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.
