center at a well-known medical school would not believe that we could treat these patients without hospitalizing them. She was actually quite arrogant saying "It just can't be done." Well, we did it because we knew the families and worked closely with them and the girls. Also the girls trusted us. I think a child's doctor should be the first one called and hope the doctor will take appropriate action.

 

Checking a Doctor's Credentials

I was talking with an elderly woman the other day who was having some medical problems. She had been referred to a specialist and was afraid he was the rude doctor who had seen her during her recent hospitalization. I suggested that she check him out before keeping her appointment and she said "How do I do that?" I gave her two resources since she knew he was an M.D. The first was to put his name and location into Google. If that didn't work then I said she could try the Medical Board of her state.  They list all the licensed M.D.s  and give information about each one including any malpractice suits filed against them. Even if the doctor is licensed, it does not mean he or she is  good.  The next step is to do a lot of networking. A doctor may have had good training but be what I call a "technician" and not a real doctor. He or she may know how to prescribe medicine and order tests, but  have no interest in you as a person  and just see you as a statistic or a way to increase  billings.

In thinking later about all the people who now call themselves doctor, I realized that the first thing you want  to know is if the M.D. is  Board-Certified. Then if the individual is not an M.D., it gets trickier. Now there are "doctors" who are naturalopaths, althernative, holistic or  have many other types of background. Some have little or no real training. Another group are osteopaths, chiropractors. optometrists, podiatrists, clinical psychologists, and also nurses who get a doctor's degree in nursing and call themselves "Doctor." It can get quite scary. The other problem  I have recently encountered is that board-certified doctors in places like Santa Fe, New Mexico now practice alternative and holistic medicine.  Your life is in your hands, so always check out anyone you allow to touch you or prescribe medicine.