Perception Is Reality
Stanley
Feld M.D.,FACP,MACE
I mentioned Joe Klein’s criticism of the VA
healthcare system in my last blog. I promised to cover some of the problems veterans
are having in the VA healthcare system.
I cannot believe the VA healthcare system is as
bad as illustrated by the following examples.
However, perception is
reality.
I believe if the government completely takes
over the healthcare systems and creates a single party payer system, Americans
will have the same perceptions that these veterans have had about the VA
healthcare system.
I have read some of the government’s official reviews
of complaints by veterans. The VA Office of Inspector General Office of
Healthcare Inspections writes the government’s official reviews.
The typical conclusion of the Inspection General
for the VA was that the overwhelming majority of the complaints in various VA
hospitals are unwarranted or insignificant.
“The VA Office of Inspector General Office of
Healthcare Inspections conducted an inspection in response to allegations of
misdiagnosis and other care issues at the Atlanta VA Medical Center (the
facility) in Atlanta, GA, and two community based outpatient clinics (CBOCs) in
Veterans Integrated Service Network 7.”
"The purpose of this
inspection was to determine the validity of the allegations. We did not
substantiate that a facility emergency department physician misdiagnosed a
stroke as vertigo (a feeling of motion while one is stationary) in September
2010. We determined that the facility emergency department physician’s evaluation
and management of the patient’s complaints and hyperglycemia were appropriate."
"We did not substantiate that the patient received
deficient care or that facility and CBOC providers failed to appropriately meet
the patient’s vision, hearing, and stroke rehabilitation needs."
This is the typical
verbage of many reports written by the VA’s Inspector General. Unfortunately,
these conclusions do not foot with veterans’ complaints.
The
general characteristics of most of the complaints fall into specific
categories.
One universal
characteristic of each complaint is the lack of development of a positive doctor patient relationship.
An Army
Major with a combat brain injury felt he had never been treated so poorly in
his life. A VA physician reviewing his condition did not even look at his
record. The physicians showed no compassion when the patient needed compassion the
most.
His
perception was that “everyone
in the system blames others or passes the buck to someone else.”
The
physician simply wrote a prescription for some medication.”
The physician
showed no interest in the patient or his disease. He showed no empathy for the
patient.
Another
former Marine, Mike Ligurri, who has written the book, The
Sandbox. He was
diagnosed with Post Traumatic Stress Disorder.
Mike
Ligurri also expressed the lack of personal contact with him by the VA physician.
He was given medication to take without explanation of the medication.
“My attitude was I don’t want to take pills
just because you tell me I will feel better.’
He felt
the physician he dealt with was cold hearted and not involved.
There is
no incentive for VA physicians to become involved with patients in the VA
system. The patients are not their patients. At
each clinic patients usually see a different physician.
The
perception of patients is that the VA physicians and the VA system do not
connect with them.
Patients are treated as commodities.
I can
relate to that feeling. When I was in training at a charity hospital I was
never able to form a relationship with patients. I did not even see the
patients I admitted to and discharged from the hospital.
There was
little continuation of care or follow-up by me.
When I went
into practice the patient was my patient and I was his doctor. The positive
patient physician relationship made the visit more satisfying to me and more
therapeutic for the patient.
If I
didn’t relate to my patient while in private practice, my patient had the
option of leaving my practice and finding another physician.
I, as
other physicians in private practice, made it my business to relate to my patients.
My incentive was to build my practice and reputation. I was a consultant to
other physicians as a clinical endocrinologist.
In order
words, I had incentive to treat my patients well and my patients and referring
physicians had freedom of choice of any other physician.
The
experience patients have at the VA is reflected in the following comment,
“They made
me feel like they had no time for me. All they did was to take notes, never
engaging with me, and after ten minutes decided to write me a pill
prescription. I was never told about alternate forms of therapy.”
Patients
want to know about their disease. They want to learn the reasoning for their
treatment. They are not stupid. They want to know what to expect from their
disease and their treatment.
They want
to have a caring and comforting physician because they are frightened about
their disease.
Patient
education and a positive patient physician relationship are essential for good
therapeutic outcomes.
A few
weeks ago at medical grand rounds I sat next to a fellow physician and good
friend who was cured of testicular cancer 30 years ago at age 32.
At that
time he was frightened out of his mind because he had no experience with
testicular cancer. He was sent to a radiation oncologist who explained his
disease, his prognosis and what to expect throughout the course of therapy.
This relationship was a total comfort to him.
He
mentioned this to me during our conversation. He said that he felt very bad
because he had not appropriately thanked the radiation oncologist for the
fantastic physician patient relationship. The relationship permitted him to
tolerate his therapy well. He said he been given hope of surviving and a
positive feeling about his outcome.
I told
this physician I was going to have lunch with that radiation oncologist the next
week. He asked me to be sure to tell the oncologist that he thinks of him all
the time.
He has
been so thankful for his help. He added that post testicular cancer therapy he
enjoyed a fantastic marriage and has been blessed with two wonderful sons.
Now that defines a wonderful physician patient relationship!
Another complaint of
VA system patients is the long wait time for appointments and the mountain of
paper work that has to be completed in order to make each appointment.
If a patient misses
an appointment because of bad weather or unforeseen circumstances you have to
start the process all over again.
It must be maddening
for VA patients. A Veterans’ study committee has reported an average wait time
has been quoted as 50 day to 273 days.
Recently an older
veteran told me that he had a cataract that was progressing yearly. He was at
the point that he needed cataract surgery to be able to see.
He was told that the
wait and backup was one year.
He made enough of a
stink about the delay in his surgery that the VA healthcare system sent him to
a private practicing ophthalmologist. The private ophthalmologist did the cataract
surgery in one week.
He was thrilled
because he could see clearly again.
I am compelled to
tell some of these stories not to point out the solutions to the problems with
the VA system.
The VA system is run by
long term employees entrenched in their jobs without a threat of either losing
their patients or their jobs.
These employees have
little accountability; they create reports and publish meaningless evaluations.
These reports are of little value in fixing a healthcare system that works
poorly for patients but looks good on paper.
“Even Jon Stewart is blasting the
handling of Veterans’ benefits, “That is f—- criminal. The VA has a backlog
of 900,000 people. McDonalds handles ten times that many customers in an hour,
and may I remind you they are run by a clown.”
The point is that Obamacare with its ever increasing
bureaucracy, agencies, and regulations is going to lead the entire population
into this trap by decreasing incentives and limiting choice.
It Is “Coming Our Way with Obamacare.”
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone
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