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.

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.

Treating Back Pain

Children can have back pain from curvature of the spine (scoliosis), as can adults, but when older adults have back pain it is often from lack of exercise and weak muscles or obesity. I am always puzzled when I am told about individuals who belong to HMOs and don't insist on seeing an orthopedist. I know one individual who is bright, has an advanced degree, and yet will see a physical therapist, but has not made any effort to see an orthopedist. In the past, a P.T could not see a patient with back pain without an Rx from an orthopedist. I am not sure this is still true in any state. I remember one man who was being treated by a P.T. for back pain  that was thought to be due to shingles or some kind of nerve problem. His pain turned out to cancer of the spine and he died in his fifties. I am not sure he ever saw an orthopedic surgeon and yet he could  have afforded the best of care. 

If you decide to see an orthopedist either for a child, teenager, or as an adult, it is important to be sure the orthopedist is board-certified and I would also want to be sure he or she is an M.D. and not a D.O. or a doctor of neuropathic medicine. There are many people these days who call themselves doctor, but they are not M.D.s or even osteopaths. If you put a doctor's name in Goggle you should be able to get their training and if they are board-certified and are an M.D. or something else.

Drug Interactions and Problems that Can Occur

When drugs are prescribed over the telephone or by someone who is not a an M.D. problems may occur. It is extremely important that patients and  parents know if there will be problems with a new drug when other medicines are being taken. Many of those who prescribe drugs do not ask what other drugs are being taken. The individual may also not check to see if the new drug will interact and cause problems with other drugs being taken. There was a wonderful pharmacist in the town where I had my pediatric practice. I could call him and check on any drug interaction. In San Francisco, I could call the UC Pharmacy hotline and get answers to my questions. I often had to do this for patients for drugs prescribed by other doctors. This was particularly true for neurologists who were seeing patients who had seizures. 

Now that many non- M.Ds are able to see patients without supervision by a physician, it is particularly important that patients and parents know if there are going to be side effects with a new drug or if the RX should be taken with food and if there is any drug interaction with other oral medications.

I had a friend whose mother was taking 26 different drugs and no one had checked for any interactions or problems with all the different drugs. It turned out that were when I called my local pharmacist.  

Finding Good Health Insurance

It is important that everyone have good health insurance. I don't like the idea of Medicare for All because it would cause countless problems. I would agree with an option to buy in to Medicare for anyone wants to do that. If you are not covered by where you work for health insurance or have insurance under the Affordable Health Care Act, it is wise to check out the different health insurance companies to see their charges.   Medicare is fine by itself if you are over 65, however it does not  cover a lot of things. Thus supplemental health insurance is wise. The CEOs of health insurance companies make millions of dollars, as do the CEOs of drug companies.  This always bothers me.  

There is a good website where you can compare the cost of private insurance. It is: ehealthinsurance.com. There are some other websites that also could be helpful. One is www.medicareadvocacy.org. Another  is healthfinder.gov. The  Health Insurance Association of American is www.hiaa.org.

For patients who can not afford prescriptions, there is a good website at www.themedicineprogram.com.

 

Guns, Guns, and More Guns = More and More Deaths

This last month there were 45 mass shootings.  Last year there were 147 mass shootings. What is wrong that we can not stop this terrible destruction? It is embarrassing to be an American when we have such a high rate of deaths from guns.  Not only do we have mass shootings, but the suicide rate with guns is also unbelievable. A study in 2018 stated that 67 Americans committed suicide each day. Yet psychiatric social workers in one state have been let go because they were declared "fluff" and there was no money to pay them.  Instead CEOs of hospitals, big corporations, and drug companies are making millions of dollars each year. 

It is estimated  that we have 400 million guns in the U.S., many of them loaded. With the pandemic more and more people are feeling depressed and worrying about feeding their families due to loss of their jobs. If we did not have so many available guns, good background checks and ways to keep guns from going across borders, we would have fewer deaths. Also, if we had more mental health services available we would be in a better place. Yes, the NRA has a terrible hold on many legislators. Perhaps if some of them lost a child or family member to a gun death, we might get some strong legislation. If any of them had seen a child die from a gun shot, as I have as a physician, perhaps we would get some strong laws. I  have no problem with responsible gun owners having unloaded guns but having a loaded gun in a house with a child, a teen or depressed, mentally ill person is a recipe for disaster. We can and MUST do better.

Concerns About Affluent Medical Students

There was a good article this week in the New York Times by David Kirp about how Ivy League colleges are choosing their students.  What the article said would also include the choice of medical students in the most sought after schools.  It noted that in five of the Ivy League colleges that "more students came from the top 1% than from the bottom 60%."  These are mostly students who graduated from prestigious private schools with access to tutoring and help with their applications. 

My concern about medical students is if they have a patient who had been  homeless or was from a low or middle income family, would they be able to understand the patient's problems, as would a medical student from a low to middle income background?

When I was a medical student at Stanford, most of our freshman class were men with families and military veterans. Only about six of us were  much younger and recent college graduates. I don't think any of us came from affluent schools or backgrounds. My favorite medical school professor said he would rather have a medical student who was a B student from a middle class family than a student from a rich family. Compassion and the art of medicine are so important in medicine, but I am finding a lot of doctors seem to be missing both of these today. My advice to people seeking a new doctor is to make an initial appointment and then if you don't feel comfortable with the doctor find a different one. I would first check the Internet to find out as much as you can about the doctor. Reviews may not always be helpful because some people may  simply a dislike the doctor's age, sex, or something else. 

 

Taxpayers' Dollars will Allow the Greed of Drug Companies to Continue

I hope all readers have had one and hopefully two of the corona virus vaccine. These are being paid for with taxpayer dollars. However, if we have to get a yearly vaccine against the virus, the drug companies are planning to charge as much as $190 or more per shot. This is despite the fact that the research for the vaccines has been paid for with our tax dollars. I don't understand how money is so much more important than children and adults' lives. I have been trying to help parents in an overseas country get the medicine for their two children  who both have a serious neuromuscular disorder. The drug is so expansive that even a family with two working  parents making good salaries can not afford it.  The drug company really does not care. I have written to the CEO, who makes 38.6 million dollars a year and I get a lot of double talk, but no help for the  children. I don't understand how CEOs can live with themselves knowing their new drugs can save lives and yet not help. I asked the CEO's assistant if he had ever seen a child with this  particular disorder and  did not get a reply.

I hope that President Biden will find a way to negotiate drug company prices, as is done in many other countries. If our tax payer dollars pay for their research, some kind of control of drug prices is badly needed.