Dr. Thompson's Blog

The Tragedy of the Children at the Border

I do not understand how Trump and his group could have put in place such a terrible policy affecting children at the border. I understand that separating  children from their parents was their way to keep those they did not like from coming into the U.S. We  have always been an inclusive country and trying to keep the country all white, as Trump has tried to do, is just wrong. The American Academy of Pediatrics has put out statements against the policy but I have not seen any real action. Many hundreds of these children will never see their parents again and thousands will  have long-lasting effects from this terrible policy. The effects will be both medical and psychological. When you  have to sleep on a concert floor in a cage with inadequate blankets, little medical or dental care how can a child not have long-term problems? Our children are our future. We already  have far too many homeless and foster children and yet the Republicans want to get rid of all abortions so we can have even more unwanted, hungry, homeless, and uncared for children.

Even if Biden wins the election, he will still probably have a Republican senate that can wreck damage. I certainly would not want to bring a child into this country with all the problems we now have.

HMOs versus PPOs versus Private Practice Medical Care

I am always surprised that many people don't realize that there are still MDs in private practice. That means they do NOT belong to an HMO or PPO. I could not have survived in an organization like Kaiser, an HMO, where I would be told how many patients I was required to see, how much time I had for each patient and how many referrals I could make. HMOs are very restrictive and if you have an emergency on a trip or away from your primary HMO facility you will have to pay the cost yourself.  HMOs use a lot of physician assistants and nurse practitioners which I would not accept.  

PPOS are a little different. They have a network of doctors  and hospitals available to you. Some coverage is offered for patients outside of their network. However, there will be a cost to you. Also what you pay each month will be a little more than in an HMO. In addiction, your  cost to see a physician in a PPO will be more than in an HMO. 

Before you decide on health insurance it is important to do a lot of research. My parents chose care at an HMO and even though I found an excellent doctor for them in private practice, they would not see him. Cost was a factor, as well as a fondness for their GP in the HMO. He had a great art of medicine but his medical knowledge was very poor. My mother paid for it with her life. She died at far too young an age and my father, who was six years older, had a lonely six years after her death. 

Advice About How To Get Good Medical Care

There are several ways to be sure you always get good medical care. Because medical care in the U.S. seems to be getting worse and worse, I would remember these points. They could make a difference in your life. Be sure that any doctor you chose is the best one you can find. Remember if a doctor friend suggests an M.D., be sure he or she is not just a golf or gym friend. I would check the doctor's website and read any references and see if there have been any malpractice suits. Be sure he or she is an M.D. not a DO, a DC, or DNP. The latter is not an M.D. but a nurse practitioner with a doctor of nursing degree. If you are a physician don't try to be your own M.D. for important  problems. Also, you know your body better than anyone else, so if an M.D. does not listen, find another one.

Be willing to pay for the best medical care you can afford. HMOs use lots of nurse practitioners and physician assistants. They try to limit care from specialists and decrease a doctor's pay if he or she makes too many referrals. Do some preparation before you go for an exam. Think about what you want to say and write down the questions you have. A friend makes a copy of her questions for the doctor and gives it to the physician.  Take along a list of medications you take and also make notes about what the doctor tells you. If you don't understand something, ask for clarification. Never let a doctor or the staff intimidate you. 

What a Covid 19 Hospitalization Could Cost You

An interesting article in yesterday's New York Times by Sarah Kliff outlined what treatment for Covid 19 could cost a hospitalized patient. Of course Trump's treatment cost him nothing, even though he put the taxpayers to the extra expense of helicopter and limousine rides, plus all the needed secret service. 

The cost of if Remdesivir with Medicare or Medicaid  would cost $2,340. Without these programs, it would cost $3,120. A Covid test could cost anywhere from $100 to $1000 or more. Hospital care without insurance could cost $61,912 and with insurance it would be $31,575. An air ambulance would be about $21,698.

Of course. if repeated X-rays, CT scans etc. were needed the hospital charge could be much more. Nothing was given about charges for the steroids that Trump was given or the antibody cocktail. Also if an ER visit was needed before a hospital bed was found that charge would have to be added also. 

The virus is deadly and must not be taken lightly. Trump has been trying to play down its effects even though he could well still be shedding the virus. One MD said the virus could be shed for 10 to 20 days. We have not been told if Trump has  yet had a negative test for the virus. 

 

Biden's Healthcare Plan

We have not heard much about Biden's plan for our healthcare because of the Corona Virus mess. In today's New York Times, there was a very good article by Paul Krugman outlining what Biden has suggested. Trump and the Republicans have said for 4 years that they had a great plan to replace Obamacare but we have not been given any details. Trump hates President Obama so much that repeated attempts have been made by him to gut the Affordable Healthcare Act. Amy Coney Barrett if put on the Supreme Court also appears willing to vote against the ACA which would mean 20 million people would lose  their healthcare and  pre-exiting conditions would not be covered. 

The Biden plan would not be Medicare for All which would be a disaster but would have a  public option where people could buy into Medicare. It would also reduce premiums for the middle class and be sure  pre-existing conditions are covered. Low-income people would be automatically enrolled in the buy-in option. I don't see any mention of making drug prices more affordable but we can hope. Drug prices are completely out of control and the drug companies are making millions of dollars. Even when a new miracle drug has been found for something like spinal muscular atrophy the price of the drugs are beyond what most parents can  afford. 

The Importance of a Second Opinion with a Serious Medical Problem

Medical care has changed so much in the last several years that the importance of  a second opinion, if there is a serious diagnosis is even more important. The glory days of medicine are certainly over. Yes, we have lots of good things, but research seems to have become more important than everyday patient care. Recently, I have been told about a woman who has had breast cancer and now has a mass in her abdomen. A biopsy was done that revealed cancer, but I don't know if someone competent looked at the biopsy slides. When I was seeing neuromuscular patients and reviewing muscle biopsies from across the U.S. I was appalled at some of the unreadable muscle biopsies I was sent, particularly when the patients had been given a diagnosis based on the unreadable biopsies. Even well-known medical centers may have pathologists with limited training.  

Instead of doing a pet scan to see if there were any metastatic lesions, the woman was told to  take a laxative and eat a limited diet. Instead of surgically removing the mass  and probably part of the affected bowel, she was told that surgery would decrease her immunity. What did the doctor think a metastatic mass would do? This is a relatively young woman' who very much needs a second opinion in a different hospital. I suspect she is being left to die.  All biopsies should be reviewed by an expert in the field of the medical problem. I was once giving a talk in a major hospital about muscle diseases and a doctor in the front row in the audience asked several questions. Later he introduced himself and said he was the head pathologist. He admitted that muscle biopsies were not part of his training and he agreed to send any further biopsies  to people I recommended. 

What Could Happen with Another Conservative Supreme Court Judge

It was a great loss when Justice Ruth Bader Ginsburg died yesterday. She was an outstanding woman and a great fighter. Now Trump and his group are gleeful thinking they can get rid of the Affordable Health Care Act and leave thousands of  people without medical care. That would be a tragedy and the poor, the disabled and minorities will be hurt the most. I have never understood why there is no Republican health care act when Trump keeps saying there will be. How could any caring individual deprive thousands of the ability to see a physician or go to the hospital ? That is inhumane.

Not only will Obamacare be at great risk, but pregnant teenagers, poor women and those with an inheritable lethal gene will be at risk. Abortions are already being impacted, but if a woman with several disabled children, such as  Duchenne muscular dystrophy,  realizes she must continue having children with a lethal disorder that is cruel and wrong. I had one  mother of three boys who all died from Duchenne dystrophy and her sisters also had  boys with the disorder.  The woman's  husband disappeared, so no more children were fortunately born with the disorder. One mother who had two boys with the disorder told me she had no idea what she would do if she could ever have time for herself. Her whole life was taking care of her two boys with no help, little money and no time for friends or fun.  

Your Choice of Medical Care Can Make a Difference in Your Life or Your Child's.

I have seen some very good medical care and some that is unbelievably bad. My parents had a doctor they loved but he was most inadequate and would ask me what tests to order for my mother! I was in Northern California, he was in Southern California, and I was a pediatrician. I found an excellent internist for my parents but they refused to change. I suspect it was partly for financial reasons, since the  doctor was in Kaiser. My mother died of a stroke and I am not sure the doctor ever saw her. 

A good friend never saw an M.D but was being cared for by a nurse practitioner in an HMO. I urged  him to see an M.D., but he liked the nurse practitioner. He  died suddenly at age 59 and was a brilliant man. It was a great loss.

A remarkable woman who helped many children told me a few years ago about a medical problem she had that her HMO doctor ignored. I urged her to change doctors but she did not. A year later my friend was found to have diffuse cancer and had several very bad and painful years. She died recently. She could have afforded to get a second opinion or change doctors, but she did not. 

I am always puzzled about how patients make medical choices. Even extremely bright patients make strange and unusual choices. If you chose a doctor, you want to check where he or she went to school, if they are board certified and also read some of the reviews that patients write. Your life or your child's may defend on it. 

Lobbyists and Health Care

While many people are hungry or at risk  of losing their homes because they are unemployed, the health care lobbyists are working hard and have been very successful. Hospitals and others are paying lobbyists thousands of dollars to be sure they are included in the different laws  Congress has passed to help businesses. Hospitals are suffering because elective surgeries are markedly decreased and because their CEOs often make several millions of dollars.

One of the major lobbying firms is Brownstein, Hyatt, Farber and Shreck. They were able to see that Tenet Healthcare received more than 1.4 billion dollars in Cares Act grants and loans. This is while small businesses are in trouble or having to close and people are relying on food banks to feed their families. Several of the lobbyists have personal connections to Trump and his  group. 

I am told by a Washington insider that many of the bills which come out of Congress are written by lobbyists and may be as long as 800 pages. Walgreens has received 35.2 million, Johnson and Johnson 15.1 million and Eli Lilly 7.6 million. 

I hear about healthcare in other countries and wonder how the U.S. can be doing such a bad job. Money here seems so much more important that good patient care. If you have money you can get good medical care, particularly if you join a Boutique medical practice or have a connection to a hospital. I would be ashamed to make the salary some doctors get when there are poor people and others who can not afford even basic medical care. Yet  Trump keeps trying to get rid of the Affordable Healthcare Act because he is so jealous of what President Obama accomplished

Dangerous Medical Advice

I am greatly appalled at the medical advice that Trump and some of his group keep giving. First it was bleach that was going to cure the virus, then it was hydro-chloroquine which can be very deadly and now it is convalescent plasma. Trump even got the head of FDA to give an emergency authorization for the use of this plasma in patients with the corona virus. The  doctor was trained as an oncologist, but then became a hospital administrator. Even most medical students know you do not prescribe a new treatment that has not been put through standard double blind tests on thousands of people to show it would be effective and not dangerous. I guess it is more important for Trump to say there are new treatments for the virus, so he can be re-elected. In doing this he is putting people's lives in real danger. I wonder what will be the next wonder drug or treatment he will push?

If he tries to push a vaccine before it is safe, there will be illnesses and deaths. People will also be afraid to  have the vaccine if and when it is actually safe.  I certainly understand that. We have enough problem now with parents who will not let their children be vaccinated for diseases like measles, polio, tetanus and diphtheria and other illnesses. These children are being put at great risk. because of this.