Dr. Thompson's Blog

When People Ignore the Pandemic

I watched a little of Trump's CPAC speech last night and was amazed at the number of people sitting close together, mostly not wearing masks. They say it is their right to chose not wear a mask or sit at a distance from others, but what happens when they get the Covid virus and give it to their children, their parents, friends, or others? 

 The medical experts say we can stop the spread of the virus if we all wear masks, stay at a social distance from others and wash our hands frequently. I was an intern during the polio epidemic and if you  have ever had to watch a child or adult die or become disabled from a virus, you would think twice about what you are doing during this pandemic. 

I live now in a small beach town and an amazed at the groups of people walking together with no masks on. I walk out in the street when I see these individuals. Yes, I wear a mask, plastic gloves, and mostly work inside during the day. If I go out it is usually early in the morning when there are few people around. It would be great to be able to do the things I did formerly but that is not going to be safe. I have had the first dose of the Moderna vaccine and am looking forward to the second dose. Even then I will wear a mask, gloves, and keep at a distance from others. I hope others will do this also. 

 

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

I am always surprised when even well education friends don't know the difference between a board-certified medical doctor and a "doctor" who is not an M.D. Now many states are allowing even nurse practitioners to write prescriptions. Then there are the so-called doctors of naturopathic medicine, doctors of chiropractic medicine, and doctors, who are not medically trained, but have a Ph.D. or dental degree and nurse practitioners who get a doctor of nursing degree.  Sadly, many M.Ds today are all about making money, so some become hospitalists, which means they have fewer hours, work in hospitals, and are not on call or have regular office hours, as do pediatricians, family doctors, internists, and other specialties. When you look at the number of hours it takes to become a board-certified physician and compare  it with the hours it takes for the other "Doctors", there is no comparison. To become an anesthesiologist or a neurosurgeon, for example, you need four years of college, four years of medical school, a year of  internship, and three or four years of residency. Doctors of naturopathic medicine do not do an internship or residency and special provisions are made if they have had just two years of college. Some nursing schools, I am told are taking students right after high school without a college degree.

Now with the Internet you can look at a "Doctor's"  training. It is always important to see where a doctor went to school, what training he or she has had and if the doctor is an M.D. or something else. You could even save your life or that of a child or  family member. 

The greed of Drug Companies

There was a good article in today's New York Times about the high cost of drugs and how much more Americans pay for drugs than in other countries. The author, Austin Frakt, hopes that President Biden can make a change. I certainly agree. Mr. Frakt notes that U.S. drug prices are" the highest in the world."  Of course, when CEOs of some drug companies are making millions of dollars a year in salary, that is understandable. The drug companies argue that the high costs are due to research and development. I laugh when I realize that a medicine I have taken for many years formerly cost one cent for each pill and now costs six dollars for each one. No research and development is needed for this drug. Countries such as  Germany have a law where " a central body evaluates the benefits of new drugs" and then negotiates with the drug companies to work out the price. Even if you have Medicare or some kind of insurance it usually does not help unless you pay extra, as for Medicare Advantage. An independent review board could be helpful, but the drug companies are so powerful that it would take Congress to pass laws that would give an agency the power to force the drug companies to charge reasonable prices. However, with their many lobbyists I wonder if anything can really be done. With some many things in the U.S. money and lobbyists make a very great difference. What makes me especially angry is that for terrible disorders such as spinal muscular atrophy, the price of the new drug that can greatly help Type one and two children is so expensive that many parents cannot afford the drug. These babies can die or be severely disabled. 

Becoming Informed about Medical Issues

Unless you have medical training, it can be hard to get true facts about medical issues or problems. There is a great dal of misinformation on the Internet and even in medical books. Sites such as the Mayo Clinic are usually good, but occasionally I find erroneous statements about subjects I know well. One day I found some wrong information on NORD, which is usually excellent, but when I told them about it they were good about letting me give them the correct information, so they could make changes. 

I was amazed to find out that some X-rays are sent to far away countries for reading. My own daughter had an X-ray of her head at UC Medical Center in San Francisco that was reported as showing a tumor.  I took the X-ray to an   excellent radiologist I knew in another hospital and he said "there is nothing wrong with your daughter's head." She could have had surgery on her head had I not done that. A second opinion is always wise in a case like this. 

I would always ask about any side effects from a medicine a doctor prescribes. If a non-M.D. prescribes a medication, I would not fill it until you check with an M.D. If you are taking multiple medications, you want to be sure there is no bad interaction between any of the medicines. You want to check also if an Rx should be taken with food or on an empty stomach. 

There are substances being purchased at health food stores that are not checked by the FDA or Food and Drug administration. Protein powders and similar substances may contain ingredients that can cause harm. 

 

How to Get Help Paying for Expensive Medicines

One of the many things Trump promised during his awful four years in office was that the cost of medicines would be reduced. Instead, he did everything he could to get rid of President Obama's Affordable Health Care Act. I am always amazed at the cost of medicine when I go to pick up a prescription. When the CEO's of drug companies, such as Roche, are being paid 38 million dollars a year or more it is just wrong for medicines to cost so much. Hopefully, President Biden will try to put some kind of limit on drug prices. Fortunately, there are some ways you can pay less for an expensive drug. One company that offers  helps is GoodRx. Their number is 1-888-277-3911. The Patient Advocate Foundation may also be able to help. Their number is 1-800-532-5274 and the website is www.patientadvocate.org. There is also a website for low income patients which is www.scbn.org. They offer assistance for low income families.  The Medicine Program at www.themedicineprogram also helps patients who can not afford prescriptions. Sometimes, too, there is another lower cost medication that can be prescribed if you talk with your prescribing doctor.  Some individual's order medicine from Canada and I have a retired doctor friend who finds that very useful. 

The Problems with Medical Care in an HMO

The individual who developed the concept of HMOs later said he regretted doing so.  There are some excellent doctors in HMOs, but I do not understand how any physician could tolerate their rules. HMOs have rules about everything, including how much time can be spent with a patient, how many referrals to specialists can be made and many others rules. I would last about 10 minutes in an HMO. Thus, I have great respect for physicians who decide HMOs are not for them and move to their own or a group private practice. One of the other problems with HMOs is they allow nurse practitioners to see patients without a physician being involved. A good nurse is worth his or her weight in gold, but nurse practitioners do not have the years of training that medical doctors do and should not see patients without supervision. I have seen some real tragedies occur when this takes place. One tragedy was my own mother's medical care. My parents loved their HMO  doctor, even though he was greatly incompetent. He would ask me what tests to order for my mother. As a pediatrician, I was certainly not the doctor to consult. 

I am always puzzled when people who can afford private insurance stay in an HMO. I realize that sometimes the people with the most money are the ones who hold on to their money the tightest.  Having great wealth wealth does not make them smart about medical care. Sadly, they may pay a high price for not  having private medical care and an excellent private physician. 

When Hospitalized patients are Sent Home without Discharge Planning

As our U S medical care seems to get worse and worse, I have heard that more and more patients are being sent home from a hospital without any or minimal discharge planning. I was accustomed to having a discharge meeting for patients with all of the specialists involved, so we would know what each specialist wanted done. I also wanted to be sure someone would be there to be sure the patient was getting adequate care, to give the patient their meds, food etc. 

I have heard too many horror stories about patients being sent home with no one at home to care for them, particularly if they were not able to do anything for themselves. This is particularly true of older, widowed or individuals without a family.  My own widowed brother was sent home from a Las Vegas hospital without any notification to me.  He ended up falling and  breaking his arm. The one person the hospital did send out was a speech therapist, when he did not need one, and she was one who found him alone with his broken arm and no food in the house. Anyone, particularly with an elderly friend or relative in a hospital must insist that adequate discharge planning be done and the friend or family member know exactly what  needs to be done and who to call if there  are any problems. 

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.