Dr. Thompson's Blog

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.

The Long-Term Effects of Emotional and Physical Abuse

Having cared for children and teens as a pediatrician for fifty plus years, I have seen the  true damage that physical and emotional abuse can do. I also have been fortunate to keep in touch with many of my former patients, so I know them now as adults. Children who were born to parents who were abusive have no idea of the damage they  were doing. I am thinking of one man who had a 15- year-old mother and a bully for a father. He grew up to be a bright and handsome man, but he could not let anyone get really close to him because of his fear they would see his true self. Years of psychiatric help could have made a difference, but few people have the time or money to be able to fight their demons that way. What a terrible waste of a human life. 

People who are against abortion have no idea what it must be like for a child to be born into a home where they are not loved or truly wanted. Several studies have been done about prostitutes who mostly came from abusive homes. They could only feel somewhat valued when they had a sexual relationship with a stranger. 

I think of the many children in foster care. Some foster parents are great, others are not. I  believe we are making a terrible mistake in this country by not providing adequate mental health services in the schools and communities. No child should ever be born who is not going to be loved and valued. Some are filled with such anger that as teens or adults they get hold of a gun or weapon and take out their anger on others. We must identify and help individuals like this before they cause irrevocable damage or deaths.

Is your "Doctor" an M.D. or Something Else?

Several years ago I accompanied and old friend to her doctor's office where she was to have a D and C. When we checked the number of  the office  on the lobby board,  I noted that the doctor was a D.O. I asked my friend if she knew the doctor was an osteopath and not an M.D. My friend was very bright and worked  in a prominent position in the nearby prestigious college. She replied that she did not know what a D.O was. I was amazed. Unfortunately, the D and C turned out badly and my friend had to be immediately hospitalized.

Since then I have discovered that a great many patients do not know what training their doctors have had. They do not know that a nurse practitioner with a doctor of nursing degree can call himself or herself, Doctor. There are other initials as DNP, doctor of neuropathy. Also nurse practitioners and physician assistants  can now in some states can take care of psychiatric patients without going to medical school or having a residency in psychiatry. I do no understand how this has been allowed to happen and it is very scary.

My advice to all patients and parents is to check a doctor's website to see where he or she went to medical school, if they did and where they did their residency. Also look for comments about them from patients and if malpractice suits have been filed against them. Remember all malpractice suits are not legitimate, but an individual may just be angry at their bill or something else. Also insurance companies want to settle all suits quickly and not go to court. 

Advice about Choosing a Hospital

If you need to have a procedure that is not urgent, I would suggest putting it off until the Corona Virus is hopefully contained. In general, I would avoid teaching hospitals unless there is a particular doctor you need to see who is an expert in a certain field of medicine or surgery. In a teaching hospital, you will have medical students, interns, and residents, which could be a problem.

If a family member or close friend cannot stay with you or one of your children, I would hire a private nurse, if you can afford to do so. Many hospitals are now using aides who may have had very little training. I can remember visiting a hospital, where I had a patient and there was an open syringe on the patient's bed.Yes, I immediately spoke to the head of nursing and she was most unhappy. 

If you are to have a procedure or surgery, be sure and follow the directions such as, "Nothing to eat or drink past midnight" There are made for safety reasons. If you are to have a breast biopsy or mastectomy or procedure where the wrong side could be chosen, I would write wrong side on the other side, so there can be no mistake.Yes, the wrong site or side  has been chosen in some critical operations. 

If you are to have a procedure for a life-threatening problem, be sure that you have signed a Living Will or Advanced Health Care Directive.  Your primary doctor should have a copy of this, as should a family member. This document explains what you want or do not want in the way of a  possibly fatal outcome. 

You may have to be quite assertive to get good care in some hospitals and if necessary you may have to move to a different hospital. 

 

When an M.D. Cares More about Money than His or Her Patients

I was on a book tour several  years ago in another state. The woman who was driving me to the different interviews told me about a GYN doctor she had had. "He said because I was 40 I need a D and C." She was not having any problems and discovered this was his routine statement for 40 year old patients. She also found out he had just purchased a large new boat, Other adults have told me of various unnecessary procedures doctors have advised which were money making. Doctors can make a lot of money by doing procedures, some needed and some unnecessary. Then if a problem is found that would take a great deal of the doctor's time, a referral is often made to the ER. That is very bad medicine. If a problem is encountered that needs a specialist, it is the doctor's responsibility to call the specialist and discuss the problem. He or she also needs to follow through with the patient to be sure the problem is resolved or further testing and other doctors become involved as needed.

If you are a parent, wife, husband, son or daughter of an older person you may  have to be extremely aggressive to ensure your child or family member receives the best care possible. If a doctor will not take your call, you can always show up at his or her office, have a doctor friend or doctor relative call or if necessary a lawyer  I am greatly troubled about the many accounts I am told about what medical practice has become. There are still some outstanding doctors, but I fear money has become, in many cases, much more important than patient care. I have even had college students say they wanted to become doctors to make "a lot of money".

Obtaining the Best Medical Care

The most important thing you can do for yourself and your family is to insist on the best medical care possible. Even if you are medically trained, try not to be your own physician. You do know your body better than anyone else, but it is hard to be objective if you are not feeling well or are worried. If you have to see a physician, don't let anyone intimidate you. Some of the staff may try. You need to be willing to pay for the best medical care you can afford. Cutting corners on medical care can cost you, perhaps even your life. Do some preparation before your doctor's visit. Think about what you want to say and write down any questions you may  have. Expect and insist your questions be answered. If you are taking several different medication, make a list of them or take along the bottles. 

I think it is wise to take notes of what a doctor is telling you or you can also take along an advocate if you feel shy or are easily intimidated. If there are things you don't understand or words the doctor is using that are foreign to you, ask the doctor to explain them in layman terms. I remember once my teenage daughter said I was using  some terms she did not understand when we were discussing a medical problem, As a physician, I learned to listen to the terms and words I use. 

Unfortunately in medicine today, many disorders and other things have been abbreviated into initials. When reading a medical report I now often have to look up what the various initials mean. 

If a physician will not sit down and talk with you, that is someone I would not want as a physician. I can always tell if I will like a physician if he or she comes into an examining room with a yellow pad or notebook, sits down, and starts talking. If he or she is standing and looks hurried, it is easy to see taht other things and patients are on his or her mind. The usual 8-10 minutes some doctors give their patients is completely inadequate. I would never go back to such an individual. 

Finding a Different Doctor

During this time of the Corona virus, some doctors are not seeing patients or taking calls. If you have had a bad experience with a physician before this, it could  be time to start looking for another M.D. There are some tips about how to find one who will meet your needs. First, I would talk to friends to see if they have a recommendation. Talking to a doctor friend can be good, but not if he or she has no knowledge of the doctor's medical practice, but just knows the M.D. from a golf, health, or tennis club.  When you have a  good referral, I would suggest checking your state's medical board website to see if any malpractice lawsuits are listed or are there any negative comments. Remember there could be patients who may or may not have a valid complaint. Often insurance companies want to settle lawsuits and not go to court when a complaint may not be valid.

I would want to know if the doctor takes his or her own calls or allows the nurse or nurse practitioner to answer them. I always took my own calls and would never have employed a nurse practitioner. I also will not go to an M.D. who lets a nurse practitioner do a lot of the work. They do not have the necessary training. Their total number of training is about 1500  hours compared with the 15,000 or more hours of training an M.D. 

I would want to find out what hospital or hospitals the doctor has staff privileges and what insurance the doctor accepts or is he or she part of an HMO?  Also will the doctor meet you on an emergency at a hospital or leave the care to the ER doctors? If you are pleased with the answers you get then you can send a note to your previous doctor and ask that your medical records be sent to the new doctor. I would check back within a few days to be sure they have been sent. Then once you have an appointment, if you are not happy with the office or the doctor you may need to change again. I fly a long distance to see a specific specialist because my local ones are not thorough and have poorly run offices.