Dr. Thompson's Blog

Leadership and Epidemics

I was an intern at Children's Hospital in San Francisco during the bad polio epidemic. The hospital was the place where all the children and private polio patients were sent. It was a difficult time for me but how glad I was that President Eisenhower didn't say, as has Trump, "You just have to live with it or get used to it." Fortunately, Dr. Salk was busy working on a vaccine and how delighted I was when it was available for wide spread use. 

I remember growing up  during the polio years how we were not allowed to go to swimming pools, movies and similar things. Now many people in the U.S. are following Trump's lead  not wearing masks, not social distancing, and attending events with large crowds. I am often the only one I see wearing a mask in the beach town where I now live. I hope that  because of their arrogance that they do not have an encounter with the virus. I also hope that parents will protect their children since Trump and his group don't seem interested in doing so. Maybe if more of his intimate circle are affected with the virus, as seems to be happening to the Secret Service men and women, that Trump will begin to realize  we have a very SERIOUS problem. I am sorry that President Eisenhower or another real leader is not in charge. Hopefully, that will change in not too many months.

The Long-Term Effects of Emotional and Physical Abuse

Having cared for children and teens as a pediatrician for fifty plus years, I have seen the  true damage that physical and emotional abuse can do. I also have been fortunate to keep in touch with many of my former patients, so I know them now as adults. Children who were born to parents who were abusive have no idea of the damage they  were doing. I am thinking of one man who had a 15- year-old mother and a bully for a father. He grew up to be a bright and handsome man, but he could not let anyone get really close to him because of his fear they would see his true self. Years of psychiatric help could have made a difference, but few people have the time or money to be able to fight their demons that way. What a terrible waste of a human life. 

People who are against abortion have no idea what it must be like for a child to be born into a home where they are not loved or truly wanted. Several studies have been done about prostitutes who mostly came from abusive homes. They could only feel somewhat valued when they had a sexual relationship with a stranger. 

I think of the many children in foster care. Some foster parents are great, others are not. I  believe we are making a terrible mistake in this country by not providing adequate mental health services in the schools and communities. No child should ever be born who is not going to be loved and valued. Some are filled with such anger that as teens or adults they get hold of a gun or weapon and take out their anger on others. We must identify and help individuals like this before they cause irrevocable damage or deaths.

Is your "Doctor" an M.D. or Something Else?

Several years ago I accompanied and old friend to her doctor's office where she was to have a D and C. When we checked the number of  the office  on the lobby board,  I noted that the doctor was a D.O. I asked my friend if she knew the doctor was an osteopath and not an M.D. My friend was very bright and worked  in a prominent position in the nearby prestigious college. She replied that she did not know what a D.O was. I was amazed. Unfortunately, the D and C turned out badly and my friend had to be immediately hospitalized.

Since then I have discovered that a great many patients do not know what training their doctors have had. They do not know that a nurse practitioner with a doctor of nursing degree can call himself or herself, Doctor. There are other initials as DNP, doctor of neuropathy. Also nurse practitioners and physician assistants  can now in some states can take care of psychiatric patients without going to medical school or having a residency in psychiatry. I do no understand how this has been allowed to happen and it is very scary.

My advice to all patients and parents is to check a doctor's website to see where he or she went to medical school, if they did and where they did their residency. Also look for comments about them from patients and if malpractice suits have been filed against them. Remember all malpractice suits are not legitimate, but an individual may just be angry at their bill or something else. Also insurance companies want to settle all suits quickly and not go to court. 

Advice about Choosing a Hospital

If you need to have a procedure that is not urgent, I would suggest putting it off until the Corona Virus is hopefully contained. In general, I would avoid teaching hospitals unless there is a particular doctor you need to see who is an expert in a certain field of medicine or surgery. In a teaching hospital, you will have medical students, interns, and residents, which could be a problem.

If a family member or close friend cannot stay with you or one of your children, I would hire a private nurse, if you can afford to do so. Many hospitals are now using aides who may have had very little training. I can remember visiting a hospital, where I had a patient and there was an open syringe on the patient's bed.Yes, I immediately spoke to the head of nursing and she was most unhappy. 

If you are to have a procedure or surgery, be sure and follow the directions such as, "Nothing to eat or drink past midnight" There are made for safety reasons. If you are to have a breast biopsy or mastectomy or procedure where the wrong side could be chosen, I would write wrong side on the other side, so there can be no mistake.Yes, the wrong site or side  has been chosen in some critical operations. 

If you are to have a procedure for a life-threatening problem, be sure that you have signed a Living Will or Advanced Health Care Directive.  Your primary doctor should have a copy of this, as should a family member. This document explains what you want or do not want in the way of a  possibly fatal outcome. 

You may have to be quite assertive to get good care in some hospitals and if necessary you may have to move to a different hospital. 

 

When an M.D. Cares More about Money than His or Her Patients

I was on a book tour several  years ago in another state. The woman who was driving me to the different interviews told me about a GYN doctor she had had. "He said because I was 40 I need a D and C." She was not having any problems and discovered this was his routine statement for 40 year old patients. She also found out he had just purchased a large new boat, Other adults have told me of various unnecessary procedures doctors have advised which were money making. Doctors can make a lot of money by doing procedures, some needed and some unnecessary. Then if a problem is found that would take a great deal of the doctor's time, a referral is often made to the ER. That is very bad medicine. If a problem is encountered that needs a specialist, it is the doctor's responsibility to call the specialist and discuss the problem. He or she also needs to follow through with the patient to be sure the problem is resolved or further testing and other doctors become involved as needed.

If you are a parent, wife, husband, son or daughter of an older person you may  have to be extremely aggressive to ensure your child or family member receives the best care possible. If a doctor will not take your call, you can always show up at his or her office, have a doctor friend or doctor relative call or if necessary a lawyer  I am greatly troubled about the many accounts I am told about what medical practice has become. There are still some outstanding doctors, but I fear money has become, in many cases, much more important than patient care. I have even had college students say they wanted to become doctors to make "a lot of money".

Obtaining the Best Medical Care

The most important thing you can do for yourself and your family is to insist on the best medical care possible. Even if you are medically trained, try not to be your own physician. You do know your body better than anyone else, but it is hard to be objective if you are not feeling well or are worried. If you have to see a physician, don't let anyone intimidate you. Some of the staff may try. You need to be willing to pay for the best medical care you can afford. Cutting corners on medical care can cost you, perhaps even your life. Do some preparation before your doctor's visit. Think about what you want to say and write down any questions you may  have. Expect and insist your questions be answered. If you are taking several different medication, make a list of them or take along the bottles. 

I think it is wise to take notes of what a doctor is telling you or you can also take along an advocate if you feel shy or are easily intimidated. If there are things you don't understand or words the doctor is using that are foreign to you, ask the doctor to explain them in layman terms. I remember once my teenage daughter said I was using  some terms she did not understand when we were discussing a medical problem, As a physician, I learned to listen to the terms and words I use. 

Unfortunately in medicine today, many disorders and other things have been abbreviated into initials. When reading a medical report I now often have to look up what the various initials mean. 

If a physician will not sit down and talk with you, that is someone I would not want as a physician. I can always tell if I will like a physician if he or she comes into an examining room with a yellow pad or notebook, sits down, and starts talking. If he or she is standing and looks hurried, it is easy to see taht other things and patients are on his or her mind. The usual 8-10 minutes some doctors give their patients is completely inadequate. I would never go back to such an individual. 

Finding a Different Doctor

During this time of the Corona virus, some doctors are not seeing patients or taking calls. If you have had a bad experience with a physician before this, it could  be time to start looking for another M.D. There are some tips about how to find one who will meet your needs. First, I would talk to friends to see if they have a recommendation. Talking to a doctor friend can be good, but not if he or she has no knowledge of the doctor's medical practice, but just knows the M.D. from a golf, health, or tennis club.  When you have a  good referral, I would suggest checking your state's medical board website to see if any malpractice lawsuits are listed or are there any negative comments. Remember there could be patients who may or may not have a valid complaint. Often insurance companies want to settle lawsuits and not go to court when a complaint may not be valid.

I would want to know if the doctor takes his or her own calls or allows the nurse or nurse practitioner to answer them. I always took my own calls and would never have employed a nurse practitioner. I also will not go to an M.D. who lets a nurse practitioner do a lot of the work. They do not have the necessary training. Their total number of training is about 1500  hours compared with the 15,000 or more hours of training an M.D. 

I would want to find out what hospital or hospitals the doctor has staff privileges and what insurance the doctor accepts or is he or she part of an HMO?  Also will the doctor meet you on an emergency at a hospital or leave the care to the ER doctors? If you are pleased with the answers you get then you can send a note to your previous doctor and ask that your medical records be sent to the new doctor. I would check back within a few days to be sure they have been sent. Then once you have an appointment, if you are not happy with the office or the doctor you may need to change again. I fly a long distance to see a specific specialist because my local ones are not thorough and have poorly run offices.  

Getting a Second or Third Opinion On-Line

If you have a question about advice or a diagnosis you have been given by a physician, it  is always wise to get a second or third opinion. It could even save your life. There is a lot of misinformation on the Internet, but also some excellent information. One of the best resources is the Mayo Clinic at www.mayoclinic.com. I now refer all neuromuscular cases to Dr, Selcen at the Mayo Clinic because there are few well trained neuromuscular specialists in the U.S. Other countries do a far better job than we do with these patients. For information about cancer, the American Cancer Society is worth checking but I would want to check with another oncologist about any cancer diagnosis. I did this for my daughter when she was diagnosed with breast cancer. Sadly, the care she received at the Cancer Center ins New Mexico was very bad resulting in her death. WebMD is usually an excellent source www.webmd.com. Specific diseases have web sites such as the American Diabetes Association, www.diabetes.org.

If you can get a second opinion from a MD, who is a specialist in the disorder you want to know about, that is best. Never be afraid to do lots of research and ask a lot of questions. When I was in private practice and wanted answers, I always called one of the top specialists in the field. I  found this an easy thing to do. Usually the top experts are most generous with their time. I still help people around  the world find specialists for children or  adults with neuromuscular disorders and am glad to do so.  

Masks, Social Distancing, and the Corona Virus

I am puzzled by all the people who are demanding that everything be opened when the corona virus is so lethal and catching. I live now in a beach town and am amazed at all the people without masks, eating, and strolling around in groups. Don't they have any idea of what the virus can do? I guess they have never had to care for a patient in an ICU struggling to stay alive.  I have British friends who remember the World War II bombings as small children and the fear they had. We have been protected from all the wars this country has been involved in because they have not been on our land.  My father, brother, and husband were in the military and I know the toll it took on them.  My older brother was never the same after the second World War. 

We all would like things to get back to normal, have people get back their jobs and be able to pay their bills. But unless we do what is necessary to stop the spread of the corona virus, it is going to be a long haul. If everything is open too early, the country and all of us are going to pay a high price. Trump is not worrying about lives being lost but about the economy. His re-election is all that matters to him. As a physician I find that appalling when I have had to work so hard to keep many people alive. As parents and grandparents, we know  the lives of our children are at stake and we  must be very careful to follow the safety procedures which have worked well in some other countries.

Red Blanket Hospital Patients

When I was a Stanford Medical student, we treated all patients the same. Part of my training was at the excellent San Francisco County Hospital. We saw everything from tuberculosis (a whole ward) to Syphilis, Gonorrhea and even Leprosy. Now many medical students are just seeing routine heart and other patients except for the Corona virus. I wish they could have the wonderful experience we did at the two hospitals where we were trained. Now I am told by physicians that many medical schools and hospitals are mainly catering to the rich and affluent. These patients are given red blankets on their beds to distinguish them from those who do not have their wealth. I find that appalling. I realize that particularly now with the corona virus that hospitals are losing money because they are not able to do the elective surgeries that they did previously. How sad that plastic surgeons are no longer able to do all their cosmetic procedures for which they charge a great deal. I say this in jest because I have cared for many poor and disabled children and teens, many of whom have little or no money or good health coverage. 

Every individual has the right to good medical care and the idea that  people with wealth receive better care than others makes me very angry. That is not what medicine should be about. Having worked in a big London hospital, I saw no difference in how rich and poor patients were treated. Of course, those in the government receive the best of care, I am sure.

Not only do red blanket patients receive  excellent medical care, but they also are given gourmet food, have deluxe rooms and many other special services. Perhaps this pandemic will change the way we provide medical care in the U.S. so it is more equal. I certainly can hope.  

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