Beyond appalling stories of neglect and bureaucracy, this form of ‘socialized medicine’ offers everything from pioneering record-keeping to vigilant volunteers.
Sunday, in case you’ve forgotten, is Veterans Day. Considering all my futile efforts to avoid military service during the Vietnam War, I never thought I would say this:
Thank God I was drafted.
More to the point, thank God the disabling injury I received in the Army — hearing loss from gunfire and exploding ordnance — didn’t prevent me from leading a normal life. Even so, my service-connected disability gives me membership in an exclusive club of Americans who qualify for “socialized medicine.”
That’s right. Like President George W. Bush and many other high-ranking officials, I get my medical care, virtually free, from the government. The president never utters an ideological complaint when he goes to the National Naval Medical Center in Bethesda, Md., for checkups and treatment. And I’m very satisfied — if not overjoyed — that I can go to the VA Medical Center in Minneapolis.
Nothing is ever perfect, of course. Whenever the military or veterans hospitals fail a patient, the impact can range from annoying to tragic. There have been appalling stories of neglect and bureaucratic chaos hurting veterans, and I do not question the veracity of those reports.
A different story
In recent years, however, another story involving veterans medical care has been reported widely, though less loudly. In numerous studies, the U.S. Department of Veterans Affairs health system has been rated as providing some of the best care in America. In fact, some argue it is the best.
But gaining access to the VA system can be a pain. It took me six months to get “rated” as disabled and I had to wait to get assigned to a “primary care physician.” I was lucky, because when it comes to getting assigned to a VA doctor, disabled veterans go to the front of the line. Veterans who don’t have a service-connected condition can wait forever to get a primary care doctor — which means they can be forced to endure the purgatory of the center’s perpetually crowded urgent-care facility.
But once you’re in, you’re in for the long haul.
The Minneapolis VA serves about 77,000 patients, an increase from 72,000 in 2006 and from 44,000 five years ago. Fewer than 2,000 Iraq and Afghanistan war patients were part of those totals last year, but they receive the most press coverage. And — rightly so — there are massive programs under way here for them, including construction of a big “poly-trauma” wing for long-term treatment, plus beefed-up counseling and mental-health services.
Older veterans like me, however, make up the bulk of the VA’s work load. Primarily an outpatient facility, the medical center reported more than 500,000 patient visits last year, conducted nearly 2.3 million lab tests and filled 2.7 million prescriptions. On any given day, the medical center’s parking lot — so vast that it’s serviced by shuttle buses — is completely full.
The center’s main building, which opened in 1988, is staggeringly huge, enclosing three cavernous atriums that were originally designed to be open to the sky until somebody calculated the energy costs involved. One atrium contains a grove of trees and has a persistent problem with furry little animals.
The VA even has its own police department, a cafeteria I’d rate as slightly better than “institutional,” and a store that sells everything from toothpaste to plasma TVs and tires but doesn’t charge sales tax.
The marvels of computerized medical records
I’ve been a patient at the VA for nearly a year and while some differences from my previous pay-for-service provider are obvious, some took longer to appreciate.
To me, the biggest difference isn’t size. It’s technology.
The VA is a pioneer in computerized information technology, something the so-called “private” medical establishment is still in the process of adopting. Here’s a personal example of how the system can work:
Last summer, I became seriously sick while camping in a remote area of the Black Hills National Forest in western South Dakota. A Forest Service employee who had a working cell phone let me borrow it to make an after-hours call to a VA call-in service that turned out to be somewhere in Iowa. The person who answered the phone pulled up my computerized medical records, discussed my symptoms with me, offered actions I could take on my own, and then advised me to check in at the VA clinic in Hot Springs, S.D., about 30 miles from my campsite.
“Or you can go to the VA hospital in Sturgis, if that’s quicker,” she said. “Take your pick.”
At either facility, all my medical records would have been available to anyone who saw me. As it turned out, I recovered enough to hobble back to the Twin Cities, where I checked in at the VA hospital. Everything that had transpired during my Iowa phone call had already been placed on my computerized medical record.
As another example, the VA center’s hematology department has been tracking a curious blood abnormality that surfaced during my routine physical earlier this year. On a recent visit, the physician’s assistant I’ve been seeing in hematology swung a computer screen around in the examination room and showed me personalized charts that compared my component blood levels against normal levels. All of it is in my file.
Clearly, the computer system increases efficiency, reduces long hours of paperwork and lessens the likelihood of medical mistakes. But on another occasion, I was interviewed by a VA physician who is studying the negative impact the new computer system might have on doctor-patient relations.
Is my doctor distracted during consultations by the need to log the information I’m giving her into the computer? What seems to be her greater source of information — what I’m saying to her or what she’s finding on the computer? In other words, is that flat-screen monitor coming between this patient and his doctor?
This underscores another big difference at the VA Medical Center. It’s also a major research facility, with hundreds of projects — great and small — going on at any given time. And it’s a teaching hospital with young doctors-to-be rushing around all day in their little white jackets, eager to diagnose something really serious or interesting.
Such eagerness makes sense considering that the vast majority of patients who go to the VA are likely to continue to be VA patients for the rest of their lives. That creates a wonderful pool for clinical studies.
Moreover, veterans seem more inclined to volunteer for studies. I volunteered to test a new topical cream for athlete’s foot and I felt like a failure when they couldn’t get the cells they scraped off my feet to grow in a petri dish. Oh, the humiliation.
About 1,300 people volunteer for more traditional tasks at the VA. They put in 240,000 hours last year, doing everything from pushing wheelchairs to pushing coffee carts. One of the doctors told me he once made the mistake of asking a coffee-cart lady for a cup of coffee. “This isn’t for you!” she replied, almost bellowing. “It’s for the guys.”
The lifelong nature of the VA patient population makes its embrace of high technology equally understandable. In a private practice, such technology carries a high front-end cost. Why install such a system for patients who are likely to move on to somebody else? At the VA, the patients are going to be there forever and the best way to maximize resources is to create efficient systems that emphasize prevention and disease management.
That’s why my doctor was eager to send me down to the center’s physical therapy department when she learned that I was getting a little bored with the vigorous exercise routine I’d adopted to control weight, reduce my blood pressure and end a dependence on prescription drugs. “Maybe they can give you some pointers,” she said as she typed an order into the computer. A week later, the notice of an appointment came in the mail.
Camaraderie and comedy
This brings me to the most obvious difference between the VA and my former private clinic. VA patients are mostly men, and there exists a palpable sense of comradeship about the place. To go there is to be reminded of the thing that every soldier experiences, the curious, binding relationships that ultimately make people willing to die for each other.
And there are other reminders. When a VA audiologist fitted me with a new set of hearing aids last summer, she handed me a notice stating, in writing, that the VA wasn’t giving me the hearing aids. They belong to the government.
It reminded me of the time, decades ago, when I was threatened with a court martial for going to the beach on a weekend pass and getting such a bad sunburn on my feet that I couldn’t wear my combat boots. The charge? Damaging government property.
David Hawley can be reached at dhawley [at] minnpost [dot] com.