Dr. Thompson's Blog

Pediatricians and Parenting Help

I have just had a parenting educator as a house guest and was amazed and appalled to have her tell me that she had two pediatricians in her parenting classes. They both told her that they did not receive any parenting instruction or education in their medical or pediatric training. How can this be, I asked her? She also said that the parents who enrolled in her classes told her that their pediatricians did not help them at all with parenting, but just took care of their children's medical problems. That makes me very sad.

I had a classroom built on the back of my office where I held monthly classes. I did not charge the parents for these, but they needed to sign up ahead of time, because the space was limited. The room was always crowded and i think that both the parents and I learned a great deal.

I knew my parents well and felt that teaching parenting was a very important part of my job as a pediatrician. Now "my babies" are having babies of their own and I hear from many of them.   Pediatricians are missing some of the real joy of pediatrics if all they do is treat ear infcitions, colic etc. Getting to know your parents and helping them raise their children and keep them safe is to me what pediatrics is all about.

As a medical student and during my pediatric training,  I had considerable parenting training.  I hope medical educators and those in charge of pediatric training programs will make some changes. It sounds as though pediatricians need to re-think their roles.

The Recession and Health Insurance

Despite the fact that the Bush administration refuses to acknowledge that we are in a recession, the thousands of individuals now losing their jobs know that we are in one. If an individual has been covered by health insurance in their old job, which now only one-third of employers apparently offer these days, they have to quickly find a source for new insurance or go uncovered. As one single mother found out recently after cancelling her health insurance, a trip to the ER for her son cost almost $5000 for a simple stomach ache. She quickly applied for new insurance and hopefully with a new job, she will be able to pay for health insurance for herself and her son.

It was interesting to read in an article by Fred Brock in the (4/21/08) New York Times that there is a good Web site that gives the states having  regulations that individuals with pre-existing conditions cannot be turned down for health insurance. The Web site is: www.healthinsuranceinfo.net.  Some of the states are: Maine, New Jersey, Vermont, and New York. Patients are being turned down by insurance companies because of things like a previous minor surgery, slightly elevated cholesterols, and similar things. The insurance companies use anything they can to keep from issuing policies to anyone who might cost them some money. They are in the business  of making large sums of  money for their CEOs and their stockholders. They have NO concern about anyone with even a minor health problem.

One thing for anyone with a major pre-existing condition is to look into high-risk health insurance.  I give a list of the states that have this in my latest book, 101 Ways To The Best Medical Care." This information is also available on the Internet and is well worth researching.

Veterans' Health Care and Suicides

We ask our servicemen and women to risk their lives in terrible wars like Iraq and then if they do get home in one piece, the stress of returning to civilian life may change their lives forever. In additon, it puts them at great risk of suicide, as shown by the statistics given in today's New York Times. (4/22/08).

In an article written by Neil MacFarquhar, he notes that there are 6,600 suicides a year among veterans and 126 suicides a week. Everyone who has had a family member, as I have had, whose  life was changed by his or her war experience should badger their senators and representatives to get our veterans the psychiatric help that they need.

My family member had been an out-going, bright student leader in high school and college before he entered the service. Then coming home from India and the Second World War, his plane crashed in the Mediterranean and he was one of eight suvivors. Yes, he should have had a great deal of counseling after this occurred, but he had none. His business ability remained excellent, but his personal life did not go well. He became anti-social, was distrustful of people, and his only true love were his dogs. Not only did he suffer, but the rest of the family also paid a high price. He did not try committing suicide, to my knowledge, but his post-war life was a most unhappy one. We owe our veterans the best medical and psychiatric care that is available. It is a national disgrance that our veterans are committing 126 suicides a week.

End of Life Medical Care

The cost of medical care in patients with major diseases has become increasingly high. Many family members and patients want everything possible done. Physicians, too, are often very aggressive in doing everything possible to keep a patient alive, even though the patient's quality of life may be miserable.

A recent study reported in the New York Times, (4/7/08), showed that there was great discrepancy in the charges for the last two years of life in different medical institutions. The Mayo Clinic, which provides wonderful care, actually was reported as charging the least of the centers studied. Medicare paid them $53,432 for care in the last two years,  while UCLA Medical Center charged $93,842. Part of the reason, according to the president of the Mayo Clinic, was that their doctors were salaried  and "have no financial incentive to do more than necessary for the patient." You wonder if the doctors at UCLA and other centers that had very high charges were motivated by money?

Because we are spending such a large share of our health care budget on care of the elderly in the last years of their lives, it makes you wonder if some guidelines shouldn't be established about what charges are acceptable. It seems to make little sense to keep someone alive by artificial and extraordinary means just to give them a few more months of life. If some doctors keep patients alive for their own monetary or religious beliefs, then I think a national debate is needed to set guidelines for what is and is not acceptable care in the last few years of life.

Health Insurance Companies and Greed

Health insurance companies are getting more and more greedy. You would think that with their enormous profits and the outrageous salaries and bonuses the CEOs are paid, as well as the bonuses made by those who deny the most insurance claims, that all these individuals would be making enough money. Apparently even these large sums of money are not enough. Now the companies have a new plan to skim extra money from the pockets of the patients who need their help the most.

The companies have announced, according to both an article and editorial in the New York Times ( 4/14/08),  that co-payments for the most expensive drugs will be increased many times. For some individuals this will mean they will pay an incredible amount of money for the drugs they need to fight very serious illnesses. If the health insurance companies only  want to ensure  healthy people,  why should people even carry  insurance? Something needs to be done to control the insatiable greed of the health insurance companies. 

Increasing Opposition to Retail Based Clinics

I was delighted to read in the last AAP news, (April 2008) that there is now increasing opposition to Retail Clinics. It has been a long time in coming, but now the AMA, the American Academy of Pediatrics, and some state legislators have finally realized that these clinics are a very bad idea.

Nurse practitioners, who give the medical care, are an important part of a medical team, but not when they try to replace doctors. If you compare their training against that of even the most minimally trained physicians, an M.D. has at least twice their number of years of training.

My principal concern, since I am a children's doctor, is that they will not diagnose a child properly. Fortunately now, the smart legislators in Massachusetts have ruled that no child under two can be seen in these clinics and no immunizations can be given except a flu shot. I wish they had had the courage to prevent all kids from being seen in these clinics. I predict some children will die because nurse practitioners just don't have adequate training to be the doctors for kids.

There are now almost 900 clinics, which of course developed because of the lack of adequate medical care in the U.S. for almost 48 million people. Until we can provide good medical care for everyone, as they do in France, Australia, and some other countries, the money hungry retail chains will see these clinics as a great way to increase their profits. Their lobbyists are very busy trying to have more and more of these clinics and few and few restrictions.

High U.S. Medical Care Dissatisfaction

A friend, Dr. Olgrad Dabbert,  a retired, excellent orthopedic surgeon sent me an article entitled "The Perversion of Medicine". In it he notes that "an abstract in the British Medical Journal (11/10/07) stated that the U.S. has the highest dissatisfaction with their health care system." How can that be when there is some extraordinary medical care in this country? Unforunately, the best medical care is found only if you can pay for it and are aggressive about finding the best doctors.

In these days when many plastic surgeons are making thousands and thousands of dollars from cosmetic surgery and paying PR firms large sums to make beautiful videos and Web sites for them,  our health care seems to be focused on looking younger and living as long as possible. Many fourth year medical students are choosing dermatology as careers. This is because the hours are short, with no night or weekend calls and their incomes will  be high if they give botox, do cosmetic procedures, and cater to those who want eternal youth.

No wonder the majority of people are dissatisfied with health care in this country if so many of our younger doctors are more interested in making money, having time off, and working a limited number of hours. Caring for patients was to me a special privlege. The patient's income made no difference in the care they received and the joy of medicine to me was keeping my patients well and being an important part of a family's support system. The young doctors who go into medicine to make money will never know the  joy of practicing medicine that Dr. Dabbert and I and many other older doctors have experienced.

A Second Opinion Needed Following a Biopsy

It is important for patients to always get a second opinion after they have had a biopsy. This can be from another pathologist or a specialist in that particular disease or disorder. I always reviewed the muscle biopsies when I did consultations for kids with muscle weakness. If they had had the muscle biopsy in another center, I requested that the slides be sent to me. The poor quality of the  biopsies, even from prestigious university medical centers, was hard to accept. Often the biopsies were unreadable and needed to be redone. Fortunately, frozen muscle is usually saved so the biopsy could be redone in a reliable pathology department.

Most doctors, including pediatric neurologists, usually make the diagnosis of Duchenne muscular dystrophy when they see a child with muscle weakness. There are many other disorders that can cause weakness and if the biopsy is inadequate or the proper DNA testing is not done, the child will be misdiagnosed. Such was the case of a child with the rapid onset of muscle weakness. Fortunately, the parents did not accept the diagnosis and called me from another state. It sounded from the symptoms that the little girl had dermatomyositis, a treatable muscle disease. On reviewing the muscle biopsy slides, that clearly was the diagnosis. The child's history and clinical findings confirmed the diagnosis and she is now well after aggressive treatment with steriods.

If biopsy slides are not reviewed, unnecessary surgery could  be done, as happened with a good friend. She was told that the biopsy showed breast cancer and a mastectomy was done. Later, she found out that the diagnosis was wrong and she did not have cancer. That never, ever, should happen to anyone.

Cardiac Arrest and CPR

Everyone should know CPR. If you don't, you can still make a difference If someone falls over in front of you and stops breathing. Someone else should call 911 while you first check to be sure nothing is lodged in the mouth. Then according to Dr. Michael Sayre of Ohio State University you should "push hard and fast in the middle of the chest" until emergency help arrives. He says 100 hard pushes a minute would be the best.

In the 4/2/08, New York Tmes article by Nicholas Bakalar, he quotes Dr.Sayre as saying, "If you do nothing, the person will die." And you can't make them worse than dead." In discussing this article with my anesthesiologist son, he said that if the action wasn't quick enough you could get the heart going, but there might not be enough oxygen to the brain. Then the patient would be alive, but there could be  brain damage. That question was not answered in the article and is worth thinking about. Most people I know would rather be dead than alive and brain dead. We are keeping far too many people alive who have no quality of life simply because relatives or the government insists that every measure possible be used to keep them alive. Other countries are wiser than we are in  the U.S. about what constitutes a good life. I think there needs to be much more discussion about this among our legislators and all of us who are voters.

Possible Causes of Autism

Yesterday was World Autism day, so considerable attention was paid to this disorder. Parents  who have an autistic child or one in the Autism spectrum want answers and they are right. Why is there such a tremendous increase in the numbers of kids who are diagnosed with these disorders? As one grandparent of an autistic child said, "All of my friends, who are grandparents, either have an autistic grandchild or have friends with one."

Those who put the blame on vaccines believe they are the cause since the number of immunizations given to kids these days has markedly increased. I agree that thirty-six seems like a great number, but according to several well documented studies, here and in England, the vaccines do not cause autism. One of the speakers on TV, an actress, who has an autistic child repeatedly said that the mercury in the vaccines causes autism. A pediatrician stated that there is no more mercury in vaccines now than in the air.

The genetic basis for autism seems to be given little weight. Yet I have  met families where there is an autistic child in each branch of the family: aunts, uncles, brothers and sisters. Certianly genetics must play a part in many of the families.

The recent decision by the government in the Hannah Poling case is unfortunate. Dr.Salvatore DiMauro, who is one of the world's experts in her underlying disorder, and whom I have  heard speak many times says "There is no evidence that children with mitochrondial enzyme deficiencies are worsened by vaccines." Apparently after not holding a hearing or having experts testify, the Polings were awarded money from the Vaccine Injury Compensation program. This has set a most unfortunate precedent. I think money should be used for research, not to line lawyers' pockets. They will be the ones to profit from this decision. Many children will go unvaccinated and some will die because of it.

 

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