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Perception Is Reality

Posted Apr 15 2013 5:58pm
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 o r 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.

I have such a low regard for the VA. I have never been treated in my life as poorly as I had with the VA.”

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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