Dr. Thompson's Blog

Choosing a Retirement Living Facility

A  friend called me recently to see if I had some thoughts about retirement homes. She knew I had had experience with my parents in checking out various places. One of the most important things I suggested was to see what medical care was available and if an R.N. was on duty at all time. Also, how near was a hospital and was it a good hospital. Many retirement facilities have very strict rules about when and where you can eat and when the laundry facilities are available. Some places  have good food and others have plain, almost inedible food. If  someone has allergies or a condition like celiac disease, they could be in trouble. Special diets are usually not catered to.

If you don't enjoy playing bridge or being idle, it is important to see if there are any fun trips to go on, who the other residents are, and the general intellectual quality of the individuals living there. My friend is a bright, published writer with a Ph.D and would need a place where there is some intellectual stimulation, not just silly activities and lots of card playing.  

The cost is always a big issue and if you don't like the facility can you leave without losing a lot of money? Some places let you pay a monthly fee, while others require an individual to buy their apartments. This can be very costly. So asking a lot of questions is important, as is  talking to various residents and eating one or two meals at the facility. 

Muscle Weakness and Neurologists

If a general physician or pediatrician see a patient with muscle weakness, they most likely will refer the child or adult to a neurologist. Sadly little is taught in most neurology programs about neuromuscular disorders. Several or our top neuromuscular specialists: Dr. Munsat, Dr  Peter, Dr. Rowland, and Lord John Walton in England  have died in the last few years.  Now there are few programs left in the U.S  where physicians can learn about neuromuscular disorders. Most neurologists order a battery of genetic tests when they have a patient with muscle weakness. They have usually not been taught how to do muscle biopsies or read muscle biopsy slides. All are important before a diagnosis is made. Often they will see an elevated  CPK, a lab  test, and immediately make a diagnosis of muscular dystrophy. The incidence of misdiagnosis in the group of muscle disorders is very high. I now will only refer patients to Dr. Selcen at the Mayo Clinic or to specific centers in Europe. 

I suspect part of the reason there is so little interest in having neuromuscular programs is that  they are not  money making. Money sadly seems to be taking over medicine in the U.S. like in so many other areas.  Thus as a parent or patient if you or someone in your family need a diagnosis, I would check on a neurologist's training and see if he or she has spent time in a neuromuscular program. Many neurologists say they are neuromusuclar specialists but if you  check the Internet  about their training it is easy to see if this is true or not. A series of genetic tests is NOT adequate to make an accurate diagnosis of a neuromuscular disorder.

There are treatable neuromuscular disorders, so an accurate diagnosis can make the difference in a patient's life.

The Problems with So-Called Free Medical Care

I wish the Democratic candidates who are proposing free medical care had some experience with bad medicine. What free care would mean is that a patient would be assigned a doctor, a nurse practitioner, or physician assistant. Free choice would be gone as would the ability to see a particular specialist. Everything would  have to go through the primary care-taker and the answer would most often be "No". This is the HMO and Kaiser system. In many HMO systems, a scorecard is kept of referrals, lab tests etc. and the primary caretaker's pay reduced according to how many referrals he or she had made. I would last about 5 minutes in such a system. In addition, there would be a time limit on the number of minutes a patient could take. The usual number is about 10 to 12 minutes. I can't even say "hello" to a patient in ten minutes.

Children and adults with serious disabilities would suffer greatly. HMO's in general only want healthy patients. When I had a child or older patient with a disability it would take me at least an hour to do a history and physical examination.   Another hour would be taken by  checking past medical records, communicating with other doctors, PTs, OT's etc. and then dictating a report. If a patient suddenly had to go to an emergency room and there was no pre-authorization, a very large bill could result. Hospitals would have markedly reduced incomes and drug, health insurance companies, and medical equipment companies would fight the so-called free medical care plan with millions of lobbyists. Let's hope the candidates who are advocating this crazy plan are defeated. 

The Problems with Medicare for All

I very much believe in health care for everyone, but do not believe that Medicare for All would work. There will be terrible lobbying by the drug and medical device companies, as well as the health insurance companies. I agree with Representative Seth Moulton that keeping and expanding  the Affordable Health Care Act, allowing a choice of good insurance plans, as was in the Public Option, and allowing a buy-in for Medicare is the way to go. Medicare for all would greatly reduce the money paid to hospitals and doctors and I don't see the U.S. bureaucracy being able to administer a health care plan for all, as is done in other countries. 

One thing that can be done right away to reduce health care costs is for Medicare to be able to negotiate drug prices, as the VA does. The drug companies are making obscene amounts of money. Last year they made 69 BILLION dollars. Yet one in five individuals in the U.S. cannot afford their medications. Our mental health care in the U.S. is very bad.  Rep. Moulton, an Iraq war veteran, says that 50 % of veterans  have PTSD, as he did, and yet  most do not get mental health help. My brother was one of those after the Second World War. It changed his life. Rep. Moulton says that two weeks after discharge a veteran should  have a mental health check-up and then annually. He also suggests this as part of yearly physicals for kids, but because  pediatric care in many places has become so inadequate, I don't see this as happening. We have get resources in this country, and some excellent doctors, but money seems to the real problem now with our medical system, as well as lots of greed.

The Consequences of the Alabama Abortion Ban

I shudder when I think of pregnant teenagers, the women too poor to  have another child and a woman who has been raped and become pregnant. To me children are very special, but to think of any child being raised in a foster home, being unwanted or abused makes my blood curl. The pro-life people think they are doing something wonderful to be sure a child will be born. But what about a child who is unwanted, the child of a teenage single  girl who has no maturity or ability to care for a child? I have seen patients like all of these. The pregnant teenage girls I cared for when I was in private pediatric practice where not even grown up themselves. Their parents would have kicked them out if they had known they were pregnant. What would  the girls have done then? Would they have become homeless, become prostitutes, or married a rich older man and been miserable.  It is fine for the pro-life people to stand on their principles. No one loves children more than I do. But these pro-life people don't seem to know or understand the consequences of a child who is unwanted, the mother who can't support another child or a woman who  has been raped and unable to  care for a baby. I wish the pro-life people could talk with some of these individuals.

As Trump is determined to get rid of the Affordable Health Care Act, reduce  funding for Medicaid, food stamps, and every other form of social support, these woman and teenagers  will have an even harder time if they are forced to have a baby they cannot care for. 

Tragic Problems with Some Medical Devices

An article in the New York Times on 5/5/19 was frightening. The title was " 80,000 Deaths. 2 Million Injuries. It's Time for Reckoning on Medical Devices." There have been multiple lawsuits, particularly about pelvic mesh. It said that "most of these medical devices were approved for market with nearly no clinical data." It also said that "most medical devices are poorly vetted before their release into the marketplace and poorly monitored after the fact." I guess the medical devices lobbyists  have been very busy and successful! Fortunately, the F.D.A pulled the vaginal mesh products from the market last month. The article went on to say that some metal hips, defibrillators and artificial heart valves have caused problems. Other pieces of equipment used in operating rooms  have also caused problems. It makes you  want to stay far away from doctors and hospitals. Money has become so important in the U.S.and morals seem to be lacking more and more. That leaves all of us as patients at risk. I think you have to careful research physicians and hospitals. There are still some wonderful doctors, but having had a recent experience with a doctor I would call a technician and not a doctor, I have become even more cautious. Fortunately, I survived his atrocious surgical care and will ever see him again. Sadly, good doctors often recommend a  colleague or partner and have no idea how he or she practices. 

Despite all the lawsuits against them, the medical device industry  earns about 400 billion dollars annually. I find that amazing and tragic. They seem to care more about making money than saving lives and helping patients. 

The Greedy Drug Companies

When Trump became president, one of the false promises he made was to lower drug prices. Instead, they seem to go up almost monthly. I heard an appalling statistic yesterday. It was that the drug companies last year spent 30  BILLION dollars on lobbying. When we have thousands of hungry children in this country, people working two jobs to try and survive, and a tax law that gave major tax breaks to corporations and the super rich, it is embarrassing.

I had an opportunity last week to speak with a couple from Norway and one from the Netherlands.  Neither couple could understand what has happened in the U.S. with the Trump group and the mess they have created.  There is excellent, free medical care in both countries and both couples said they always thought America was a world leader. We   have lost that status. There are now more lobbyists in Washington D.C. than there are members of Congress. 

As parents and grandparents and every day citizens, we certainly need to let our voices be hard. Drug prices must come down. There is no reason that the government cannot  negotiate with the drug companies and also pass laws that don't allow such greed.

Many people do not fill the prescriptions they need because of the cost. It is either that or they skip meals in order to pay for the drugs and yet we are the richest country in the world. How can we allow such a terrible problem to continue?

Many Medical Schools are Graduating Technicians, not Physicians

My favorite professor when I was a Stanford medical student said " I can train almost anyone to be a technician, but I cannot train just anyone to be a physician." He taught us a physician should have concern for his or her patients, get to know them, and truly care about them. He was a wonderful neurosurgeon.  I am seeing more and more medical students who know what to do on a computer, but many seem to have little or no compassion or concern for patients.  An outstanding older surgical nurse told me today she is seeing the  same thing in many young nurses. She said for them it is all about earning a big salary. If caring for patients is not why someone goes to nursing or medical school, our country is in big trouble. I loved the British nurses when I worked at Hammersmith Hospital in London. Several told me they wanted to take care of patients, not be administrators or head nurses. 

A Kaiser administrator I recently met in an airport asked me what I thought about Kaiser starting their own medical school. I said I had no problem with that as long as they had doctors teaching the art of medicine, as well as good clinical care. If all they do, as sadly I am seeing in many medical schools, is to  just teach the mechanics of medicine and not art and caring then I hope it is not built. Patients also need to be taught how to find the best medical care and not accept poor care from either doctors or nurses. We have some wonderful doctors and nurses in the U.S., but many are dropping out and giving up because  medicine has become a business, not a caring profession. For many it is about money and prestige.

The Border Problems and Family and Pediatric Doctors

It is so hard to hear and see all the misery and terrible care that children and people are receiving at the border. Some children and adults have died. Now that Trump has decided to get even tougher  on immigrants, as physicians I think we all need to speak up. I realize it is hard to be a practicing physician, who is trying to earn a living  to also have to worry about the people at the border. I can remember how tired I would get when I saw patients all day and often into the night and then went to Mexico on weekends to see children.  I  went several time with the Flying Samaritans to a clinic in  Mexico where long lines of people would be waiting overnight to be seen. We worked on cold pavement floors and I always wore a warm jacket to try and keep from shivering. The patients were very grateful for our help and I think we did some good. The best thing I felt I accomplished was to  have some polio vaccine donated and also to refer several cases to orthopedists and other specialists for care in San Diego. 

Now however the problem is  much worse as Trump says "The country is full" and he wants to reinstate his family separation policy. I don't know if some of the family doctors and pediatricians are being forceful about complaining and helping.  I hope so. I also hope the members of their National Boards  of  Directors are complaining to Trump and to Congress. The children in cages are going to suffer long-term effects. We are creating a terrible problem, made even worse because Trump has  taken away the money we formerly gave to these impoverished countries south of the Border.

Good and Bad Health Insurance

The Trump administration is doing their best to destroy everything that President Obama accomplished with his health plan. Now they are allowing junk health insurance to again be  available. In addition, they are doing their best to get rid of the Affordable Health Care Act.  If they do twenty plus million people will lose their health insurance.  Those with pre-existing conditions will be in deep trouble. Also, those with large medical or hospital bills will find that the new junk insurance will not cover their bills. Also, the junk insurance companies can take away insurance from an individual if their medical or  hospital bills get too large. Because Trump has had millions of dollars available to him, even as a child, he has no concept of what not being able to pay your medical bills is all about. The Republicans have no back-up plan if they destroy Obamacare. This is unAmerican and wrong. 

In my book, 101 Ways To The Best Medical Care, I have a large Appendix with many websites that could be helpful if you lose your insurance. A good one that gives a comparison of different insurances is: www.ehealthinsurance.com. There is also a list of state departments of insurance and health that could be helpful. Many people end up signing up for HMOs because they are cheaper. Unfortunately, you usually do get what you pay for and there are lots of problems with HMOs. In my book, I describe these and also what you should check in before you sign up with an HMO. One of my biggest worries about HMOs is that they allow nurse practitioners to see patients without the supervision of physicians. I have seen some tragic results because of this policy. We have to fight the  Trump administration to ensure every American gets the best medical care possible. I spend a lot of time helping parents and others find ways to get good medical care for their children and themselves.