In Defense Of The VA: Doctor's Reality Check On Congressman's Bad Experience

This from our friends at Radio Boston:

It’s a sad truth that we’ve come to expect some hassles when it comes to health care — long waits to see the doctor, confusing paper trails and maybe poor communication about prescriptions. But when U.S. Rep. Seth Moulton dealt with all of the above at the Department of Veterans Affairs, he decided to take some action.

The Salem Democrat and Iraq War veteran, who earned two medals for valor, needed treatment for a hernia, and his experience with the VA was so frustrating (he discussed it on Radio Boston) that he’s now looking to pass legislation that he hopes will improve things.

But Dr. Henry J. Feldman argued in a letter to The Boston Globe that Congressman Moulton had unrealistic expectations, and was presenting "an almost impossible service expectation:"

Let’s put what he did in non-VA terms. He is outside of his home state, and shows up at a random, but somehow in-network, clinic. He presents, not with an emergency, but as a walk-in for a routine surgical evaluation (hernia), without his insurance cards or records. His records are at a far-away hospital, and while he is insistent that he has insurance, the local clinic is unable to easily verify this.

Dr. Feldman has a rare perspective on the issues involved: He works part-time at the VA in West Roxbury; he is also a hospitalist at Beth Israel Deaconess Medical Center and its chief information architect of the division of clinical informatics, meaning he builds and analyzes electronic medical records. He expanded on his defense of the VA in a persuasive Radio Boston segment on Friday.

On the VA's initial inability to find Rep. Moulton's records, Dr. Feldman says that was likely a computer glitch, because the VA is a leader in its ability to access patient records from anywhere in the network. (The VA has declined to comment, citing patient privacy; Dr. Feldman is sharing his personal opinions.)

Listen to the full segment above. Highlights, lightly edited:

Host Meghna Chakrabarti: So it might have been that Congressman Moulton just ran into a series of unusual glitches — that is a possibility because ultimately, the VA in Washington did find out that Seth Moulton is a congressman and he got his surgery, but he says that they still sent him home with the wrong medication after the surgery. Here's what he said: "If I was sent home without all the medications that I needed, just imagine the care that the average veteran often gets at the VA."

Do you think that's a fair concern for him to have?

"[Y]ou go to war with the army you have, but for God's sake, you should be able to come back to a different VA than you went to war with."

Dr. Henry Feldman

Dr. Henry Feldman: I would like to take that statement apart into two parts:

One, we do not provide superior care just because you're a congressman. In fact, he should not receive any better care than a homeless veteran. In fact, the homeless veteran should probably get better care because he's more at risk

I don't have any access to what happened — it's hard to know. There could be three errors that resulted in him getting the wrong medication:

One, it was an error in communication. I will admit every doctor and nurse on earth has made this error, which is: 'I'm going to write you [a prescription] for X,' and then you go back to the chart and you look and you go, 'You know what, I'm actually going to write him for Y.'  And you forgot to go back to the room and say, 'Oh, by the way, I'm going to write you for Y.'  That, to the patient, seems like an error. In fact, there was no error.

There are two real errors which could have occurred, one much more serious than the other,
which is that the person who wrote the prescription made an error, selected the wrong medication to prescribe.

And the third, which would be of course the most serious error, is that the prescription was written for medication A and medication B was dispensed by the pharmacy. That last one is really, really unusual — in a fully electronic pharmacy world, it's pretty hard to dispense the wrong medication.

i actually have to say, the care the VA provides in general — I have family members who are veterans as well, who go there, and they've never had anything other than good things to say about the VA.

Of course there are administrative glitches but you know what? We have administrative glitches at our fancy Harvard hospital as well — that's just the nature of health care. It's very complicated and messy.

MC: There is a lot of room for improvement in health care delivery overall...but to be fair, over the past many years there have been some very serious and legitimate criticisms levied against the VA as a system: questions about leadership, about efficiency, stories of some vets having to wait long periods for care, etc. Do you think, is it fair to have an expectation that an agency dedicated to serving veterans should have a higher standard?

HF: The VA, because it is a publicly owned hospital, if you will, is under much more transparent scrutiny than a private hospital ... I will say, with my personal physicians, some of them have fairly long waits. If I want a routine dermatology appointment with my dermatologist, I am sure I'm not getting that in the next six weeks. Now, if I saw a melanoma on my arm, I'm sure I would be seen the same day because that's what we do as doctors — when we hear about something serious, we somehow make room, we stay late, we do whatever.

MC: So are we, as a nation, right to have a higher standard, that the VA's perform better than the Beth Israels of the world?

On many metrics, they do. But if you walk up to the VA and hold a gun to its head and say, 'You better, somehow, magically, with no extra dollars, see twice as many patients per day, and oh, by the way, you can't put anybody on overtime.' You can't have twice as many visits without expanding rooms and doctors and nurses and staff, it just doesn't work that way. And that's in fact what we did.

If you think about it, we went to war and we basically didn't increase what we did at the VA. To quote Cheney [it was actually Donald Rumsfeld], you go to war with the army you have, but for God's sake, you should be able to come back to a different VA than you went to war with. If you're going to increase the number of veterans by millions of people, you better have capacity for millions of people to come back. We did that after World War II but we sure as heck didn't do it after our current conflicts and because of that, I think we've put the VA in an unfair situation.

Readers, thoughts, reactions, VA experiences?