Dr. Thompson's Blog

Nurse Anesthetist Training Versus a Board Certified Anesthesiologist

 A good friend who has been fighting widespread cancer for several years told me an amazing account of a previous eleven hour surgery. She said she checked about who was to do the anesthesia and was horrified to learn it was a nurse anesthetist. Her HMO uses these for most of their surgeries. She called the surgeon and said she wanted a board-certified anesthesiologist. When she insisted, one was provided and the surgery went well. My friend and I had talked about this problem previously and she knew one pf my family members was a board certified anesthesiologist. He had four years of college, four years of medical school, an internship and four years of anesthesia training. The training of nurse anesthetists is six to seven years. This includes obtaining a bachelor of nursing degree which is usually four years, one year of acute nursing care and two years of anesthesia training or a total of six to seven years. Many of these individuals do a good job if there are no problems, but as one of my professors in medical school told me "The problem is that there are usually some tricky, scary times when a surgery is being done and then you need a board certified anesthesiologist."

There have been some high profile individuals who have died in a doctor's office when  surgery was done using a nurse anesthetist and in one case I know of the doctor lost his  medical license.

Is US Medical Care Now about Making Money or Patient Care?

I was siting next to a teenager some time ago at a graduation luncheon and knew that his  father was an affluent surgeon. I asked the teen what he wanted to do as an adult and he said "I want to  make a lot of money" I asked him how he planned to do that and he said "I am going to go to medical school." Of course that made me see red. We had a long talk and fortunately he ended up going to work for Goldman Saks. Sadly, I am seeing the quest for money more and more in the American medical profession. CEOs of hospitals are making one or two million dollars or more and surgeons and others in the medical profession are making a great deal of money. Pediatricians, psychiatrists, and family doctors are at the bottom of the money scale and yet they are tremendously important. If a psychiatrist will not accept insurance, but expects payment up front then he or she can make a great deal of money.

I talked to a woman from an affluent family some time ago and her thoughts about this were important. She said that because so many people going into medicine come from private schools they have no idea how poor and working people struggle for food, housing and medical care. Yes, there are some fine doctors from affluent families but I am finding that more and more medical students and young doctors are more interested in their  financial status than their patients.  When women medical students set the terms for what they will and will not do as medical students and when they will have pregnancies, we have  real trouble. We would have been let go as medical students if we had demanded all the benefits and time off that women medical students now demand. Patient care is certainly going to suffer if all their demands are met since more women are now enrolled more than men in U S medical schools.

 

Medical Suicides in the U.S.

There was a frightening statement in a recent article in the New York Times. It was written by two professors, one a nurse and the other a physician. They stated that  "Enough doctors in the U.S. commit suicide every year to fill two large medical school classes."  We already have a shortage of physicians, so that is frightening. Many roles that doctors previously filled are being filled by nurse practitioners. Their clinical training is 720 to 1200 hours compared with 12,000 to 16,000 hours for physicians. Some doctors  have even more training than 16,000 hours.  

A 2017 study in England found the suicide rate of nurses to be 23 percent above the national average. The article stated there are so many hours have to be devoted to electronic and other medical records that nurses and physicians become overburdened. A lot of this is related to what hospitals and insurance companies can bill. Money does drive medical care these days. Sadly,many medical students and residents chose professions that will give them big incomes. If medical schools enrolled students who could have their tuition paid by agreeing to serve for two or more years in low income areas, they could  have the great joy there is in practicing real medicine and getting to know their patients. Having practiced 50 years, I loved my patients, their families, and medicine. I wish the medical schools could change the type of students they admit and enroll students who wanted to practice real medicine, instead of  looking for a way to make a lot of money. The government also must find a way to control hospitals and insurance companies,  so  medical records records are not so difficult that  nurses and physicians retire, commit suicide or just give up. 

Why is Compassion and Concern Now Lacking in Many Nurses, Medical Students, and Doctors?

I recently have talked with several older doctors and nurses about what has happened to the lack of compassion and concern I am seeing in too many medical students, nurses, and doctors. One affluent mother of a teenager said she believed it is because many of the A students being accepted to nursing and medical schools are coming from affluent families  and don't understand what it is to not have their privileged backgrounds. This is certainly something to think about. Is medicine becoming like the political and business world where money and power seem to be all important?  Caring for patients should never be about how much money you can make. I worry about the many medical students who chose to become dermatologists because they can make a lot of money with botox and other cosmetic procedures. As a pediatrician, I never thought about how much money I could make and loved my babies, children, and teens. I hear from countless numbers of them at Christmas time and often during the year. This is worth so much more than making a lot of money, which I never did.  

I wish nursing and medical schools could look at why their applicants want to enter the medical world rather than what grades they received and their various activities. My favorite wonderful professor at the old Stanford Medical school told me he would rather have a caring, compassionate B medical student than a entitled one who never had to have various jobs to pay his or her tuition. I think American will pay dearly if the trend to making money in medicine does not change. 

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.