Dr. Thompson's Blog

Caring for Elderly Parents or Family Members

As our population ages, many of us  have had to be caretakers for elderly family members.  For some reason the job always seems to be given to the same person. Fighting with health insurance problems is only part of the problem but a big one. Recently, I been helping a family member get a special piece of medical equipment and I cannot believe the amount of time, telephone calls, and Internet searches it has taken. If you are dealing with an HMO that is even worse. The companies spend extraordinary amounts of money in an attempt to keep patients from getting  good care. Recently, in talking with a friend, she was amazed to hear that the U.S. is far down the list of countries providing  the best health care. The last I checked, the top two were France and England. 

You  have to be very tenacious to get good care whether it is from an insurance company, an HMO or a nursing home. Often Medicaid patients and those in Veterans' hospitals get the worst care. One woman told me the Veterans' hospital where her father was sent was dirty and his care was bad. Even with good insurance some of the care for elderly patients is below standard. Few physicians seem to want to spend time talking with patients. A wealthy friend in San Francisco told me that eight different doctors came into her room over several days but none of them came closer than the foot of her bed. I was amazed. 

Some family caretakers may not know about hospitalists but they can be a nightmare. The one I dealt with in Las Vegas came in mid-morning, wrote a few notes in the patients' charts and then was gone. Hospitalists make large salaries and should spend time talking to family members, studying patients' medical records and giving good care. Even in two medical schools,I know about, the hospitalists are terrible. So don't give up, because your tenacity will usually pay off. 

Helpful Websites for Medicare Recipients, Veterans, and Patients with Disabilities

Now that Trump and his wealthy Republicans in Congress are trying to get rid of Medicare, Social Security, and Medicaid, there are some agencies and groups that can help if you have problems with different benefits. 

The first group is the Patient Advocate Foundation. Their website is www.paf.org and the telephone number is 1-800-532-5274. The Center for Medicare Advocacy can also be helpful. Their website is www.medicareadvocacy.org and the telephone number is 1-860-456-7790. Medicare is 1-800-633-4227

If you are disabled at any age, a wonderful group to help is Protection and Advocacy. They have lawyers on the staff and if they feel they can help there is no better group. They  have helped many patients for me, both children and adults.

For veterans there is a Veterans Crisis line at 1-800-273-TALK. It is shameful that the U.S. does such a very bad  job  of helping men and women who have put their lives on line to serve in the military. I know of this first hand. My brother was in the Air force in the second World War and served in India. As he was flying home the plane crashed in the Mediterranean and he was one of eight survivors. Keith recovered and professionally he did a fine job as a hospital administrator. His personal life was not happy and his social life changed dramatically. He had been an outstanding student, stage manager, and  leader. He became reclusive and was not happy. I tried hard in his later years, when I saw more of him, to get him some counseling, but the VA did nothing. He died several years ago.After the second World War he was not the big brother I had known as a little girl. 

Misdiagnosis of Childhood Diseases

Because so many older doctors have retired or are retiring because of the difficulty in  practicing, childhood diseases are not something that most younger doctors have seen. Immunizations have been wonderful in protecting children unless the parents refuse them.(We owe Dr. Salk and Dr. Sabin and the others who have developed vaccines a great thanks for their work.)

When I was a resident in pediatrics, I was  married and had two children. Both children had had measles and mumps, because vaccines were not available. I was on ward rounds with an attending staff doctor who specialized in developmental problems. One little boy looked quite ill and to my eye had had regular measles or rubeola. The attending doctor said he though it was an allergic dermatitis. The child  had a fever and all the signs of rubeola. I spoke up and said I thought he had regular measles.  The child was on an open ward, so it was important that he be moved and treated for the disease. The attending doctor was upset with me but agreed to call the infectious disease doctor. That doctor agreed with my diagnosis and I was never the attending doctor's favorite after that.

When I had my own pediatric practice, a mother brought her child in and said she had been diagnosed as having mumps. The location of the swelling didn't seem right to me and I suspected the child  had an abscess in one of  her teeth. The mother immediately contacted the child's dentist and the abscess was treated. The "mumps"  was cured. 

Another time when I was consulting in a Navy muscle disease clinic, I was presented with a child the resident doctor diagnosed as having muscular dystrophy. The muscle weakness was not symmetrical, as occurs in muscular dystrophy.  I asked the parents if cases of polio had occurred when the child became weak. They said "Yes" and the boy had also had a fever. The diagnosis was polio, not muscular dystrophy. So a second opinion is often a very wise thing to get, particularly from an older physician. 

 

 

Is Dental Care Deteriorating as Much as Medical Care?

A good friend developed some white patches in her mouth and on her tongue. Her dentist watched them for a while and then referred her to various dental specialists. She ended up being told it was mostly likely cancer. A biopsy was done which was reported to be inconclusive. Despite this she was referred to a radiologist who advised that six to eight teeth be removed before radiation was started. The woman was also referred to a cancer nurse and another biopsy was done. This, too, was inconclusive.

Having always reviewed the muscle biopsies of my intramuscular patients, I knew how really bad and inconclusive many of them could be. Some were unreadable, even from major medical schools and hospitals. I asked if I could call the pathologist at the University of the  Pacific Dental School in San Francisco. They had seen many patients for me and were outstanding. The pathologist there said he would be glad to review the biopsies. When his report and the last  one were sent to me, I was amazed at what I read. Both reports noted some fungal elements. The San Francisco report urged that anti-fungal oral treatment be given. This had never been done. When I was in practice and seeing newborn babies quite a few had thrush, which is due to a fungus. We treated the babies with oral drops and they did well.

In checking the Internet, I saw pictures of small white patches in the mouth and it was noted that these occurred more readily in patients with diabetes. My friend has diabetes! 

It took some strong urging from my friend and myself but she is now on oral anti-fungal treatment. Hopefully, this will cure the lesions and no teeth will need to be removed and no radiation or chemotherapy will be needed. 

 

 

Suicide Rate Continues to Increase

We've heard for a long time that 22 veterans commit suicide each day and yet veteran medical and psychiatric care seems to get worse and worse. An article in the 6/8/18/ New York Times by Benedict Carey noted that the rate of suicides has "climbed 25%." This past week alone, there were 16,000 suicides. In 2016, according to the article "nearly 45,000 Americans aged 10 or older died" by suicides.  Suicide is now the tenth leading cause of death in the U.S. Males commit suicide more than females and guns are usually their weapons of choice.  Now that  physicians spend less and less time with their patients how can they  know when a patient needs to talk or needs help and  they don't  have or take the time to listen?  They probably don't even offer the number for the Suicide Hotline which is 1-800-273-8255.

In the past, when I was in private pediatric practice, I knew my families well and if there was a problem with depression, anger, medical problems or other reasons of concern I heard about them. House calls were a wonderful way to see how a family operated. I still hear from family members who were patients over 40 years ago. They know if they have a problem, I will still listen and find a way to help. This is one of the great joys of medicine. Young doctors are having trouble with depression and also far too many commit suicide. I don't understand what we are doing as a nation that money and the need for power have  taken over when compassion, caring and taking care of each other were formerly so important. 

Many medical schools are grooming their young doctors to be research scientists instead of caring physicians. They are far more interested in  having a Nobel prize winner than a doctor who is loved and offers wonderful care to his or her patients. 

 

 

 

Concern about Anthem Health Insurance not Paying ER Bills

There was a Letter to the Editor in the 5/28/18  New York Times that greatly concerns me.  it was written by an M.D. in Illinois about about the insurance company, Anthem, and their "tactic of refusing to pay emergency room bills in certain cases." I had not heard  of this and certainly want to find out if more health insurance companies are doing it.  The doctor noted that Anthem had profits of $3.8 billion in 2017. Their stockholders must be very happy, but don't the CEO or the Board of Directors have any worries that someone could die or lose their home because of this policy? I realize the company is trying to keep non-emergencies out of the ER, but if doctors won't take Medicaid or Medicare or a family does not have Anthem health insurance what are they to do if there is a medical problem? The glory days of medicine are certainly over.

I thought it was illegal for an ER to refuse to see a patient.  Perhaps they see them but then just find a way to bill them? As Trump and the Republicans try to chisel away at Obamacare, more and more patients are going to  have to use an ER for medical care. Mrs. Trump was able to  stay in  the hospital at no charge for as long as she  wanted without any charge when that family is worth billions. Something is certainly wrong.

I realize there are certainly problems with universal health care, such as they  have in England and other civilized countries. However, this country has been very innovative in other areas, so why can't we find a way to offer medical care at affordable rates to everyone? No one should become homeless or die because they were refused good medical care or did not  have the money to pay for it.

Hospital Care for the Rich Versus Care for the Poor and Middle Class

I asked a physician who is familiar with the procedure Melania Trump had how a patient without her status would been treated. If the patient was able to get approval for the procedure, he said then he or she would be discharged the same day or the next day. A week's stay would not be possible. How fortunate to have the very best medical care at no cost to yourself and no restrictions on the length of a hospital stay. 

Something is very wrong that Congress and people in the administration can get wonderful medical care and the poor and middle class cannot. Trump and the Congress are slowly  working to get rid of as much of Obamacare as they can. Medicine has changed so much that patients  have to fight not only insurance companies, but also physicians to get the care they need and deserve. Every patient needs a family member or friend to be an advocate if they are sick. 

I spend considerable time helping patients find good medical care and  giving them the questions they need to ask. I always suggest they keep a written record of every contact they  have with insurance companies, Medicare and physicians or their assistants. Now that nurse practitioners are taking over a lot of medical care, patients must be particularly assertive to be sure the care they receive is adequate. It was wonderful to be in private practice when you could keep a patient in the hospital as long as was needed and not get prior approval from an insurance company. I had one mother who asked to stay a few extra days after  her baby was born because she could not tolerate her visiting mother-in-law.  Her mental health was very much at risk and to me it was important that she not have to do battle with the woman. I made a few house calls when the mother was home and the mother-in-law was gone. I was glad to see that everything was going smoothly. That could not happen today.

Orthopedic Surgery Post-Op Care-Good and Bad

A long-time friend had surgery recently on her hip. I knew the hospital was excellent, but had some concerns about the young orthopedic surgeon. Having been married to one who gave outstanding care to his patients I had some real concern about what was ahead for my friend. My concerns proved to be true. The surgery went well, so technically the surgeon was good. However, she visited my friend just twice after the surgery. I would  have expected a visit in the morning and one in the afternoon. Care was left to the nurses and a young intern. I always visited my patients in the hospital twice a day. A lot can go wrong in eight hours and  patients need to feel safe and comfortable that they are getting the best of care.

Not only did the surgeon leave the care to others, which was wrong, but she also could not be reached by telephone. That is unacceptable. I spent a lot of time on the telephone with my friend both while she was in the hospital and on her return home. She had a real problem with constipation which happens often when a patient is bed-ridden. This is true for both children and adults. No discharge instructions were given in writing and some of the oral instructions were contradicted by different  individuals. A hospitalist was both rude and ineffective. 

My friend is to see the orthopedist in about two weeks and I hope she will be very frank about all the problems she has had. The orthopedist is what my favorite medical school professor would say is a "technician", not a doctor. Fortunately, my friend with my coaching, was able to be very assertive, so together we were able to get several problems resolved.

I am glad I was able to help and she was very grateful.

Tips to Receive Good Care in Hospitals

As a doctor friend said recently, "The glory days of medicine are gone". I couldn't agree with her more but there are still ways to get the best care you can in a hospital. If you are timid or feel too ill to fight for yourself, you need a partner, a family member or friend to go to bat for you. A good friend recently had major surgery in probably the best hospital in her area. Sadly, the  hospital now uses hospitalists who have greatly changed the practice of medicine. These doctors usually have board certification in internal medicine and then one or two more  years to become hospitalists. They come to the hospital, seemingly at their own time, write some orders, may or may not talk with the patients and then go home as soon as they can. I had a very bad experience with one when my brother was ill in Las Vegas. The man neither spoke to  Keith's private physician, reviewed his medical record, would not speak with me and provided terrible care. Other doctor friends have had similar experiences even in major medical school hospitals. The whole idea is that private physicians can now avoid going to hospitals. It is appalling that there are now even pediatric hospitalists. I would never let such an individual care for my babies or children. 

My suggestion to my friend was to speak to the CEO of the hospital or have a family member do so. The woman also had a problem with two nurses and once again I suggested she ask to speak with the director of nursing. There is no excuse for bad medical care in a hospital. If the food is a  problem, then I would speak with the head dietitian. The squeaky wheel does not the grease. Hospitals should be clean, well run and with caring staff. 

More Guns=More Deaths and Injuries

I am so proud of our U.S. teenagers and those that marched with them. With Trump and the Republicans indebted to the NRA how wonderful that others decided "MO MORE". I loved the little boy standing on a barrel with a sign saying "I can't even take a peanut butter sandwich to school." And yet Trump wants guns in the classrooms for teachers!

There have been 200 school shootings since the tragedies at Sandy Hook. 96 individuals are killed every day in the U.S. by gun violence and we have 350 million guns in the United States. In Chicago alone, there have been 5000 kids killed since 2006 and 16,000 injured. I do not understand how Republicans, who are parents, can sleep at night. Of course, their children probably go to expensive private schools. 

The teens say they are going to keep the pressure up on their members of Congress. Another march is scheduled for April 20th and they plan to hold Town Halls and invite their members of Congress to these. It is great that as many as 25% of the teens will be 18 in time to vote in the mid-terms. They plan to vote the NRA recipients out of office. It is a sad day when children and teens  have to lead the way. Yes, many parents are involved, but Trump was playing golf during the march. I also didn't see any Republicans marching with the group.

Senator Feinstein was with them in San Francisco. She keeps trying to get an assault weapon ban passed. There was one from 1994 to 2004 and then none since. The NRA spends tremendous amounts of money to keep members of Congress in line. It is embarrassing and immoral.