You will find good and bad in all sectors of Health Care. I’ve had great civilian docs and great VA docs…and I’ve had bad ones in both areas. Luckily, I’m happy with what I’ve got at the moment – which oddly enough is a strange little clinic that handles both – a civilian doc that contracts with the VA to do some outpatient care in a remote location.

For the guy suing the VA – go for it. Unfortunately, that is par fo the course these days. No one knows what the underlying problem is, but far too many vets get denied care and are forced to sue. Don’t feel bad about it. The court will decide if you are getting a bum rap or not. If you get the rating, you deserved it. If you don’t, well, you wasted your money.

I’ve never experienced the B’ham VA, so I don’t know what it is like. I’ve been to DC, two in Virginia and one in MD. One of the Virginia facilities was pretty run-down and the doctors weren’t so great. All the rest were great. The care has improved quite a bit over the last 10 or so years. It seems to be easier to get an appointment. Tests still take forever unless it is an emergency test, but not so much that I died…obviously.

I do think there are a few shoulder chips floating around this board. It seems like there are stories from both ends of the spectrum – all of which appear to be outside of the ordinary, run of the mill kind, both good and bad. You can’t make judgements on the extreme edges of an issue. However, I agree with the overall point of the article.

Nationalized healthcare is a really, really bad idea. The VA system is about as good as it can get – and there is a lot of room for improvement there. The whole nation wouldn’t be able to get seen properly in that type of system. There would be too many horror stories, too much room for corruption and too little incentive to give the needed care, as opposed to the minimum required to get a good evaluation rating.

With regards the Veteran being interviewed, this is a defensive move by the VA. They get hammered constantly for privacy violations. The healthcare side never had a big problem…not yet anyway. The benefits and cemetary parts of the VA have both had issues though, so the upper management punishes everyone. But, the healthcare side would be in huge trouble if they breached privacy. That’s why they take such a paternal view of patients. That and the fact that a lot of the vets are mentally disturbed in some way – by drugs, pain, medical condition or mental condition. It seems prudent to get a Veteran’s permission before a reporter starts bugging them for the next “scoop.”

Everyone should just relax, see that other points of experience-based view are valid and accept that different people will react differently to differing experiences.

Dr. S—

I see that you are actually posting from the VA Hosp in Bham. You have that kind of time? Or are you taking the time away from the patients you say you have MORE time with than in private practice?

Secondly, the utter dreck of your first comment kind of goes a long way TOWARDS making my point, rather than the other way around. So much for a professional and caring attitude.

To quote your own words—”Furthermore, for any of you guys, if care is so bad….leave. Go elsewhere. I cant stand seeing patients like you with such a chip on your shoulder.” —

I’m sure that kind of talk goes over real well with the patients that you see every day. I can hear it now, “Well sarge, your knee is blown and all I can do is give you a sugar pill or drug so strong that you won’t be able to work and may cause your kidneys to fall out. If you don’t like it, you can go fuck yourself but don’t complain about the care here cuz I ain’t listenin’!” You might fancy up the language a bit, but that is ABSOLUTELY the message you sent in your first comment.

While sitting in the actual VA hospital, no less.

Your second comment comes off as trying to ameliorate the effects of the first, as if you realized just how colossally rude and unprofessional you had been the first time you wrote in. Or did you want to show off your scathing repartee to someone in the office who then looked at you like you were an asshole and convinced you to send the second one. It was an attempt to be conciliatory without ever actually apologizing, an urging of us vets to stand up for ourselves and demand better treatment (which many of us have been doing for years), and a sop to history saying “it is all better now, please forget the last ten, twenty, thirty, etc. years, pleeeeze.”

Overall, I think you win the Tool of the Day award. You have not only proved my exact point, you have demonstrated the utmost in UN-professionalism to do so. For that, I thank you.

Precisely my point, Dr. S. I don’t doubt that we could collect endless stories of excellent care and sheer horror both in the VA and in the private sector. But I’m willing to bet you’ll find a stark difference in BOTH areas, showing that most of the horror stories are the direct or indirect result of attempting to comply with rules made by a) politicians or b) insurance company executives, *rather than by senior doctors.*

That’s why government healthcare scares me. As Lenny Bruce once said of Communism, “It’s like one huge phone company. If I get too rank with this company I can’t just go to another one, I’m stuck with a dixie cup and a string.”

My experiences are not a fabrication, they are all too real, and I have access professionally to – as noted – thousands of Veterans who have related their less-than-ideal experiences to me over the years.

Perhaps you are the exception to the rule. If so, please co-opt your peers into obtaining employment with the VA. Because as things stand now, we Veterans, on average, receive piss-poor care and a boatload of crap for our very real medical issues.

I left the university to be a full time provider because the VA provided a better work environment- maily more time with patients. At the private clinic I had to see more and more in less time. Cant do a good job doing that. What I gained at the VA was more time per patient so I could do a better job.

Unfortunately the subspecialists (I am a general internist) do work the way we do. They are understaffed and have no incentive to operate (in fact, since they are salaried the incentive is to not operate). The VA pays very well for primary care but cant compete with private practice for subspecialists.

I challenge all veterans to write their congressmen or senators (it really does work and every VA has to respond to congressional complaints) if they see true incompetence and docs who dont care. Its unprofessional and they should be gotten rid of. I know I have been involved with trying to get rid of them.

One last note…I get more complements about how much better the VA is compared to 10-20 yrs ago from my patients probably 20 to 1 compared to complaints. I have numerous patients who have given up their private care because they think the VA does a better job than their private doc did.

No offense, Doctor, but perhaps the standard of care at the VAMC you work at is quite different from mine.

It isn’t, as Prof will no doubt rebut later, having been a “guest” of the Birmingham VA more times than I care to remember.

I am a former Biomedical Engineer, and worked at some of the top teaching hospitals in the world (does maintaining the ER at the Brigham and Women’s sound less-than-competent?); I have something of a clue about quality healthcare versus substandard care. I have also utilized the VA for my service-connected healthcare issues for 25 years. I DO know the difference, and my experiences between the standards of care at the two are glaring.

I have literally had VA physicians provide me with a letter for my employer post severe knee issues such that I could NOT WALK for eight days. The letter stated I was seen for “knee pain.”

I have been rated with “mild osteoarthritis” of the knee only recently, despite having a detached and quite large bone-spur under the medial side of the knee, which was documented TEN YEARS AGO (indicating degenerative osteoarthritis as an active process a decade ago or more). My knee is now grossly misshapen, and these changes have been documented over the years and then ignored.

My medical records inexplicably disappear. Records requests disappear and the very person who I hand-submitted the request to says, “what do you want me to do about it? (yawn)”

My degrees of flexion and extension of the knee have been eyeballed for over twenty years, despite clear policy directives by the VA as to the use of a Goniometer. I have had the VA deny claims for increases in rating for “failure to attend a scheduled C&P examination,” which I had rescheduled and had the letters from the VA to prove same; I was denied nevertheless. I was again then denied for a “failure to provide requested documentation,” letter sent to an address I did not live at and had not for over a decade; the VA again agreed the denial was “fair,” despite their glaring error.

These are only the tip of the iceberg of my personal experiences at the VA.

No offense, Doctor, but perhaps the standard of care at the VAMC you work at is quite different from mine. My experiences however are simply chock-full of incompetence, indifference, obfuscation, delays, denials, and outright lies.

Sorry for the angry screed, but as Omar Bradley once said to General Montgomery’s Chief of Staff, Sir Frederick DeGuingand, “I trust you understand that I am not angry, but I am Goddamned well incensed.”

Are there problems in the VA? of course. Are there problems at private hospitals? Of course. You dont hear about them because they arent as news worth. I could practice anywhere I desire. I, like many of my colleagues who came from the university hospital across the street, have impressive credentials. WE choose to be at the VA for a variety of reasons, one of which is service to our fighting men and women.

The VA has every class of drug available on the market. Do we supply the most expensive one when cheaper, equivalent ones are available…no! and a private doc shouldnt either.
Does it take longer to get some routine tests done? Yes, but not if they are emergently needed. Do we have some docs I wouldnt want to go to? Yes but so does every single hospital in the US.

I challenge all of you to objectively look at the care given or vets and not the crap that gets published in the media. Then look at your local private hospital and see what really happens there. I think you will be surprised