So You Want A Government Run Health System: Me and the VA

This is not a “trash the VA” piece by any stretch of the imagination. It is, however, a reality of a centralized medical system be it governmental or any other that is very large in nature. I am one of those folks that recognize very early on that having a “shrink” was a good idea. I will not bore you with the details of my background that convinced me it was a good idea but for well over 25 years I have found that better living through properly administered chemicals was a good thing. I started going to the VA here in Tuscaloosa a little over ten years ago primary for cost considerations in terms of the co pays of both the medications and the doctors. I like many others had heard horror stories of how bad the VA was and how you could never get to see a doctor , etc. To my surprise the VA Hospital here in Tuscaloosa was better run than the local hospital, the people working there treated you much nicer, and the waiting time was minimal. I was really impressed. I was assigned to a specific treatment team for my medical problems and while they had no emergency services, I could call if I had any questions about my medications. If I had an emergency I had to go to the local hospital ER. I saw my medical doctor every 6 months or every three months if necessary and my prescriptions were mailed to me in a timely fashion. The one thing I did not care for was that there was a significant turnover in medical doctors. I might see the same doctor twice but the third time it may be a completely new doctor and a completely new nurse. That did not bother me too much because I had good insurance and I was also still going to my personal private physician as a backup.
The other positive thing about the VA was that they cover just about everything else. When I needed glasses my primary care doctor made an appointment for me and my eyes were checked and I got new glasses; not top of the line, but serviceable and they were free. When I had sleep apnea problems they arranged for me to be tested by a private specialist and VA furnished me with a CPAP machine. The unique part of this was that all of my records were there for any of my healthcare people to review where I was in the facility. It was a bit disconcerting that so many people from secretaries to lab techs to nurses to doctors everywhere in the hospital could pull up my records at any time if they chose to find out what was going on with me. Then, the bottom fell out. I don’t know why or how it happen, but it happen.
From the first day I had gone to the VA I had been assigned to a particular psychiatrist, whom I will call Dr. B. Over a period of ten years Dr. B and I had developed a very good working relationship. As I was supposed to do I had come to trust her a great deal and had told her a lot more about me and my problems than I had ever told anyone. In return Dr. B had worked with me and had carefully adjusted my medications to the point where I was feeling better about myself and life in general than I had ever remembered feeling before. It was to the point that for the last four years before the incident that my appointments with her were fairly short checkups and “how are you doing?”, “I am doing great.” type meetings. I had my alcohol problem well under control, had re establish solid contacts with my kids and grandkids, and my work was going well. Everything was absolutely great, Then, I went to my last appointment only find that Dr. B have been transferred to in patient only and I had been assigned a temporary psychiatrist. Now, I am not sure if any of you can relate to this but it was as close to ripping my guts out as it could get knowing that this ten confidential relationship with Dr. B had been, without notice or warning, jerked away from me.
As I sat in the hallway waiting to meet my new Doctor I thought I needed to calm down. She had all of Dr, B’s notes so there should be no big changes. I was WRONG! As I entered Dr. W’s office she was sitting at the computer and without looking up she told me she was concerned about my medications. I asked her why and she looked at me over her professorial looking reading glasses and said that they did not coincide with the new VA protocols. Trying to stay as calm as a nut case can I said again that didn’t understand. She said that the VA had established certain medication protocols that had to be followed under certain conditions and that Dr. B was not following them and that she was going to have to change them. And, then, what can I say, the red eyed, fire breathing dragon came out of his cage. I launched into a tirade about how in the h___ could she or any other pinhead develop protocols which would over ride a doctor’s treatment plan that had been treating me for ten years. I, in no calm terms explain how bad it had been and how much better it was now (not that my behavior was showing it). Her response was simply that was the protocol. I then ask her what if her protocol didn’t work would she change me back at our next appointment and she said she would not me again because she was a temporary fill in until they could hire someone permanent. At that point I am really surprised that they didn’t lock me up somewhere. To think that they had run a substitute in for one meeting who was going to completely change a treatment plan that was ten years in the making and was working fine and then take off for somewhere else was completely beyond my ability to comprehend. I think she finally got frightened (her chair was pushed as far in one corner as it could go) and Dr. B’s former nurse came and calmed me down and assured me that my treatment plan would stay the same until a permanent psychiatrist had been hired and had conferred with Dr. B.
I guess the point of this is that within any large healthcare organization the doctors and nurses work at will of the organization. While you may be their patient today, tomorrow the organization may need them elsewhere. I still go to the VA but I am far less enthused about it because they are undergoing a lot of transition and changes. I still keep my personal doctor as my primary physician and I am undecided about my psychiatrist. An additional problem at the VA is that the generic co pay on medication is $8 while the generic co pay from my personal physician at Walgreen’s is $5, $4 if I go to Wal Mart. This last point I will make here is that the VA in Tuscaloosa runs a very tight ship. I have heard from other vets that it is the exception to the VA hospitals rather than the rule. This I cannot speak to, but I will continue to go to the VA if for no other reason, as a back up to my private care system.

The downside of Streamlining the Healthcare System

While I am in favor of President Obama’s plan to overhaul America’s healthcare system and in particular the health insurance system, my experience shows there are limitations and exceptions which should be accounted for in the new system. The system proposed by the President’s cost containment seems to indicate that all medical personnel are equally competent. The following is my dark comedy of unequal’s in the medical community in Tuscaloosa, AL.
On a Friday evening in 1999 I was ending the week as usual by stopping by my haunt for a couple of drinks before going back to my apartment. Surprisingly, after the first drink I didn’t feel well so I left and went home and lay down thinking I was just tired. Later that night I felt worse, bad enough in fact, that I called my son to take me to the emergency room. I have only vague memories of getting to the emergency room but apparently was immediately admitted to the hospital. When my personal doctor came out and was putting together my “treatment team” I remember insisting that a friend who was a surgeon be assigned to the team. I am not sure this would be allowed under the new plan but he became a critical part of the team as time went on.
At some point the team had determined that the problem was caused by my liver shutting down. A radiologist was called in to take a biopsy of my liver to determine the problem. He inserted a needle into my right side into my liver, and through my liver, into my right lung causing it to collapse. Now I had a problem I didn’t have when I went in the hospital. Fortunately, my surgeon friend was standing there and heard the air rush from my lung and got me into immediate surgery to put in a chest tube.
After that I lingered in the hospital in another week being treated by an internist with antibiotics for a strep infection and not getting any better. I had gotten to the point that I told my children that I had made my peace and was ready to die because I felt pretty sure I was going to die. The internist, over the week I was there, insisted that the antibiotics would work if given enough time. His time frame was six to eight weeks in the hospital though he did not know if there was any malignancy or not. I vaguely remember calling him some less than polite names and calling my personal physician and my friend. My wife had been arguing all along that I needed to leave Tuscaloosa and go to the University of Alabama – Birmingham hospital. My surgeon friend agreed with her and made the referral. I left for Birmingham that day. To make a long story short, after two surgeries; one to repair my lung and another to insert tubes into my liver to drain off the infection, and four more weeks recovery time I came home with a new appreciation for second opinions.
The point of this is that all doctors and hospitals are not created equally. Streamlining the healthcare system to cut cost is a great idea as long as it accounts for the previous sentence. I tend to have a great deal of confidence in my personal doctor and the doctors I choose, however, I even ask to get a second opinion on their decisions from time to time. I think it is a wise thing to do since everybody has an off day now and then. I also think that any doctor should have the right to redo tests if there are reasons to question the first tests.