Dr. Thompson's Blog

Medical Care for Seniors

A woman called me about the concerns she had  regarding her eighty-year-old husband. She said he now always seemed very tired. I knew the couple received their medical care in an HMO. The  accounts she had told me previously about their internist were disturbing.  The doctor said anyone in their eighties who had a problem was "just getting older". He seemed to discount they might have an actual medical problem.  I asked the wife when her husband had last had a complete physical examination,  chest X-ray, pulmonary function tests,  EKG and a blood panel. None of those had been done recently or ever!

I don't know how  any doctor can dismiss an older patient's concerns without doing a physical examination and some tests. What patients in HMOs may not know is that each test costs the doctor money. HMOs really just want healthy,young patients who don't cost them any money. No matter how hard I try to keep people, who can afford good medical care, to get it, I often fail. To me the best medical  care can made the difference between life and death or a life that has no fun or quality to it. 

The other problem I have found with many HMOs is that they have nurse practitioners who see patients without any oversight by a physician. A brilliant man in his fifties who did book editing for me died with terrible medical care in an HMO. He did not see any doctors but a nurse practitioner. I am sure there are some excellent nurse practitioners in areas where no physician wants to practice and they fill an important need. Now too many doctors are choosing specialties that make them a lot of money. Family doctors, pediatricians and psychiatrists are at the bottom of the pay scale. Some psychiatrists will just accept cash payments, so they may do very well. So I would urge family members who have an elderly spouse or parents insist that an elderly person receive the best medical care possible and not in an HMO.

When M.Ds Order Tests and Treat Outside Their Areas of Expertise

I am always amazed when I am told about doctors who have training in one area of medicine, but have the arrogance to treat patients in fields of medicine not in their areas of expertise. A woman recently called me to ask about some medicine her physician had ordered. The doctor was a gastroenterologist, but wanted a blood sample sent for a cardiac test to a doctor in another state. The test was supposed to show if the woman had any cardiac problems. This was despite the  patient having had a clean bill of health a few months ago from a cardiologist. I would  have assumed the patient's doctor would have consuilted the cardiologist to see if she agreed, but this was not done. Instead, when the report was received the gastroenterologist prescribed two cardiac medicines. I was appalled. The  patient did call her cardiologist who said, "Oh, it is a low dose,  go ahead and take it." If I had been the cardiologist, I would  have found out who did the study, what were the doctor's credentials, and were there any controls or oversight on the study. This was not done.

My advice to the woman was two things: Find a different cardiologist for a second opinion and find a new internist. I think both doctors were not practicing good medicine. I asked the patient to give me a follow-up and am sure she will. As physicians, I think even a simple test can cause a lot of problems and an Rx for cardiac medicine certainly can if it is not warranted. Whenever I had a cardiac question, I picked up the phone and called the pedaitric cardiologist that I trusted the most. I certainly would never have ordered a cardiac test and certainly not medicines. Medicine has become so very specialized that no M.D. can be up-to-date on everything and having a large group of doctors you can call to ask advice about patients is crucial. I am finding though that many doctors rarely ask other doctors for advice. That takes too much of their time.

Medical Errors in Novels, TV Dramas, and Movies

I am always surprised when I read a novel, see a movie, or watch a TV drama about what little research  authors or directors have done when medical characters or information is included. Of particular concern is that some teenagers and college students decide to become doctors because of the "glamour" they see portrayed on the screen or in books. Seeing a glamourous young woman doctor in high heels and wearing designer clothes just isn't the real world. I am sure there are some physicians in fields, such as psychiatry, who can dress like that, but if you are a doctor working in an emergency room, the operating  room or seeing countless patients each day, that isn't the life of a real doctor.  

My other concern about the impression young people can get is that doctors make great amounts of money. Yes, there are plastic surgeons and cardiac surgeons who do make far too much money. Pediatricians and psychiatrists are at the bottom of the money made made unless they accept only cash or bill enormous false amounts to Medicare or Medicaid. I once had a doctor friend, who worked as an investigator for Medi-Cal in California, ask me if a pediatrician could make $100,000 in one year by billing Medi-Cal. That would be impossible, I told him, unless the man was cheating. Unfortunately, that seems to happen a lot these days. I sat next to a teenager at the luncheon for my son when he graduated from medical school and asked the youth what he wanted to be. He quickly answered "I want to be a doctor and make a lot of money." We had a long talk and I understand  he now works on Wall Street. I am so glad he is not another greedy doctor. I recently had a woman skin doctor say she needed  one hundred dollars before she would remove a benign lesion.  Her doctor father would  have been appalled. I did not pay the money, but went elsewhere.