Dr. Thompson's Blog

Improving Care of Patients with Disabilities or Chronic Illness

Even though medical care for patients with disabilities or chronic illness is too often sub-standard, there are some technology advances that hopefully will make up for the lack of good medical care.The key to success is coordination of the efforts of the different individuals caring for  a patient. A team of professionals is important, but communication among and between them is important. Doctors, social workers, physical and occupational therapists are essential for most of the patients. I was fortunate to have access to both art and music therapists when I founded and was directing the Center for Handicapped Children in San Francisco. We even had a dance therapist who was amazing. She brought some fun, socialization and even physical exercise to the patients who could benefit from it. 

Computers and other new devices now allow patients to turn on lights and other equipment and this can make a great difference. Most importantly a good quality of life should be the goal to strive for. If a patient sits in a wheelchair or lies in bed with no fun, no intellectual stimulation, and no socialization, the best medical care in the world can not make living bearable. When patients  have a progressive disorder as Duchenne muscular dystrophy and other disorders. I believe the patients, who are able to to make decisions about their lives, should be given a choice about what they want. As patients become more and more incapacitated their ability to fight off unwanted life-prolonging medicine or technology becomes less and less.  When my patients were reaching the stage where some decisions needed to be made, I always asked what  they wanted in the way of life-saving care. Only one young man told me I should use every means to keep him alive. The other patients said "I don't want any breathing or other technology to keep me alive." I   have seen both families and doctors bully patients into  having care they did not want and that would greatly decrease their quality of life. I believe that is morally wrong. 

 

Holiday Safety Tips for Parents and Grandparents

December usually becomes a very busy month for parents and grandparents with entertaining, baking, buying gifts, and trying to follow family traditions. Because the days can get pretty chaotic, it is important to  keep children's safety uppermost in your minds. One thing to be particularly careful about is toys.  Remember that some many toys have detachable pieces which if swallowed can lodge in a child's throat.  I would also check  for sharp edges. Remember, too, that magnets in toys are a problem because they can cause perforations or blockages in the intestines, if they are swallowed.

If you are decorating with Christmas or holiday plants, remember that the poinsettia and some holly and mistletoe plants are  poisonous. Candles can be beautiful, but you want to be sure that they are in a safe location and not near anything inflammable. If you forget and leave a candle burning, big trouble could result. Holiday lights should be checked for safety and turned off when you leave the house. 

Children need plenty of rest and routines, especially during the holidays. This is particularly true of those who fit into the autism spectrum. Hiring a baby sitter to help when you are stressed or overworked could make the difference in your life and your child's or grandchild's. A meltdown in the middle of shopping or entertaining can ruin things for everyone. Planning ahead for some extra help or trading childcare with a friend can help greatly.

If you have questions about the safety of toys or other gifts you are buying for children, the Consumer Product Safety Website can be checked at  www.cpsc.gov. Also, it is wise to always have the 800 number for the Poison Control Center posted. It is 1-800-222-1222. There is also a Web site at www.poisonprevention,org.

Happy Holidays!

Online Medical Care Can Be Dangerous

Online medicine can be a problem even in dermatology. Many people think of skin doctors as just giving botox or doing something else to make patients look younger. Dr. Resneck, a doctor in San Francisco, and others published an article recently showing the importance of actual contact with patients. They noted how serious infections can be missed, inadequate histories taken, and the "risks and side effects of medicine  prescribed were only discussed in their study just 32% of the time."

A skin rash can be the main sign of a serious underlying condition, such as lupus. A complete physical examination is needed and lab work obtained. Delay in diagnosis can make a great difference.  There are many other conditions where  skin problems are just the "tip of the iceberg". If you don't have actual contact with the patient, as a physician, how can you possibly make a diagnosis? I have always refused to order antibiotics or other medicines over the telephone without seeing a child. Tragic fatalities have occurred when this is done. A stiff neck, a painful joint, a bulging eardrum can not be detected with  a video of a child. With adults, there are many problems that also need a complete physical examination.

I understand that when a patient lives in a far away rural area and is too sick to travel that the idea of telemedicine seems like a good idea. However, there has to be a way to get a patient to an ER or an urgent care center. Seniors can wear a special alarm and push a button  that alerts an emergency center they are in trouble. With all our brilliant technology people, I think we have to find a way not to use telemedicine. 

Virtual Medicine is a Frightening Concept

I recently was sent an e-mail by a company trying to entice doctors to sign up for "Virtual medicine" The idea is that a mother or father would hold a child up to a video camera and a doctor would make a diagnosis. The e-mail seemed to be targeted to pediatricians. I checked the unsubscribe box and when asked why, I stated that I could not understand why any doctor would practice this way and that children could be hurt or even die. How could you possibly diagnose a stiff neck, a congenital hip, child abuse, a bulging eardrum or any myriad of other problems? Children can become ill very quickly and any doctor who relies on this kind of  diagnosis could make a lot of bad mistakes.

I think technioliogy has done some wonderful things, but video or virtual  medicine is not one of them.  How could you get to know your patients and their parents if all you saw was someone on a video camera? The argument the company was making was that a doctor could make a lot more money, see more patients and parents would save time by not coming to your office. I thought about some of the problems I had diagnosed in children by talking with both the children and their parents and doing a good examination. A throat culture for a possible strept throat or a urine culture for a bladder or kidney infection could not be done by video. What about a child with an emotional problem or one who is being bullied? Could you see that on a video? Or what about a teen who plans to commit suicide? All of these are patients who may need a doctor's help and the doctor needs to care more about his patients than making a lot of money.

 

Parenting Medical and Other Information on Apps and the Web

I am having a hard time understanding why parents need to resort to Apps and the Internet to raise their children. Where are the family doctors and the pediatricians? Don't the doctors talk to their patients any more? I still hear from parents whose children I cared for when I first started my pediatric practice in 1963.

I think part of the problem is that parents are so busy these days that looking something up on their Smartphone or other gadget may be faster than trying to get in touch with a doctor. Unfortunately, there is a great deal of misinformation on the Internet. The New York Times today has an article stating that WebMD now has a parenting app. I have done interviews on WebMD and know they are more reliable than several other sources. However, once again if there is a problem with a child, the doctor should know about it.

Another reason I believe that parents are turning to all these artifical ways to get information is that most medical schools these days are not teaching practical pediatrics. Now it is all about theory and technology.   I think this is a tragedy. I had a classroom built onto my office where I held free monthly parenting classes. They were lots of fun and both the parents and I learned a lot.