Dr. Thompson's Blog

Physicians Who Become "Beauticians"

I am puzzled why any physician would go through the hard work of medical school and residency training and then become essentially a beautician? Apparently, that is what a percentage of dermatologists are doing these days. How can the lure of doubling their incomes allow these doctors to forget what the practice of medicine is about?  I thought we became doctors to heal the sick and keep people as healthy as we could. Somehow doing cosmetic procedures and injecting botox into youth-craving women and men doesn't seem like practicing medicine.

Even more worrisome is the article in the July  28, New York Times by Natasha Singer saying that some dermatologists are even turning their medical patients over to nurse practitioners and "physician extenders". That last term is a new and scary one to me. I wonder how many malignant melanomas will be missed or how many other patients with serious skin diseass will not receive adequate treatment? I hope the American Academy of Dermatology will have the courage to speak out or legislate against this practice. Greedy physicians are already giving all doctors a bad name. No wonder the opinion about physicians in general is falling to a new low. The good old days of doctors giving the best possible care to patients, whether they were rich or poor seems sadly to be a thing of the past. 

Paying Doctors to Practice Bad Medicine

I wonder if we will ever get back to the "glory" days when doctors were paid to practice good medicine. Now the more tests doctors do, the more money they make. The art of medicine, which means sitting down and talking with a patient, really listening, and then doing a good physical examination seem to be gone. Yes, there are still some fine doctors. I saw one this week for an eye examination. Dr. Kartsonis takes an hour or more to do an examination and when you leave you feel as though you have had the best possible eye care. He even makes house calls! Unheard of in this day and age.

Now according to an article by Peter Bach in yesterday's New York Times, Medicare is "Paying Doctors to Ignore Patients." The more tests they do, the more money they make. How tempting it must be if a doctor has a CT machine to keep ordering CT scans, even after the machine is paid for. Those of us who did not do procedures, but spent our time talking with patients and actually examining them made much lower fees. I saw many Medi-Cal patients for whom I received no payment at all, even though their complicated cases took many hours of my time. (These were children with physical disabilities or neuromuscular disorders.)  I loved practicing medicine and am sorry for the doctors whose only interest is how much money they can put in their bank accounts. Even the medical schools are falling into the trap of not teaching their students the "art of medicine", but instead how to order countless tests.

We need some changes in the way doctors are paid and perhaps the idea being discussed of paying primary care doctors more will help improve patient care. I certainly hope so. I wonder how much worse our medical care can get with the present payment system and the way medical students are being taught.

Talk Show Host's Rude Remarks about Autism

It is hard to believe that a talk show host is so ignorant about medicine and the problems of parents today that he would say autism is just poor parenting and bad behavior. I hope the owners of Mr.Savage's radio station will either censor him severely or let him go.

I wish he could talk with some of the wonderful parents and grandparents I speak with who have one or more children with autism. It would be hard to mimic many of the autistic characteristics  just by behaving badly. I wonder if Mr. Savage is a parent? That would be interesting to know. I assume if he is that his children are little robots and don't speak unless spoken to and are perfectly behaved. It is hard enough to be the parent of a child with special needs without having someone tell you that it is all your fault and you are just a bad parent.

I do worry  that many parents want to be "friends" with their children rather than parents. Every child wants their parents to be in control. They want friends their own age and their parents don't qualify. Many kids have said to me. "I wish my parents would act like parents and give me boundaries." That way kids feel safe and know the rules.

A Different Scale for Medicare Payments

Because the U.S. is in such bad shape financially and  health care costs are so high, an interesting idea has been put forth. It seems to make sense to me, but I doubt that it will ever be put into place becasue so many in Congress are very wealthy and will protect their turf. The idea is to charge wealthy people more for their Medicare coverage. Full benefits would be paid for those with a certain income level and  others would be paid according to their lifetime income.

In the July 20, 2008 New York Times, the reporter, Tyler Cowen, gives a good review of a means test for health care. I've never understood why my taxes should pay the health care costs of those with great wealth. I can remember an extremely weatlhy woman saying that she wasn't  going to do something because it wasn't covered by Medicare. Her wealth was enormous and she could have bought and sold many doctors' practices and had her own private physician. Instead, she felt entitled to have her medical care covered by the government. If we can get over the idea of entitlement and care more about those who have no health insurance, jobs, or even homes, we will have come a long way. I wonder if this day will ever come?

PCT124 Not a Cure for Duchenne Dystrophy

Having cared for boys with Duchenne dystrophy for fifty years, I have seen great hype about different drugs with parents' hopes dashed when the drugs didn't pan out. The newest hope is the drug, PT124. However, according to an e-mail from Professor Sewry, the world's expert in muscle pathology and always on the cutting edge of research, the drug has only been successful in mice. Three trials are now to start at Centers in England, she said. The  drug will not cure dystrophy, but for some cases will covert a Duchenne dystrophy to a Becker dystrophy. Becker dystrophy patients have a longer life-span, but can have serious heart problems in some cases. It is true that Duchenne Dystrophy patients can also have serious cardiac problems.

I was sad to read the article by Reed Abelson in the July 17, 2008 New York Times where a mother was suing a drug company because her son was not being allowed to be a part of their drug trials. The boy looked unusually healthy for a Duchenne patient at age sixteen. It may be that if there are bad side effects from the drug that the mother will be glad her son did not receive it. I have never suggested that my patients take part in drug trials. I would want to know that the drugs are safe before I submit a child to a drug trial. Each parent has to decide what is best, but there are just too many risks for kids. Instead, I kept my patients walking for many years longer than usual by insisting they use standtables at school and at home, as much as possible, be involved in swimming and horseback riding programs and have daily stretching of contractures. Now prednisone given in appropriate doses and carefully moniotored has proven effective in keeping the boys with Duchenne dystrophy walking much longer.

Health Care in United States Deteriorating

A new study by the Commonwealth Fund,  a non-profit research group, was reported in the July 17, 2008 New York Times. The reporter, Reed Abelson, states "that the United States spends more than twice as much on each person for health care as most other industrialized countries." Unforunately, despite this large expenditure of money, the access to health care in the U.S. has declined, so that about seventy-five million people most likely lack adequate heatlh insurance or are uninsured. Also, "the cost and quality of care vary drastically". We rank last in preventable mortality. France, Japan, and Australia rank the best.

It is puzzling that the reporter states that "the adminstrative costs of the medical insurance system consume much more of the current health care dollar, about 7.5 percent, than in other countries.' I would disagree strongly with this statement. It has been well documented by numerous studies that medical administrative costs take thirty percent of the health care dollar. I'm not sure who came up with 7.5 percent, unless it is a typo? 

I was fascinated that the representative of the insurance industry, Karen Ignagni, blamed the high cost of administration on "additional services provided by United States insurers , like disease management programs etc.' I have never heard of any preventative programs sponsored by an insurance company. Their only interest is in denying as much coverage as possible to as many people in possible, so they can fill their pockets with more and more money.

Cholesterol Reducing Drugs in Children

There have been numerous articles written about the recent report from the American Academy of Pediatrics on their recommendation of cholesterol reducing drugs for children. Both many pediatricians and parents are wisely concerned about the long-term effects of the statin or cholesterol-reducing drugs.

In an article by Tara Pope in the New York Times, 7/13/08, she notes that "it is estimated that thirteen percent of children have a total cholesterol above two hundred milligrams." This is the level above which the drugs would  be used. Rather than immediately giving a child statin drugs, it would seem wise to take a family history of heart disease and also ask about a child's diet and exercise. Schools these days are much more interested in having their students pass the standardized tests set by the Bush administration, rather than having the kids get an education and some exercise. Hopefully, with a new administration these ridiculous tests will be eliminated and the schools can get back to teaching kids reading, writing, and arithmetic. Now they just want their students to have high scores on the tests, so they can qualify for federal funds.  We are not teaching kids to think or solve problems, but just turning them into little robots who can pass tests. Now we also want to turn them into pill-taking robots. Something has to be done and hopefully parents and pediatricians can rebel and change what is happening to our children.

Autism and Mitochondrial Disorders

I found an interesting aritcle by Dr.Gregory Enns in the July  2008 issue of the American Academy of Pediatrics' newsletter. He discussed the awarding of compensation to the parents of a child who developed neurological symptoms after receiving a vaccination,. She subsequently was diagnosed as having a mitochondrial electron transport chain defect. Dr. Enns notes that "mitochondrial disorders may be a rare cause of classic autism spectrum disorder."  He went on to say that other "inborn errors of metablism, such as phenylketonuria and disorders of purine metabolism, and a variety of genetic conditions, including fragile X syndrome, distal chromosome 22q deletion, 15p duplication, Williams syndrome, and Rett syndrome, have also been associated with autistic features."

I believe this is very important information for parents who think immunizations are the cause of autism.  There may be an underlying mitochondrial disorder that has not been detected. With the poor training that most pediatric neurologists get in neuromuscular disorders these days, an underlying disorder may not be diagnosed and parents will blame a child's autism spectrum disorder on an immunization. We are already seeing a decrease in immunizations in this country and have had several small outbreaks of preventable diseases. No relationship has been found between immunizations and autism after some excellent, well documented studies.

Parenting Books and Pediatricians

I was in a local book store yesterday looking at new parenting books. As I skimmed quickly through one book written by two doctors in a major medical school, I saw a bad mistake. Then I picked up another parenting  book about Autism and saw another glaring mistake. These mistakes are of great concern since parents are assuming major publishers have their books checked by other experts in the field. The first glaring error was a description of muscular dystrophy in chiildren. I doubt that the authors had ever seen a case. They described the symptons as "weakness of the legs." That is exactly opposite of the problem. Duchenne dystrophy begins as weakness of the proximal muscles or the muscles in and around the trunk of the body. The weakness starts in the lower part of the body or pelvic muscles and then goes slowly upward. The second glaring mistake was that autistic kids should have an I.Q. test. A Stanford-Binet or I.Q. test does not work with  kids with special needs. Instead, they must be given a battery of different tests to find out where their strengths and weaknesses lie. This is called a "psychometric profile" and the tests should be given by an educational, child psychologist. Testing kids is a real art and is certainly not just an I.Q. test.

Whne I picked up the New York Times later in the day, I found an article about testing for cholesterol in children. This certainly should be done if there is a strong family histroy of high cholesterol and heart disease. However,  the article states that the American Academy of Pediatrics, of which I am a member, is recommending  screening for cholesterol at age two and no later than age ten. Then say cholesterol lowering drugs or statins should be used in children with a bad cholesterol level of over 190, even thoough these drugs have some bad side effects. There is no mention of talking to parents about what their kids are eating. In the 8.5 minute office visit that most doctors are allowed these days, that takes time. I have been told by several medical students and residents that I am the only doctor they have ever heard who took a diet history. So ordering lab tests and drugs takes over once again!

More Bad News about Health Care Greed

At a Fourth of July party, I was talking with a woman who was in charge of ordering  the specialized medical equipment for a very large hospital. I was saying how the insurance and drug companies were taking such a large chunk  of the health care dollar and she said, " There is a third reason that health care is so expensive. The large medical equipment companies charge enormous amounts for even the smallest pieces of equipment. For example, the screws used in orthopedic procedures cost the hospital hundreds of dollars each, when they could be purchased for under a dollar! These companies are very rich." What a tragedy for the American taxpayer and yet the present administation will not allow Medicare to negotiate or put caps on medical prices.

The woman's other piece of distressing news was that her hospital  was recruiting "hospitalists" from overseas. She said most of these doctors had difficulty speaking English, had no interest in communicating with the patients, their families, their doctors, or reviewing past medical records. The hospital  apparently hired these doctors because they could pay low salaries and few benefits. Yet the CEO of that particular hospital makes over a million dollars. As taxpayers, we need to all speak up. It appears as though greed has taken over health care and the possiblity for any improvement in the future seems unlikely.