Dr. Thompson's Blog

Medical Care and the Republicans

I get shivers down my back when I hear Mr. Romney and Paul Ryan tell what they would do to medical care in the United States. Mr. Romney says that "He doesn't care about the very poor because they have safety nets" and yet the Ryan budget, which he supports, would take away the safety net. Mr. Romney says he will get rid of Planned Parenthood which allows poor women to have mammograms, Pap smears, and general health care. What is the man thinking? I realize that he has never been poor, hungry, and not sure where his next meal is coming from or what to do if he becomes ill.  He also says that he would make changes to Medicare, which means that many older and disabled individuals would be without health care. Of course, both he and Paul Ryan would get rid of the Affordable Health Care Act. I wish these two men could have seen some of the problems I have seen where famlies did not have the means to buy health insurance and if they did have coverage the insurance companies kept raising their premiums or cancelled their policies, if the cost was too high.

With the Affordable Health Care Act, insurance companies could not do this. They would also have to charge women and men the same amount for health insurance. At this time, women pay a great deal more than men.  Children now can stay on their parents' health insurance until they are 26 and kids cannot be denied coverage if they have pre-exisiting conditions. All this would change under Mr. Romney. I hope all Americans will realize what a disaster it would be for this country if the Republicans win in Novemeber,

Will the Affordable Health Care Act Be Saved?

As the Supreme Court starts three days of hearings and arguments about the Affordable Health Care Act, I am wondering why they are even bothering? I doubt that they will consider the law, but just vote along party lines. Justice Clarence Thomas should certainly not have a vote since his wife has a firm that has lobbied against the act since it was passed. I would be greatly embarrassed if I were Justice Thomas, but I suspect that little bothers him.

As a physician who has seen many people without health care and known how much they have suffered, I know how much we need this bill to be enforced. I still don't understand why many of the provisions don't go into effect until 2014, but perhaps that was the only way they could get it passed. The things that have already been accomplished are: College age young people can stay on their parents' health insurance until they are twenty-six and the insurance companies cannot deny coverage for pre-existing conditions. This is a particularly important provision. Also, an individual's insurance cannot be cancelled if he or she has very expensive medical care. Preventive health care services are covered which will save much money in the long-term. Of great importance is that women will have their health care covered for things such as breast X-rays, contraceptives, and Pap smears. This will save tremendous amounts of money and lives.

Guns and Kids

As I watched the news yesterday telling the horror of the newest school shooting, I wondered when, if ever, Congress was going to have the courage to stand up to the National Rifle Association and do something about the easy access to guns in the U.S. How many more young people are going to be killed in schools, colleges, homes, and in the school yard before parents and members of the community start screaming for something to be done? This violence must end. What must the civilized world think of America? We are the  most violent country in the civilized world. How can parents send their kids to school or college these days thinking that a shooter or more than one can claim their child's life?  I hope, too, that pediatricians and the American Academy of Pediatrics will take a strong stand and lobby Congress for something to be done.

I have  not heard where T.J. Lang, the shooter, bought or obtained his gun, but obviously he did not have a problem in finding one. The sad details of his life made him exactly the kind of teenager who would vent his anger by shooting. The news accounts gave details of his life that fit the pattern of an at-risk, unhappy teenager with apparently absent or no parents, a brother in jail for drug problems, and schooling in a high school for at-risk kids. I wonder if the youth had emotional problems that were untreated, was learning disabled, or had some type of mental illness? Any of these conditions could make him an angry young man who needed help. They also make him an ideal candidate for bullying. We MUST do better before more parents lose their children.

Pregant Teenagers

As I have watched the news the last few days I have wondered what the Republican men in Congress would do if one of their teenage daughters became pregnant? Would they insist the girl carry the baby to term, then insist the infant be placed for adoption, or would they make secret plans for an abortion? it is possible that they would have a family member raise the child, but in my experience with pregnant teens that doesn't happen very often.

Having cared for quite a few teenagers who became pregnant I have seen all of the above take place. It is tragic when parents insist a teenager carry a baby to term. if you have seen a pregnant, angry, and depressed thirteen-year-old whose childhood has been taken away, you will never forget it. I never had. If a teenager has an abortion, she can then go on to have a full and happy life. I know this from receiving letters from teenagers whose lives were not ruined by being forced to carry an unwanted child to term. There is nothing so sad as a baby who is not wanted, unloved, and put up for adoption. There is also a high incidence of abuse in children placed for adoption or given away. The Catholic Church talks about the "sacred gift of life". Life is not a gift when your childhood is filled with abuse, being unloved, and unwanted. Even being adopted by a loving couple leaves a big hole, as a long-time good friend often tells me. I don't understand why the women in the U.S. are not screaming? Yes, some are, but to allow a group of narrow-minded Republican men decide the future for countless children  is beyond my belief. There are already about 750,000 unwanted children ready for adoption. Are we going to start adding more?

Medical Research and the Drug Companies

Recently, I had an extended conversation with an internationally prominent physician. We talked at length about how badly medical care had deteriorated in his country and the United States.  Money seems to be the overriding problem.  When I asked what he thought about the progress of medical research in his country and the United States, the doctor said, "Sadly, the drug companies in the U.S. have taken over much of medical research. The companies often put enormous sums of money into drug trials, but if they don't get results very quickly, they end the studies. This is despite the fact that with more time there might be good results. The companies are impatient to get a drug out into the market, so they can start making a big profit.  Sadly, some M.D.s are allowing their names to be used on the articles when the drug studies are published, even though they have had no control and often have had little to do with the drug trials. I told him of a news account several months ago about a medical school professor who allowed this to happen and got into serious trouble, as she should have.

The other thing I learned was that some non-profit groups are raising money and giving the money to drug companies to use in various drug trials. They don't realize that the drug trials may not be set up and controlled by M.Ds, but by the drug companies. "The medical people must get back in control of these the doctor said." I certainly hope this will happen, but I wonder if it will?

 

 

Medical Concerns When Parents Push Their Kids

I was talking to a grandmother some time ago who told me of her concerns about what her son and daughter-in-law were doing to their only child. They are " hover" or "helicopter" parents who constantly push their son, never allowing him time to just be a child. Kids need time to lie on their backs and look at the clouds, dream dreams and make-up stories. Today, it seems that affluent kids are constantly busy with ballet, gymnastocs, swimming lessons, or tutoring. The suicide rate at prestigious colleges is worrisome and stress in children is a common problem that pediatricians have to or should address. Sadly, if the doctors don't know their parents and kids, stress may not be recognized and instead the child may be put on medication.

Now there is a new concern as affluent parents put their children in "educational" pre-schools, even as young as two-years-old. That is incredible to me. It has long been shown by Gesell and Ilg, the well known child deveopment experts, that starting school at a later date, particularly for boys, creates less stress and better long-term results. An interesting article in the New YorkTimes on May 27th by Winnie Hu discuuses the problem of "Too Young for Kindergarten". The author says that 38 states and the District of Columbia now have cut-off dates of October first to start kindergarten. Many parents are concerned about this, particularly low income parents who need their children in school so they can work. Kindergarten was formerly a time for kids to develop social skills and have fun. Now it is about learning to read and taking tests. No wonder our kids are so far behind other civilized countries in their education.  We are hurting our children by all this pushing and the educational, medical, and emotional results show what a bad job we are doing.

Politics and the Decline of Medical Care

I was startled and sad to hear a long-time physician friend say somewhat heatedly yesterday that the decline of medical care was due to the present administration. Since medical care started going downhill in the seventies with the advent of HMO's or health maintainance organizations and the beginning power of the insurance companies, that seemed an unusual statement for a bright physician. In thinking about his statement later, I realized that because my friend was raised in an affluent physician's home and in the Mormon church, he was spouting the doctrine preached by conservative Republicans and Mormons.

When an individual has always had money and not seen the pain of suffering of those without adequate medical care and limited financial means, it is easy to have tunnel vision.  Members  of Congress have excellent medical care and don't have any true understanding of how bad medical care has become in many places. Nurse practitioners have made great strides in taking over a lot of medical care and doctors now have hospitalists, ER doctors, and Urgent care Centers, so they have to work less and less. There are still some outstanding doctors but as I told my friend I think part of the problem is the students that medical schools now admit. Only the brightest are admitted and many of the young people are just interested in the money and prestige that being a doctor can bring. In addition, rote learning and passing tests is the main focus of medical schools today and compassion and concern about patients is not often discussed.

 

Electronic Medical Records and Insurance Companies

There has been a lot of controversy about electronic medical records. Many doctors in private practice say they will soon leave medicine becasue they are being forced to comply with the requirement for electronic medical records. It makes no sense for a small office to be required to make their records electronic.   Another problem is the  question of whether there is a privacy issue. If people can hack into phone and computer records, why can't they hack into your medical records?

Now it seems that insurance companies don't have to hack into a doctor's medical records but by signing a consent form at your doctor's office, you may be allowing insurance companies to have access to your records. This information was kindly sent to me by David Matthew of Software Advice. He gave me the link to an important  article by Houston Neal discussing how insurance companies review medical records to help them then decide if a patients are a good insurance risk, if they can be denied certain treatments , drugs etc. The link for the article is: http://www.softwareadvice.com/articles/medical/your-health-information-is-not-secure-its-not-an-emr-problem-1070811/

I can understand why big clinics and hospitals might be required to make medical record electronic  but if insurance companies can use this information to deny payments or cancel policies, which they will do if they possibly can, then big problems are ahead for patients. It seems to get worse and worse!

Gun Crazyness in Florida

It was hard for me to read the article in the current American Academy of Pediatrics News that Governor Rick Scott of Florida just signed a law that restricted  physicians or their staffs from asking parents or patients about guns in the home. Physicians could be punished by their medical boards if it was reported that guns wre discussed.  In the United States today, a child or teenager is killed every three hours by a gun. I wonder if Governor Scott has children? Does he have any idea what havoc this law could cause if physicians pay any attention to it? Other states are reported to be considering similar laws.    This is not only an incredibly stupid law but it takes away a physician's right to free speech and to practice medicine as he or she has been trained to do. There is no way that I would allow such a law to keep me from asking about guns in the home. If you have ever had to care for a child who was shot in the head by another child playing with a gun and then watched him die, as I have, you would fight hard against such a  law. I was a third year Stanford medical student at the time and this was the first child I had had to watch die despite our heroic efforts at San Francisco General Hospital.

People in other civilized countries don't understand why the gun lobby has such clout in the U.S. and why we have so many killings. Parents need to start complaining to their legislators. It could be your child who is at risk from another child who has found a gun in his home. if there are guns in a home they should be under lock and key and careful gun use taught to children.  

 

Outrageous Pay for Health Insurance Executives

As more and more people are struggling to survive from day to day, the cost of their health insurance keeps going up. When I read that the highest paid CEO in the U.S. is the CEO of UnitedHealth Insurance Company, I became very angry. How can CEO, Stephen Hemsley, sleep at night or look at himself in the mirror?  His enormous wealth has been created because many, many people insured by United Health have been and are being denied payments for needed medical care. Last year Mr. Hemsley made $101.96 million! In addition, he has stock options worth over one billion dollars. The other thing that bothers me about UnitedHealth is that they are the insurnace company associated with AARP. How could AARP possibly align themselves with an insurance company that doesn't care about those they insure but instead worships the almighty dollar? The CEOs of several other health insurance companies also make outrageous salaries.

I believe that health insurance companies should either have strong controls placed on them by the government or they should be eliminated. As a physician, I have never made  much money because pediatricians are the lowest paid of any M.D. Also I have spent the last thirty years caring for kids with disabilities which made my income even less.  Medi-cal payments are extremely low in Califronia, even if they pay at all and many of our familes had welfare or Medi-cal. At least, I can look at myself in the mirror and know that the joy I had in practicing medicine and the love I received from my patients and their families made it all worthwhile. I wonder if  Mr. Hemsley's money brings him any real joy?