Then there was the time that we had fresh morning vital signs charted on a patient that we found dead, cold, and starting to stiffen.

Problems coordinating care with private systems IS a problem with the VA system.

If it promises care to veterans, and due to availability, geography and patient preference ends up providing partial care in conjunction with other providers, then any problems coordinating that are at least in part theirs to solve.

That failure to take ownership is why it doesn’t get solved. It would be a simple matter to solve if they did:

An 800 number for all providers anywhere to call 24/7 that would answer questions, make apts (or take responsibility for calling the patient with an apt when the clinic opens), take lab orders and schedule it, and authorize payment for bridging prescriptions.

But it calls to mind the comment a VA pathologist said to me as a resident when I couldn’t ellicit a timely effort to type and cross a patient who had the temerity to bleed to death at the end of the work day.

“This is a 9 to 5 hospital”

I thought that odd as I had noticed doctors, nurses, and sick and dying patients there 24/7.

That’s an interesting statement since I take care of VA patients week after week, month after month who say there ain’t a chance in hell they would ever subject themselves to the VA style of in patient medicine. They have abandoned it, some, for fear of their lives.

I worked in the VA as a resident. I know exactly how the system of communication works within those walls.

It doesn’t. The waits for anything are ridiculous and the not my problem mentality prevails above most other patient care concepts.

It is a giant faceless beaurocracy with constantly shifting responsibility and nobody in charge.

It’s just like trying to walk up hill on a sand dune.

It’s a struggle and it wears you out.

It’s not just communication with the real word, it is also a communication within the walls.

That is my experience.

Even if the problem was only with VA interaction with outside facilities, it’s not that easy. In our rural area many problems cannot be handled by the VAMC an hour away and the patient is faced with mixing private or Medicare funded care at the local hospitals or repeated trips to a VA tertiary care center several states away. Many mix VA and local care causing significant problems due to the VA’s lack of communication unless our staff spends significant (unreimbursed) time trying to obtain office notes, labs, etc. and dealing with their pharmacy.

I’m a (noncombat) vet prior to medical school and we’re no longer taking new patients who get most of their care at the VA due to these problems.

It’s a shame.