Dr. Thompson's Blog

Finding the Best Hospital or Hospitals

There  can be a major difference in the care received in one hospital, as compared with another. Some have  a greater rate of  infection, deaths, and long-term survival. There may also be considerable difference in what different hospitals charge. There is a website at www.hospitalcompare.hhs.gov. that compares different hospitals.

If you need elective surgery, you want to be sure you are having it done at the best  hospital. A hospital that was formerly excellent may not be the same a few years later. I found that out myself when I had a procedure in a hospital that formerly had been outstanding. I did write a letter to the CEO but I doubt it accomplished anything. Now it seems many hospitals are all about money, not the best possible care.  Of course, some of the doctors are to blame for this. Many have turned the hospital care of their patients over to hospitalists and several doctor friends have had the same bad experience with the care of family members that I have had. 

If a child  has to be hospitalized, you want to be sure the hospital and staff are well equipped to take care of children. I can think of several where I would not want a child to be hospitalized. Medical school hospitals can be a problem because young interns and residents may be in charge of a lot of the care. Many hospitals now have pediatric hospitalists and then the child's pediatrician doesn't take care of his or her own patients in the hospital. My advice to anyone in a hospital and particularly when it is a child is to always have a family member or good friend in the room at all times. I would never, ever leave a child in a hospital room alone at the mercy of the staff.

How to Get good Medical Care in the U. S.

Even though the United States in the richest country in the world, we are rated 27th or lower in the world for health care. France, Germany, Holland, and Australia are rated much higher and have some of the world's best health care. They also do not have people in their countries without medical care, as we do in this country. It is embarrassing to know that we have so many people who either can't afford medical care or get care that is extremely inadequate.  The average time a doctor in an HMO is allotted to see a patient is 8.5 to 10 minutes. Also a considerable amount of HMO health care is given by nurse practitioners. I found a statistic recently that the training of a nurse practitioner is 720 to 1200 hours of clinical care, where as doctors have from 12,000 to 16,000 hours or more. I was amazed at the difference. 

The first step to getting good care is to have health insurance that allows you to go to a doctor of your choice. If you are in an HMO, you are limited in your choices, but you can still do some research and find how about the doctors in the health plan. The  Medical Board of your state should list a doctor's training, years of practice, and any malpractice claims against him or her. Remember even excellent doctors may have a disgruntled, unhappy patient with lots of money who files a malpractice claim. So you do have to take this into consideration.

If you have an initial visit to a physician and feel uncomfortable for any reason, I would not go back or allow the doctor to order any tests, write any prescriptions, or do anything else.

You want a physician who sits down and talks with you, takes a good medical history, including a family and social history. An examination should be done with you undressed to your shorts or panties and a gown to wear. Any doctor who listens to your heart and lungs through your clothing is not a doctor you want.  No doctor should ever order tests without taking a history and doing an examination.  

When to Seek a Second Opinion

I am always puzzled why some patients are timid about seeking a second opinion. Sometimes it can mean the difference between a good and bad outcome. If you don't feel confident about what a doctor suggests then I would get another doctor's opinion. If you have been given a diagnosis that could be potentially bad, I would want another doctor's opinion. I would always do it if a diagnosis is given you about something like cancer. If a biopsy has been done and the diagnosis is bad I would get an expert to review the slides. I  have reviewed muscle biopsies from all over the U.S.  and was often amazed  how a diagnosis could have been made because of the poor quality of the slides. If I ever had a question I would send the slides to Professor Caroline Sewry in London. She is the world's expert in muscle pathology and has just finished re-doing the book on muscle diseases. 

If you have chosen a "popular doctor" without checking his or her credentials, I would want to be sure he or she is not only popular but also excellent. My parents had a doctor who had great "art of medicine" but he was terrible. I tried to get them to change doctors but they did not do it and my mother paid with  her life. 

If your doctor does not take his or her own after-hours calls or will not meet you in the ER, unless it is a case of trauma, that is not the doctor you want. Also, if he or she does not go the the hospital to see patients but leaves the care to a  hospitalist that also is not a doctor I would accept. Your life can literally be in your own hands if you are afraid to speak up or don't change doctors if you need to. 

 

Preventive Health Measures for Seniors

There are several preventive health measures seniors or older people can do to help prevent medical problems. One of the most important things is to be sure and have  a Shingles vaccine.The only exceptions would be for anyone who is or has been treated with steroids or drugs that affect their immune system.  If an individual has had radiation or chemotherapy, cancer affecting the bone marrow, lymph system or tuberculosis they should check with their doctor.

A pneumococcal vaccine should be received every five years and a yearly flu vaccine is a must.  If you are a smoker or have been a smoker, a yearly chest X-ray should be on your list. Also, a yearly blood count, blood panel, and urinalysis are important. Taking a recognized multi-vitamin that has been certified by the FDA and extra Vitamin D if your doctor recommends this can help you stay healthy.. Mammograms year are important yearly, even as you  get older. This is particularly true if you know you are a BRACA gene carrier. 

Finding a doctor who knows you  and truly cares  is important. I am appalled at the people who accept care from a doctor who cares more about money than patient care. I am also greatly concerned about individuals who allow nurse practitioner to be in charge of their medical care. As doctors are practicing fewer and fewer hours and many new young doctors decide to either work just a few hours or a few days a week, more and more medical care is going to be left to individuals who are not doctors. I had a wonderful, brilliant book editor who received his medical care from a nurse practitioner at Kaiser and died at 59. That should not have happened. Even a small child  who had spinal muscular atrophy did not have a pediatrician and died before he was two. I am still angry about that.  You are in charge of your own medical care, but if you accept poor care, you could pay a very  high price.

 

Overseas Travel and Medical Care

If you are planning to travel overseas, it is wise to think about what to do if you need medical care. This isn't just for older people but for all ages. Children may become ill, as well as teenagers. It is possible that your child's doctor may have contacts overseas, so I would want to at least ask. If you plan on staying in a hotel, a good hotel should be able to suggest a doctor. I've found that people in other countries are very helpful and glad to help.

There are several companies that offer travel insurance  you can take out before you leave. Some of these are On Call International, MedjetAssist, Insuremytrip and Totaltravelinsurance. If you  or a family member have a chronic condition, I would carry any needed prescriptions from your doctor or doctors and be sure you have plenty of medicine with you, not in any checked baggage. Suitcases do get lost or could take days to find you. You should be able to get lots of information about travel insurance on the Internet. If you wear glasses or have need of other devices, I would either carry a second one or have information about the device with you.

Medical care in England or Europe is reported to be at the top of medical care in the world. The U.S. is way down on the list. The American Hospital in Pairs has a wonderful reputation. Remember that there is still polio and childhood diseases in Asia, Mexico, Africa, and South America. I  have cared for many children from Mexico and was able to get some polio vaccine donated to clinics in Mexico when I saw patients in one several  years ago.  Travel is wonderful and should be worry free if you have made preparations ahead of time. 

 

 

 

The Good and Bad Changes in American Medical Care

As  politicians talk about Medicare for All and Single Payer Health Care, I wish at least one of the politicians had some medical training. They have no idea of what a terrible mess we could  have with either of these. I certainly believe that everyone in American deserves the best healthcare possible. However, even though there have been some remarkable advances, particularly in surgical devices that allow procedures such as hip and other replacements, there has been a great decline in personal care, compassion and good old-fashioned medicine. I greatly miss seeing my babies, children, and teenagers  as I did when I was in practice, but I would not tolerate all the paperwork and regulations that are now required of physicians. 

Now we are seeing too many suicides and depression among medical students, young and older doctors.  The joy of really getting to know your patients and being an important  part of their lives is mostly gone, except perhaps in small towns, as in the Midwest. Many medical schools are turning out graduates who have no training in the art of medicine, but they do know how to click boxes on a computer. Money is the driving force for many of these students, as we can see from the number choosing cosmetic dermatology. They won't have night or weekend calls and can make very large amounts of money. Nurses are not being given much information about physical diagnosis, even those who become nurse  practitioners. I have seen some serious results because of this. Some nurses are choosing to become hospital administrators and this too can create major problems. A caring, compassion nurse is worth his or her weight in gold. Some nurses have minimal training and then if they become nurse practitioners they are often seeing patients without an M.D's supervision.  In many states now they can both see patients without a doctor's supervision and write prescriptions. With the shortage of  doctors that is envisioned, nurse practitioners will take over a great deal of medical practice. Kaiser already allows this.

Trump, Pence and Women's Health Care

I am amazed that Trump and his group are not only trying to get rid of the Affordable Health Care Act, but now they are insisting that Planned Parenthood start charging for things like Pap smears ($264) and contraception injections. ($1000). Many poor women will thus be prevented from having access to the needed preventive care, so they won't get pregnant. Then if a child is born to a poor woman who could not  afford to have an abortion or pay for contraceptive injections, many of these children will be hungry and often be homeless. The Republicans don't seem to care that we have thousands of hungry, poor homeless children. That added to Trump's  immigration policy where nine children in the cages have died from lack of medical care, our  allies must think we are all monsters. I wish pediatricians and family doctors would start protesting more, as should all caring Americans. Most of us do care deeply, but with Trump and Pence in charge, our nation is in a very bad state. (Nicholas Kristof, a New York Times columnist was the source of many of these statistics and his column today is worth reading.  It can be accessed online.)

The recent Supreme Court decision that Trump can have 2.6 billion dollars from defense spending to build his coveted border wall is money that should be spent on giving hungry, poor children food, a place to live, and a decent education. It is going to take many years to recover from the Trump years and many of us wonder if our nation  will ever recover.  

 

Choosing a Retirement Living Facility

A  friend called me recently to see if I had some thoughts about retirement homes. She knew I had had experience with my parents in checking out various places. One of the most important things I suggested was to see what medical care was available and if an R.N. was on duty at all time. Also, how near was a hospital and was it a good hospital. Many retirement facilities have very strict rules about when and where you can eat and when the laundry facilities are available. Some places  have good food and others have plain, almost inedible food. If  someone has allergies or a condition like celiac disease, they could be in trouble. Special diets are usually not catered to.

If you don't enjoy playing bridge or being idle, it is important to see if there are any fun trips to go on, who the other residents are, and the general intellectual quality of the individuals living there. My friend is a bright, published writer with a Ph.D and would need a place where there is some intellectual stimulation, not just silly activities and lots of card playing.  

The cost is always a big issue and if you don't like the facility can you leave without losing a lot of money? Some places let you pay a monthly fee, while others require an individual to buy their apartments. This can be very costly. So asking a lot of questions is important, as is  talking to various residents and eating one or two meals at the facility. 

Muscle Weakness and Neurologists

If a general physician or pediatrician see a patient with muscle weakness, they most likely will refer the child or adult to a neurologist. Sadly little is taught in most neurology programs about neuromuscular disorders. Several or our top neuromuscular specialists: Dr. Munsat, Dr  Peter, Dr. Rowland, and Lord John Walton in England  have died in the last few years.  Now there are few programs left in the U.S  where physicians can learn about neuromuscular disorders. Most neurologists order a battery of genetic tests when they have a patient with muscle weakness. They have usually not been taught how to do muscle biopsies or read muscle biopsy slides. All are important before a diagnosis is made. Often they will see an elevated  CPK, a lab  test, and immediately make a diagnosis of muscular dystrophy. The incidence of misdiagnosis in the group of muscle disorders is very high. I now will only refer patients to Dr. Selcen at the Mayo Clinic or to specific centers in Europe. 

I suspect part of the reason there is so little interest in having neuromuscular programs is that  they are not  money making. Money sadly seems to be taking over medicine in the U.S. like in so many other areas.  Thus as a parent or patient if you or someone in your family need a diagnosis, I would check on a neurologist's training and see if he or she has spent time in a neuromuscular program. Many neurologists say they are neuromusuclar specialists but if you  check the Internet  about their training it is easy to see if this is true or not. A series of genetic tests is NOT adequate to make an accurate diagnosis of a neuromuscular disorder.

There are treatable neuromuscular disorders, so an accurate diagnosis can make the difference in a patient's life.

The Problems with So-Called Free Medical Care

I wish the Democratic candidates who are proposing free medical care had some experience with bad medicine. What free care would mean is that a patient would be assigned a doctor, a nurse practitioner, or physician assistant. Free choice would be gone as would the ability to see a particular specialist. Everything would  have to go through the primary care-taker and the answer would most often be "No". This is the HMO and Kaiser system. In many HMO systems, a scorecard is kept of referrals, lab tests etc. and the primary caretaker's pay reduced according to how many referrals he or she had made. I would last about 5 minutes in such a system. In addition, there would be a time limit on the number of minutes a patient could take. The usual number is about 10 to 12 minutes. I can't even say "hello" to a patient in ten minutes.

Children and adults with serious disabilities would suffer greatly. HMO's in general only want healthy patients. When I had a child or older patient with a disability it would take me at least an hour to do a history and physical examination.   Another hour would be taken by  checking past medical records, communicating with other doctors, PTs, OT's etc. and then dictating a report. If a patient suddenly had to go to an emergency room and there was no pre-authorization, a very large bill could result. Hospitals would have markedly reduced incomes and drug, health insurance companies, and medical equipment companies would fight the so-called free medical care plan with millions of lobbyists. Let's hope the candidates who are advocating this crazy plan are defeated.