Our veterans deserve so much better than the VA

After I graduated from medical school, my very first real ward rotation as an internal medicine intern was at the VA.  Therefore, I can say with absolute certainty that all the stuff being said about the VA health system is true.  The place is a mess.

Let’s start with the computer system.  The VA medical record system has been held up as an example of an effective EMR system, in which you can get any information on any VA patient no matter what facility you are in.  This is true, but try to actually find useful information and you’re in for a slog.  The interface is old and clunky, and most of my time was spent cutting and pasting from prior visits or admissions.  This may have changed since 2001.  I hope, for the sake of my fellow interns, that it is.  I spent more hours in front of those computers than I ever did seeing patients.

How about the diagnostic services, labs and x-rays?  All available, although I often had to transport the patients to radiology myself.  If I sent a patient for a test that required IV dye and the patient didn’t have an IV, the techs just cancelled the case and sent the patient back, without a word to anyone.  So it was generally better to go along, so I could put the IV in myself.

Same with lab tests.  If the nurse couldn’t obtain blood work, she just cancelled the order.  I would hear about it later, maybe.  So I came in early and did my own blood draws.  Government workers, at their most government-ish: stable salary, hard to get fired, good pension.  Everybody at the VA seemed to be marking time to retirement.

If you live near a VA, drive by on a Monday and then again on a Saturday.  The parking lot on Monday is overflowing.  On Saturday it’s a ghost town.  One of the reasons I pushed patients down to x-ray myself was to get the images done before 5 p.m. on Friday.  Absolutely nothing would get done after that until the following Monday.  No one gets discharged, it’s hard to get images or labs, and not one single administrative person is on site.  If I had a list of 12 patients on Friday, I had that same 12 on Monday, guaranteed, plus whoever came in over the weekend.  Every week we would have a sit down with a whole roomful of social workers, who would review each patient and ask us interns what the plan was.  I got in big trouble one day for suggesting that it didn’t matter what I thought, my patients would stay until the system ground it’s way through the governmental labyrinth.

How about the patients?  Nice old men, all.  Super nice.  Very grateful.  Multiple medical issues, some of which you rarely see anymore.  Complicated patients.  I felt bad for them.  I tried my best, but boy when that month was over was gone.  The patients were not so lucky.

Our veterans deserve so much better than the VA.

Shirie Leng, a former nurse, is an anesthesiologist who blogs at medicine for real.

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  • QQQ

    In 2008 Obama said he would quote, “Make the VA a leader of national healthcare reform so that veterans get the best care possible”. Now he claims to be completely unaware of any problems and as usual appoints the person he put in charge to investigate what he did wrong so he can clear himself.

    This is the government model. Say much, spend others money, promote and protect your friends and supporters regardless of ability, exempt you and yours from the measures you pass, destroy moral values to gain support. Then when everything is so bad it can no longer be ignored dig as deep into the sludge bucket as you have to, diverting responsibility before your next spending spree. That is ACA and everything with big daddy government.

  • ninguem

    The supercilious “experts” have been telling us, for years, how great the VA system is, and how terrible we private doctors are.

    They point to the EMR in particular.

    When doctors object, we are dismissed as tinfoil hat crazies.

    “Teabaggers.”

    Only now, are we seeing how wrong they are.

    In fact, they were lying.

    Krugman. Berwick.

    Among others.

  • Jenny Jackman

    VISTA has actually been improved, but not by much. One of their problems is getting doctors and nurses who are actually willing to work for what the government pays them. I don’t know about other states, but the nursing pay $15/hr less than what the private sector paid in my state, and that was 7 years ago. Nobody is going to take $30k/year less than what they can make at the hospital down the street for more than a short period of time, which is why turnover is so high. Most of the doctors are military retirees who are collecting pensions in addition to their biweekly pay, which covers the wage gap.

  • DeceasedMD1

    You wonder why this is a surprise to the public. Everyone here has probably done time at the VA-sort of like prison time. The care or lack of ancillary staff, was something taht was joked about. it is very sad agree it should be better but it takes awareness and people that care. How can you make admins care about vets? clearly it’s all in the bonus for them. like Dr. Leng said it was a pleasure to work with some of these men-not all. but the cx there is they just don’t care and want to extract as much money as they can from the gov’t. Pathetic.

  • buzzkillerjsmith

    In 1985 I had a vet wheel up to me at a nursing station at the Fort Miley VA and ask me if I knew a word that started with f and ended with uck. I said I did. He said firetruck and wheeled away. I never saw him again.

  • QQQ

    One sure way to “fix” the VA healthcare problem would be to make all of the congress and White House staff go to a VA hospital for their health care needs. If they had to use it, the damn sure would be sure it works. We could fix social security the same way, eliminating congresses pension plan and make them go under social security. Take away their super platinum type taxpayer funded plans and make them use the same systems they impose on the vets and the public.

  • Chris Porter MD

    While the medical record is a little tricky to navigate, it’s also integrated: pharmacy, labs, imaging, inpatient and outpatient record, vitals signs, consults, ordering. Is there a comparable system elsewhere, allowing access to the patient’s record at hospitals all across the nation?

    I think when people critique the VA medical record they focus on glitches in the user interface, and forget that workflow without such a system involves finding a script pad, walking to radiology, phoning and paging consultants/nurses/residents, faxing records from all over town (after faxing authorizations all over town), looking at bagfulls of pill bottles to divine meds, looking at scars to guess surgical history, hunting down a missing inpatient chart, flowsheet, I&O’s,..

  • QQQ

    Nicely said Dr Strong. Thank you for treating our veterans!

  • Jenny Jackman

    I was basing my comments off my personal experience being offered a position at a VA facility in my state. It would have been a significant pay cut for me to accept the offer. However, as I noted, that was 7 years ago.

  • mj122

    Your experience at a VA hospital sounds exactly like my experience as a hospitalist at Bridgeport Hospital. It’s not just government facilities that function like that unfortunately.

  • militarymedical

    Really, Dr. Leng? One month’s experience at one VA hospital thirteen years ago makes you a qualified expert on the quality and quantity of VA medical care, practices and personnel? I spent longer than that as a student at the Durham (NC) VA facility over 40 years ago … I suppose by your criteria, that makes me more qualified than you. (By the way, like all others who have responded, you ignore the single fastest-growing sub-population of VA patients: female veterans. Time to lose the “our boys/our men” rhetoric.) I usually regard your columns/posts as relevant and thoughtful; this one is just old, smelly stereotypical garbage.

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