Dr. Thompson's Blog

Non M.D.s Practicing Medicine

There are some wonderful MDs and healthcare workers, but I am seeing more and more non-MDs calling themselves doctor and trying to care for patients. I am worried that as health care gets more expensive and patients don't check on their "doctors" credentials we are going to see more non-medically trained people taking care of patients. We now have nurse practitioners who get a doctor's degree calling themselves doctor and caring for patients without the supervision of an M.D. Kaiser uses a lot of nurse practitioners. When someone in a white coat introduces himself or herself as a "Doctor" be sure you are talking to an actual M.D.  There are osteopaths, neuropathic physicians, chiropractors and neuropathic "doctors ".

I was in a doctor's office and saw a woman in a white coat and asked my doctor if he had a new associate. "No" he said, "she is a nurse practitioner, but I don't use her". If he did, I would not have gone back to him. I  have had very bad luck with several individuals who call themselves doctor.  They have never gone through medical school or received board certification. Thus, before you see a new doctor, please do check on the training they have had and if they truly  have gone to medical school, completed an internship and residency and passed board exams. 

Now the organization that is on charge of  physicians assistants wants to change their name to  physician associate. No, they still have the same limited training and should always work under a physician. I  hope they are unable to get the name changed.

Problems with Surgery in July and August

A friend e-mailed me that she was to have surgery at a university medical school hospital in August. She wanted to know my opinion of the surgeon and the hospital. I talked to my anesthesiologist son about her request and he reminded me of the problems with July and August in teaching hospitals. New interns and residents start their rotations on July first. I certainly remember walking up the front steps of Children's Hospital in San Francisco on July first wondering what lay ahead where I was to be a new interne.

Even though the surgeon has promised my friend that he would do her surgery himself, I would not count on that. Often a surgeon will let a new resident do all or part of a surgery even if he is in the room. In general, I would never plan a surgery in these two months if it can be postponed. I also would be particularly careful about university hospitals that depend on a big staff of new residents and interns. 

My experience at Children's was generally good, although there were some scary moments. One was when I had a resident who was never in the room during the polio year that left me to make decisions about when to put patients in iron lungs. Another was when my OB resident was never in the room and I had to  deliver babies by myself. Fortunately, luck and common sense were with me and I never had a major problem. 

The Amazing Double Standard at Fox News

I don't watch Fox News. but know the damage they do to their viewers. They  don't get Covid shots because Tucker Carlson and his group of co-anchors tell them not to.  Yet a recent news report said that no one can work at Fox News unless they have been fully vaccinated for the virus. I wonder if Tucker and his group realize that most of the Covid deaths are unvaccinated patients and probably their viewers? Are they trying to cut down on the number of viewers they have?  That makes no sense. 

Trump and his family have all been vaccinated and yet he tells the Big lie and also that vaccinations are wrong. If only he would tell the truth for once  it could save a lot of lives.  It is embarrassing, as a physician, to know that any leader of a country could care only about himself and not the country he represents. That would be like a physician telling his patients one thing and doing something else himself or herself. I hope the time comes when the Republicans and others who are not getting the vaccine come to their senses. I know how grateful I was when the Salk vaccine was available. Having seen both  children and adults die from polio, it was a blessing  when Dr. Salk and his group saved so many lives.

San Diego Lost a Wonderful Man this Week

San Diego lost Father Joe this week. He dedicated his life to helping the homeless with housing, medical care and many other things. I was not raised Catholic but in seeing the enormous good that Father Joe did in San Diego, makes me wish other San Diego churches and houses of worship cared and did as much for the homeless as he did. I have not seen this happening and hope I am wrong. In Alexandria, Virginia there was a protestant church next to my daughter's office I always think of. Outside was a large sign saying " We are open three times a day if you desire to join us for a meal." In San Francisco there is also a wonderful church where the homeless line up daily for food. In this country where two billionaires are spending their money  going to space, just think what that money could for the 30 million hungry children and all the homeless we  have. 

This is an extremely difficult time for our country and we need to put aside our differences and find some solutions for the  hungry, the homeless, our poor education and medical systems and many other things. In a recent article in the New York Times by Nicholas Kristof he notes how poorly the U.S does on international  surveys about health, graduation rates from high schools, math, safety, and health care. 

It is hard to watch the lack of concern for others in many places, children who are abused and our lack of social services, psychiatric and drug care for those who need this help. We can do better.

Hysterical Paralysis Versus a Muscle Disorder

Hysteria is no longer considered a separate diagnosis. Now these patients are put in the category of a conversion disorder, a dissociative or somatic symptom disorder.

I have had two patients I diagnosed as Hysterical Paralysis before the classification was changed. One was a woman from Florida who was diagnosed at the University of Florida as having a form of muscular dystrophy. Her internist called me and asked if I would see her.  She arrived at my office in San Francisco in a wheel chair. After a complete examination I could not find any signs of muscular dystrophy. We did a muscle biopsy under a local anesthetic and it was completely normal. Her blood tests, such as a CPK, were also within normal limits. In taking a detailed history, I found that she  had gone through some very traumatic times. I talked with her doctor in Florida and also arranged for physical therapy while she was in California. In outlining a P.T. plan and some good psychological therapy when she got back home, she was able to be out of her wheel chair within a few months and lead a normal life. 

The other patient was an overweight teenager youth, who on coming back from some time at a summer camp, suddenly fell and became unable to walk. He seemed very unhappy when I examined him, but it was hard to get a good history from him. I handed him a crayon and a big pad of paper and asked him to draw what he was feeling. He pressed so hard on the paper that it was  almost torn.  The picture he drew showed volcanoes spewing fire.  I  had a muscle biopsy and lab work done and both were completely normal. I am not sure what happened at the camp but I suspect he was bullied and teased because he was overweight and quite uncoordinated. With some good psychological counseling, an eating plan, and physical therapy he was able to return to school and resume his normal activities. 

I wish we had more physicians with neuromuscular training but this country is sadly lacking in them. Neurologists rarely get adequate training in these disorders unless they are in a training program that has an interest in them.