Tuesday, August 21, 2007


The universe is a big place. I'm sure there's more in it than we know.
There are a lot of bad things involved in medical diagnoses these days. Sometimes they seem to involve a lack of knowledge on a doctor's part.
Others, and this is not an opinion, involve a fear of lawsuits if the doctor is proven wrong. Even if he/she hasn't made a mistake. Lawsuits, both genuine and money grabbing efforts, are way too much of a consideration when an error is made in recognizing a particular disease or physical condition.
Consider the infamous $54 million law suit over a pair of pants. (Click on the header.) My personal belief is that the judge wanted to make a point about frivolous lawsuits.
So, in order to avoid these expensive and reputation breaking lawsuits, doctors order more and more and more "tests" for their patients. And these tests are not cheap. Doctors are aware of this and are very likely aware that there are health insurance companies that will not allow many of them. In re that, it brings up another problem with health care. One that is not spoken about in newspaper or TV stories discussing the need for health care. A lot (read many, many) of people simply drop out of the health care picture. If their bodies can't repair the physical problem they simply "pass away". "Old Age" is a common phrase for the cause of death. So is "he/she needed to get medical attention" but didn't take action. How ironic.
Doctors overbook themselves so much that even with an appointment you might wait two or three hours in their offices. It's a way for them to make big profits while paying for malpractice insurance.
So what's all that got to do with the VA?
Here's an answer I have seen in practice so many times that I am convinced it is a major stumbling block to adequate health care. Doctors, perhaps with teaching from their insurance agents, have been lumping patients together based on various symptoms.
For instance, if you exhibit symptoms A, B, C and D this is the general treatment. If A, B, C, and E, then this is the treatment. And so on.
It seems the VA doctors do this also. I've discussed it with my doctor and pointed out that my body probably doesn't fit in any of these neat pigeon holes. He agreed. The look on his face seemed to imply "I've got to do as I'm told". (I'd probably bet big money, say 5 cents, that I'm not the only one who doesn't fit in.)
So what happens then? Doc goes on with his examination of me and has me give blood samples for tests, or makes an appointment for me to see a specialist for other tests, or orders a new pair of diabetic shoes for me.
He can do wonders along these lines and I respect his opinions. But there is one thing he cannot do that I feel should be done. The VA is crowded with patients. I mean overcrowded to the rafters with patients. The vast majority of their patients cannot afford private medical care any longer. They've been priced out of that market. So he has to squeeze in appointments to see all of the people under his care.
And that is where the problem lies. He just cannot spend the time with each patient that he should.
My doctor (and all doctors at the VA) are alloted 30 minutes to see each patient. That means in an eight hour day, they each must see 16 patients. And they must try to remember all these patients and the various problems they have. So, they use a computer to call up the data on each person. Now, I have been a patient for about 5 years. My medical record looks as though it's War and Peace size. Doc has to glance through this huge record and pay attention to the most recent bellyache from me while recalling all the various things that have been done for me and what medicines I'm currently ingesting.
Yes, there are patients with both longer and shorter tomes of treatment, but I figure I'm somewhere near average. The point being that sometimes doc refers to that computer screen for at half of the appointed time of my consultation. And then he has to ask me the questions that need to be asked. So, if it's a new complaint, he checks my prescriptions and tries to decide if I need a new medicine or if he should alter one that I am taking.
And he does this with all his patients. Now, I'm not an efficiency expert, but common sense tells me there is no way he can accomplish all this in the alloted 30 minutes. He's very, very good, but he can't walk on water any more than I can. (Parenthetically, I've gotten phone calls from him as late as 6:30 p.m. when he needs to tell me something. And I don't believe he is paid overtime for that, either.) I love my Doc.
Well, you say, you're getting medical treatment, aren't you? Sure am. But some new things are going on at our VA hospital. Maybe all VA hospitals. We've used to be automatically scheduled for an appointment every six months. But that's been changed. We now get a "telephone consultation" from our doctors once a yhear that takes the place of a visit. Now, what the hell good is that to me? Doc can't see me. I can't see his face. He can't look me over and note a subtle change in complexion or physiology. So we talk about how I "feel". Crap. Sometimes I want to say, "just seeing you personally is a big pick up for me". I need to see the person who helps me be in charge of my body up front and personal.
There is also an "open clinic" which all doctors have. You have to call in on a particular day (the earlier you call the better chance you have of getting an appointment) and you can schedule an appointment with your regular doc. The problem is, if you're just a little late with your call, the nurse will have filled all the open appointments.
There must have been a lot of complaints about these events, because our hospital administrator has instituted a new thing. Oh, yeah. We can now make appointments with doctors in a new clinic. Any time we need one, that is. But of course, there's a problem. You bet there is. These doctors the VA has hired are new. I mean really new. They seem to be med students finishing up being interns. Those I've seen always have to go and talk the case over with their Attending Physician. Not one of them has made a decision on his/her own. And they come back to see me with instructions from the Attending without him ever seeing me or hearing me. I'm sure these apprentice doctors have the best intentions in the world, but medical school has not yet taught them how to look at a patient and apply what they see to what the patient is there about. In short, they do not yet have the experience to be let out on their own. That'll make me feel secure.
What I'm griping about, I guess, is that Democrats and Republicans and Presidents have allowed this to happen. While a protracted war we didn't want costs billions every day, our veterans who need care are not being taken care of humanely. The situation that has been created is beyond political party, beyond an easy solution. But it is a situation looking for an answer. Lip service doesn't work any more.