Dr. Thompson's Blog

What Could Happen with Another Conservative Supreme Court Judge

It was a great loss when Justice Ruth Bader Ginsburg died yesterday. She was an outstanding woman and a great fighter. Now Trump and his group are gleeful thinking they can get rid of the Affordable Health Care Act and leave thousands of  people without medical care. That would be a tragedy and the poor, the disabled and minorities will be hurt the most. I have never understood why there is no Republican health care act when Trump keeps saying there will be. How could any caring individual deprive thousands of the ability to see a physician or go to the hospital ? That is inhumane.

Not only will Obamacare be at great risk, but pregnant teenagers, poor women and those with an inheritable lethal gene will be at risk. Abortions are already being impacted, but if a woman with several disabled children, such as  Duchenne muscular dystrophy,  realizes she must continue having children with a lethal disorder that is cruel and wrong. I had one  mother of three boys who all died from Duchenne dystrophy and her sisters also had  boys with the disorder.  The woman's  husband disappeared, so no more children were fortunately born with the disorder. One mother who had two boys with the disorder told me she had no idea what she would do if she could ever have time for herself. Her whole life was taking care of her two boys with no help, little money and no time for friends or fun.  

Your Choice of Medical Care Can Make a Difference in Your Life or Your Child's.

I have seen some very good medical care and some that is unbelievably bad. My parents had a doctor they loved but he was most inadequate and would ask me what tests to order for my mother! I was in Northern California, he was in Southern California, and I was a pediatrician. I found an excellent internist for my parents but they refused to change. I suspect it was partly for financial reasons, since the  doctor was in Kaiser. My mother died of a stroke and I am not sure the doctor ever saw her. 

A good friend never saw an M.D but was being cared for by a nurse practitioner in an HMO. I urged  him to see an M.D., but he liked the nurse practitioner. He  died suddenly at age 59 and was a brilliant man. It was a great loss.

A remarkable woman who helped many children told me a few years ago about a medical problem she had that her HMO doctor ignored. I urged her to change doctors but she did not. A year later my friend was found to have diffuse cancer and had several very bad and painful years. She died recently. She could have afforded to get a second opinion or change doctors, but she did not. 

I am always puzzled about how patients make medical choices. Even extremely bright patients make strange and unusual choices. If you chose a doctor, you want to check where he or she went to school, if they are board certified and also read some of the reviews that patients write. Your life or your child's may defend on it. 

Lobbyists and Health Care

While many people are hungry or at risk  of losing their homes because they are unemployed, the health care lobbyists are working hard and have been very successful. Hospitals and others are paying lobbyists thousands of dollars to be sure they are included in the different laws  Congress has passed to help businesses. Hospitals are suffering because elective surgeries are markedly decreased and because their CEOs often make several millions of dollars.

One of the major lobbying firms is Brownstein, Hyatt, Farber and Shreck. They were able to see that Tenet Healthcare received more than 1.4 billion dollars in Cares Act grants and loans. This is while small businesses are in trouble or having to close and people are relying on food banks to feed their families. Several of the lobbyists have personal connections to Trump and his  group. 

I am told by a Washington insider that many of the bills which come out of Congress are written by lobbyists and may be as long as 800 pages. Walgreens has received 35.2 million, Johnson and Johnson 15.1 million and Eli Lilly 7.6 million. 

I hear about healthcare in other countries and wonder how the U.S. can be doing such a bad job. Money here seems so much more important that good patient care. If you have money you can get good medical care, particularly if you join a Boutique medical practice or have a connection to a hospital. I would be ashamed to make the salary some doctors get when there are poor people and others who can not afford even basic medical care. Yet  Trump keeps trying to get rid of the Affordable Healthcare Act because he is so jealous of what President Obama accomplished

Dangerous Medical Advice

I am greatly appalled at the medical advice that Trump and some of his group keep giving. First it was bleach that was going to cure the virus, then it was hydro-chloroquine which can be very deadly and now it is convalescent plasma. Trump even got the head of FDA to give an emergency authorization for the use of this plasma in patients with the corona virus. The  doctor was trained as an oncologist, but then became a hospital administrator. Even most medical students know you do not prescribe a new treatment that has not been put through standard double blind tests on thousands of people to show it would be effective and not dangerous. I guess it is more important for Trump to say there are new treatments for the virus, so he can be re-elected. In doing this he is putting people's lives in real danger. I wonder what will be the next wonder drug or treatment he will push?

If he tries to push a vaccine before it is safe, there will be illnesses and deaths. People will also be afraid to  have the vaccine if and when it is actually safe.  I certainly understand that. We have enough problem now with parents who will not let their children be vaccinated for diseases like measles, polio, tetanus and diphtheria and other illnesses. These children are being put at great risk. because of this. 

Mail Problems and Health Care

I am greatly concerned that Trump and the new Postmaster General will do everything they can to slow down the delivery of mail before the election. I was amazed to read that 1.6 billion prescriptions are sent to veterans, seniors, and others through the mail. Fighting the virus is bad enough but having to fight to get your prescriptions is completely wrong. Of course when Judge Berry, Trump's sister said he was "cruel" I guess  if veterans, seniors and others do not get their medications, it is of no concern to him.  

I think every one of us who have or had veterans in our family, knew veterans, or are worried about seniors have to speak out and not allow this to happen. Prescriptions have become so expensive, I wonder how the average citizen is able to manage. There are some organizations that offer help with the cost of prescriptions.  Partnership for Prescription is one and their website is www.pparx.org and their telephone number is 1-888-477-2669.  GoodRx and similar discount groups also offer help with the cost of prescriptions. It seems so wrong that the CEO, Larry Merlo, of CVS which also owns Athena Insurance made 36.5 million last year. No wonder the cost of prescriptions is so high. I would be embarrassed to make a salary like that particularly when there are so many people in this country  who are now jobless and homeless. 

Be Aware of Medical Misinformation, Unnecessary Tests, or Medications

Medical misinformation or unnecessary tests can cause a lot of problems and hurt patients.  There are some excellent Internet sites such as the Mayo Clinic, but even medical books can have statements that are incorrect.  Several years ago an article of mine was published about a Duchenne muscular dystrophy patient who had a child. I had sent blood from the patient, his wife, and child to a prominent geneticist at USC Medical Center to ensure the child was the son of the father.  Probably still in medical books today you may read that Duchenne dystrophy males are unable to  have  children. The Internet has several websites that contain erroneous information, so it is always wise to check with a physician you trust if you have a medical question. When you see an M.D., it is also wise to ask why a specific medical procedure, X-ray, MRI or blood tests are needed. My  granddaughter saw an internist for a physical exam at a California medical school. However, the physician did not take a history or do a physical examination but instead ordered a bunch of lab tests, none of which were indicated. The one test she should have ordered was not ordered. She also never called my granddaughter to give the results of the tests.  So bad medicine exists even in medical schools. If a new medicine is prescribed, you want to be sure it does not interact with any other medication you may be taking. Too many physicians do not check about interactions. A good pharmacist can help if you have questions. Some medicines should not be taken on an empty stomach, so that is also wise to check. 

The Problems with Telemedicine

I have a neighbor who is a psychiatrist and telemedicine works well for him and his patients. I am not sure about payment because Medicare and some insurance companies do not pay for telemedicine consultations. However, he is not one of the greedy doctors, so for him helping his patients is what matters. 

The there is the other side of telemedicine. A woman who is probably in her eighties and lives in a senior center was having terrible back pain. Her insurance company referred her to a pain specialist. It turned out the woman was a DO and not an M.D. or orthopedist. She talked to the patient by way of telemedicine and said she would  prescribe some medicine and also order back X-rays. She did not order an MRI of the back or refer her to an orthopedist. After seeing the X-ray report she was going to order some injections into the back when my friend called me. I was appalled. How could any M.D. or D.O. order injections and medicine when she have never examined the patient? It would be like me as a pediatrician using telemedicine to decide if a child had a strep throat, an ear infection, or something like meningitis. That is just very BAD medicine and should not be allowed. My friend promised to cancel the appointment for the injections and find an orthopedist or a spine surgeon. 

The only way a medical problem can be addressed is by taking a good history and doing a complete physical examination. I could never survive in an HMO like Kaiser where a doctor is limited to the amount of time he or she can spend with a patient. I have picked up some amazing things by being thorough and also knowing my  patients and their families. Oh for the good old days of medicine!

Caring for an Elderly Parent

It is hard work to have to care for an elderly parent particularly if they are not close. I know because I flew 400 miles twice a month to care for my father who was in a nursing home. The staff knew I was checking on him regularly, so they mostly did a good job. The medical care was not great but I always checked the orders that were written and called the on-call doctor if I saw a problem. Dad was a very non-complaining patient. The principal problem was a lot of things, including clothes disappearing from his single room and the worst was when he didn't have his glasses so he could read. I'm not sure why they disappeared. Most health care workers in nursing homes do not receive much pay but many are very caring.

With the nasty virus that is now present, I understand that family members are not being allowed into nursing homes. I am not sure how the  patients are surviving such confinement. Even homes for seniors are very restrictive and the individuals have little freedom.

Some doctors use nursing homes as a way to make quick money. They visit infrequently and may over bill. It is important if your parent is on Medicare to be sure the charges are correct. If not you can call 1-716-586-1770.

All seniors need to have signed a Living will, so you will know what their wishes are if a serious illness occurs. I would not be willing to be kept alive with lots of tubes etc. Your primary doctor, a family member and the senior center or nursing home should have a copy. 

 

 

 

 

 

How Each Individual Can Make a Difference During This Pandemic

I now live in a beach town, which I do not like, and am constantly amazed at the behavior I see of far too many young people and adults. Few people wear masks and social distancing is not practiced. No wonder many of the beach and border states are seeing a great increase in the number of corona virus cases and deaths. No it is NOT cool to go without a mask and to attend parties or to carry on as though the pandemic did not exist. Being deprived of activities such as eating out, going to bars, and attending big parties seems to be intolerable to many. The virus is NOT a hoax, as Trump likes to insist. I do not know what bubble he lives in. Where are the courageous Senators and others when we need them. I applaud Senator Romney for being the only one to stand out against what the White House is saying. We must listen to the medical experts, such as the great patriot, Dr. Anthony Fauci. How lucky we are that he is still speaking  out and in practice. My friends in other countries, many of whom are in the medical professions, are puzzled about how this country got into such a mess. We can beat this virus, as we have others, such as polio and measles. However, we all have to help and those who think they are entitled to act however they wish are hurting  the rest of us.  If they have ever seen someone die of a serious illness, as I have, they would re-think what they are doing. At least we can HOPE!

 

Leadership and Epidemics

I was an intern at Children's Hospital in San Francisco during the bad polio epidemic. The hospital was the place where all the children and private polio patients were sent. It was a difficult time for me but how glad I was that President Eisenhower didn't say, as has Trump, "You just have to live with it or get used to it." Fortunately, Dr. Salk was busy working on a vaccine and how delighted I was when it was available for wide spread use. 

I remember growing up  during the polio years how we were not allowed to go to swimming pools, movies and similar things. Now many people in the U.S. are following Trump's lead  not wearing masks, not social distancing, and attending events with large crowds. I am often the only one I see wearing a mask in the beach town where I now live. I hope that  because of their arrogance that they do not have an encounter with the virus. I also hope that parents will protect their children since Trump and his group don't seem interested in doing so. Maybe if more of his intimate circle are affected with the virus, as seems to be happening to the Secret Service men and women, that Trump will begin to realize  we have a very SERIOUS problem. I am sorry that President Eisenhower or another real leader is not in charge. Hopefully, that will change in not too many months.