Death by Numbers

A day of reckoning has come, and this time it's at the top.

My experience on both sides of the VA healthcare system:

I worked at Hines VA hospital, when Sharon Helman was hospital director (see above), for three years on and off while doing my resident rotations. I spent a significant amount of time at Hines, not just as a physician, but as a family member visiting my WWII vet grandfather. He lived in its extended care facility after surviving a car accident that nearly took his life and rendered him unable to walk again.

As a resident physician, I witnessed and experienced the love and dedication many clinicians, pharmacists,and social workers have towards our special population of patients. It was an honor to serve these vets and I can honestly say that most people with whom I worked side-by-side were deeply dedicated to providing the best care available.

But then came the numbers game.

Perhaps it was always this way, but I distinctly remember that sometime during my years at the VA everything had to come down to stats. We were told that requests for a primary care physician visit were so overwhelming that everyone else's clinic encounters would have to bear some of that burden, too. That meant that in a 20 minute patient encounter in a totally unrelated field, like orthopedics, one might be asked to screen patients for alcohol dependence, check if they were up to date on their mammograms and/or colonoscopies, etc. I am in a specialized field and I can tell you that this ate into each patient encounter, for better and more often worse. When some of us complained, the general response was that there were "quality markers" that needed to be met by whatever means necessary, and the conversation didn't go much further.

The ideal solution, of course, would have been to recruit and promote more primary care in the VA. May God bless those who are up to the task, but the VA doesn't make this palatable to most physicians. Don't get me wrong, there are many perks to working at the VA, but the amount of bureaucracy there is hard to overlook. Here's an example I have, which I believe encapsulates many points: With the flood of quality markers upon us, one physician suggested that a survey be given to clinic patients asking the necessary questions before entering the exam room so that we could all stay afloat and on schedule. -Seems reasonable, right? Well, the response by staff members was "That wasn't in my job description." Or "I won't do anything unless it was approved by the higher-ups." That's right, copying a sheet of paper and handing it to the veteran across the desk was to be an endeavor of great proportions.

It is no wonder why there is shortage of physicians in the VA system, let alone those dedicated to primary care, which is the least appreciated of the bunch.

Things got deeply personal when my grandfather needed acute medical care. His low grade fever and cough worried my mother so she recommended he get checked out in the adjacent emergency room. A chest X-ray did not definitively find pneumonia, but he was kept on the medical floor for further testing and observation. Unknown to me, the following day a resident physician told my grandfather that all looked well, except his labs. My grandfather was slightly anemic. The resident physician recommended, not dietary changes nor iron supplements, but a blood transfusion. He flatly told my grandfather that "things have to look good," before he could send him back to his room. That's all my grandfather wanted, so he consented. It took just a few hours for the additional volume of blood to put him into heart failure.

"Grampa" always wore that army beret.

After a series of events, my grandfather (WWII Purple Heart army veteran) died. I got to witness his downfall firsthand. What happened to him could have happened at any other hospital, honestly. Yet I feel it important to note that this culture of making things "look good" on paper is now deeply entrenched in the VA system, and with devastating consequences for our veterans as we are all now coming to understand.

I share this post, not to condemn the VA system, but to hopefully garner care and concern from those who could help and save it. At this point, in my opinion, outside assistance is needed because I know how thorny the path to change is from within it. The people need to speak up and say this is not an acceptable way to treat the men and women who deserve only the best this country has to offer. They are far more than numbers.