Dr. Thompson's Blog

Preventing Parasites in Pets from infecting your Children

Veterinarians can make a big difference if they are sure the parents of children who have dogs or  cats for playmates understand about the parasites that animals can transmit. The principal parasites are roundworms, tapeworms, and hookworms. Little children who  play in a yard barefoot are at risk for picking up parasites. If they play with their pets and then put  hands in their mouth, this can be a source of contamination. Some kids eat soil, grass or other areas contaminated by  parasites' eggs. 

One way to prevent infection is to have your pet or pets routinely dewormed. It is important to know that hookworm larvae can penetrate the skin. One study showed that 80% of parents had no idea that parasites were a problems with their children's pets. People who have pets spend billions of dollars on their animal which is far more money than is spent on children in the U.S.

One important fact is if pets are kept free from fleas, this can help prevent tapeworm infection. Also litter boxes need to be cleaned regularly  and hands washed afterwards. 

 

What is Needed to see a Specialist outside an HMO

If your HMO will not refer you to a specialist who is part of the HMO, there are several things an outside specialist will need. When you make the appointment, the secretary should know you have medical records at an  HMO and also be told if there are any X-rays, CT scans or MRIs. All of these can be sent and received by e-mail. It is important to check that the secretary has make the request and the records and other things have been received. You may have to check several different times before your appointment because some secretaries are very efficient, others are too busy and some don't  want to make the effort.  You want to be very pleasant at first, but if nothing has been done, you may have to become assertive. 

I had one parent who wanted her child to see by a specialist in another town. The HMO was not willing to help her in any way, so she resorted to an article in her local paper and as a final desperate attempt to get the appointment and records sent, she had her friends and family join her and  they picketed outside the the HMO facility. She was a former teacher and  a mild, pleasant woman. However, since she felt her daughter's life was at stake no measure was too hard for her. She got the appointment and the records transferred! 

Questions to ask your Doctor about a new Rx

Now that many doctors are limited to 8.5 minutes to see a patient, it is important for all patients to make sure they understand what to do when a new medication is prescribed. Be sure you know the name of the medicine and why it is being prescribed. It is important to know when to take it, ie. one, two, or three times a day and in the a.m  or p.m.  Also,  should you take it on a full or empty stomach? Is alcohol O.K. to  drink  with the Rx or not at all?  If you have any reaction should you call the doctor or what do you do? Are there known side effects?  Also you want to know if there is a cheaper generic form because many doctors have no idea what a medication costs. I remember when my good, long-time eye doctor prescribed a lotion for my itchy eyes. It was over two hundred dollars for a small tube and I did not buy it. I am sure he had no idea of the cost. 

A major problem that often occurs, particularly when a patient is taking several different drugs is that there may be interactions and problems  with some of the drugs. I have called pharmacies many times when a new medication was prescribed for patient and found that it interacted badly with a drug they were taking. This was true for children with seizures and other disorders. Sometimes doctors don't bother to ask if a patient is taking other medications and  don't check with a pharmacist to be sure there  are no bad interactions. A friend's mother was taking over 20 medications, so she took all the drugs to an excellent pharmacist and he was appalled. It took a while to get the different doctors her mother saw to straighten it all out.

 

Handling the Fear and Anxiety of Corona Virus

This is a anxious, fearful time for the world. I feel fortunate to live in California were our Governor seems to be working hard to keep us all safe. I wish there was better leadership from Trump, but I don't think he can understand the gravity of what is happening. For those of us in medicine, we can well understand the tremendous need to protect doctors, nurses and other medical personnel, as well as all those who work to keep our country working. 

What I have found to be the best way to handle this terrible pandemic is to go one day at a time. I have decreased the amount of news I listen to because it can cause a lot of anxiety. Staying at home and being so isolated is hard, but it gives us a chance to catch up with old friends, sort through old papers and documents and do a lot of reading. I have two favorite British authors I re-read. I have always been a reader and don't read heavy books but novels that are about real life.  A quick walk can help and having  faith and can make a difference. My father used to say "This too will past" and hopefully our country and the rest of the world will realize we all need each other and tariff barriers and border closures are not the answer. 

Scary Facts about Medicare for All

An excellent article by Scott Atlas in the New York Times pointed out many facts about Medicare for All that are important to know. I strongly believe that everyone in the U.S. should have access to good health care but Medicare for All is not the answer. Scott Atlas pointed out the estimated cost would be 32 Trillion dollars in the first ten years.  Not only is the cost prohibitive but the restrictions would change people's lives and increase  the death rate. Hospitals would suffer cuts of about 40% and doctors would have their payments reduced by 30% when their payments are already low.

Medical care would be severely restricted and the waiting time to see a doctor would be greatly increased. Treatment  for things like cancer, brain tumors and heart disease would be restricted and there would be an increased death rate. 

The answer has to be that people can keep their private insurance but it must be good insurance and not junk insurance. Then like Obamacare, patients could buy into something like a Medicare plan or Obama's plan. 

 

The Problems with HMO Medical Care

HMOs are fine for medical care if you don't have any real problems. However, if you have something serious, you could be in BIG trouble. An individual I know who has some serious back problems, as shown by MRI and a CT scan has still not been given an appointment to see an orthopedist specializing in back and spinal problems.

I spoke to the medical director of an HMO some time ago about a child with a disability who needed to see an orthopedist. The doctor actually said:  "We are not responsible for  medical care for a disabled child. That is up to the school and the community." I was appalled.

One major problem with HMOs is that a lot of care is provided by nurse practitioners. They do not have the needed years of medical training to care for individuals with serious problems. Patients can file first and second appeals to see a particular specialist but these are very time consuming and may be denied. If you have an emergency and go to an ER not in your HMO, the charges will probably not be covered. Thus you want to read the rules and regulations of an HMO before you enroll in one. It could be a very costly and unwise decision. 

If you have children, it would be important to be sure immunizations, blood, urine and other tests are covered, as well as routine well baby care by a pediatrician. Are cochlear implants or special surgeries covered if there is a birth defect or spina bifida and can an outside specialist be seen?. Also what hospital care will be paid for? Don't be afraid to ask questions. The squeaky wheel does get the grease.

 

 

 

 

 

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.