Dr. Thompson's Blog

The Good and Bad Changes in American Medical Care

As  politicians talk about Medicare for All and Single Payer Health Care, I wish at least one of the politicians had some medical training. They have no idea of what a terrible mess we could  have with either of these. I certainly believe that everyone in American deserves the best healthcare possible. However, even though there have been some remarkable advances, particularly in surgical devices that allow procedures such as hip and other replacements, there has been a great decline in personal care, compassion and good old-fashioned medicine. I greatly miss seeing my babies, children, and teenagers  as I did when I was in practice, but I would not tolerate all the paperwork and regulations that are now required of physicians. 

Now we are seeing too many suicides and depression among medical students, young and older doctors.  The joy of really getting to know your patients and being an important  part of their lives is mostly gone, except perhaps in small towns, as in the Midwest. Many medical schools are turning out graduates who have no training in the art of medicine, but they do know how to click boxes on a computer. Money is the driving force for many of these students, as we can see from the number choosing cosmetic dermatology. They won't have night or weekend calls and can make very large amounts of money. Nurses are not being given much information about physical diagnosis, even those who become nurse  practitioners. I have seen some serious results because of this. Some nurses are choosing to become hospital administrators and this too can create major problems. A caring, compassion nurse is worth his or her weight in gold. Some nurses have minimal training and then if they become nurse practitioners they are often seeing patients without an M.D's supervision.  In many states now they can both see patients without a doctor's supervision and write prescriptions. With the shortage of  doctors that is envisioned, nurse practitioners will take over a great deal of medical practice. Kaiser already allows this.

Trump, Pence and Women's Health Care

I am amazed that Trump and his group are not only trying to get rid of the Affordable Health Care Act, but now they are insisting that Planned Parenthood start charging for things like Pap smears ($264) and contraception injections. ($1000). Many poor women will thus be prevented from having access to the needed preventive care, so they won't get pregnant. Then if a child is born to a poor woman who could not  afford to have an abortion or pay for contraceptive injections, many of these children will be hungry and often be homeless. The Republicans don't seem to care that we have thousands of hungry, poor homeless children. That added to Trump's  immigration policy where nine children in the cages have died from lack of medical care, our  allies must think we are all monsters. I wish pediatricians and family doctors would start protesting more, as should all caring Americans. Most of us do care deeply, but with Trump and Pence in charge, our nation is in a very bad state. (Nicholas Kristof, a New York Times columnist was the source of many of these statistics and his column today is worth reading.  It can be accessed online.)

The recent Supreme Court decision that Trump can have 2.6 billion dollars from defense spending to build his coveted border wall is money that should be spent on giving hungry, poor children food, a place to live, and a decent education. It is going to take many years to recover from the Trump years and many of us wonder if our nation  will ever recover.  

 

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.