Army "Healthcare" Wins Again

[WernickeDO]

I personally just had a wonderful experience with army "Healthcare" that would defy the belief of a normal person but has become the sad status quo for AD and veterans.

My wife (also a physician) made an appointment to be seen at one of the small soldier family clinics on post. The NP who saw her not only was accommodating to my wife's schedule (we know what they say about the cobbler and his shoes), but also was a good clinician who handled everything like a pro. Kudos to her.

Prior to her appointment, my wife had to obtain labs within 24h. I called the lab at the clinic and asked their hours, and they told me 0700-1600. I told my wife and she re-arranged her patients and schedule to be at the lab for the draw. She arrives at the lab at 1230 to find they were closed for "training". There is only a sign hanging on the door of a shuttered lab, advising those seeking labs to go to the main hospital. The hospital is a 20 minute drive, plus going through the check point, plus parking, plus waiting in line for the labs to be drawn, then driving back. Going to main hospital would have added 60-90 minutes to this ordeal, easily. This was not feasible, as my wife had to get back to her own patients and doesn't have an hour to kill in the afternoon. Her confidence in the military healthcare system was hanging by a thread at that point, and after this it was gone completely.

Naturally, I was upset. The Army can abuse me and waste my time all it wants, but I won't accept this treatment of my family. I filed an ICE complaint and expected a response within 24h. Of course that didn't happen. I pushed it up the COC and eventually I got some traction. I got a call from the highest ranking GS employee (because there was no OIC), and he was ready to apologize to my wife for wasting her time, which was one of my ICE complaint demands. I asked why the lab was closed, especially as I had called earlier in the week to confirm the lab hours. He said that right after I called the order came down from on high to close the lab for "training", and what could he as a lowly GS employee do about that? I asked how the lab plans on pushing out information to people as hours change, and he suggested a second call to confirm my earlier confirmation call. The poor guy was trying to make things right, and that was the best he could come up with: that patient's should make a second confirmation call to confirm the first confirmation call. It was at this point that my soul broke a little bit, and I thanked him for his time and efforts, and that we as a family will simply seek healthcare elsewhere. He was upset that the Army had failed its soldiers and his family, but in the end he knew I was right: the system is broken to its core and there is nothing to do to fix it except go elsewhere.

I feel this anecdote sums up everything that is wrong about healthcare delivery in the Army. Healthcare is 24/7/365. You don't close critical ancillary services like the lab or radiology on a whim for "training". If the machine is broken/on fire/aliens have invaded then yes, there will be a delay or perhaps you need to go elsewhere. This was not the case. More likely is that whoever gave the order to close the lab, which if I had to guess would have been some O5 that doesn't even work in the clinic, is more interested in 100% SHARP compliance for their OER than actually delivering healthcare.

The inmates have taken over the asylum. Whether its keeping services open, or booking OR time, or working more people into the clinic, the emphasis is not on the patient, but rather in keep the GS employees happy and helping some desk jockey officer get promoted. Doing what is best for the patient or behaving in a way that inspires trust is far, far down the list. If this was Kaiser, or Mayo, or even Our Lady of Sorrows hospital, what do you think would happen to the head of the lab if they decided to just close down lab and turn patients away? They would be out on their butt. In the Army, that same person will probably get promoted.

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[HighPriest]

That's great. Our entire facility is closed today, save for an emergency skeleton crew, for what amounts to a pep session on post. I just heard the hospital commander say that our access to care time is too high, and yet he initiated this debacle in which all of our clinics were closed today.

 

[WernickeDO]

That's great. Our entire facility is closed today, save for an emergency skeleton crew, for what amounts to a pep session on post. I just heard the hospital commander say that our access to care time is too high, and yet he initiated this debacle in which all of our clinics were closed today.

Bingo. This struggle is real. "It's unacceptable that it takes longer than 7 days for a soldier to see a 'provider'. Somebody fix that. On another unrelated note, we will close the clinic today for a mandatory safety stand down and classes on how to ground guide a vehicle. All doctors must attend".

 

[dr zaius]

That's great. Our entire facility is closed today, save for an emergency skeleton crew, for what amounts to a pep session on post. I just heard the hospital commander say that our access to care time is too high, and yet he initiated this debacle in which all of our clinics were closed today.

Did anyone bring this up during the session? We've had some department (and more encompassing) mandatory meetings about random issues and when the obviously system/admin based problem is point blank addressed in a question from the crowd the response is often comical, and if I still had any idealism left in me it would cause my heart to break. I can't imagine the response in this situation where the mandatory meeting itself is absolutely adding to the problem...being addressed...at the meeting.

 

[Perrotfish]

Is this an Army thing? I have had a lot of mandatory, long, and silly meeting in the military, but I've never been given less than several weeks notice if it was going to close clinic.

 

[HighPriest]

We had notice, but notice doesnt help the access to care issue. Those clinics are still closed. We certainly did not have three month's notice, which is how far out my clinics are booked.

 

[Perrotfish]

We had notice, but notice doesnt help the access to care issue. Those clinics are still closed. We certainly did not have three month's notice, which is how far out my clinics are booked.

I guess the problem is the three month thing. We've never had less than a month's notice, which is how far our clinics book out.

 

[Gastrapathy]

perrot: only booking a month out is one of the ways they make access look better than it is. Patients are told to call back when we open the sked. Meanwhile in the real world, we book out months in advance.

 

[Crabbygas]

OMFG. Every time I see post like this I get a recrudescence of PTSD mixed with gratefulness for being out of it now. Too bad somebody didnt invite a local reporter to one of those meetings. I doubt there are really any half measures that can fix these problems. The military should probably just sell off all their medical facilities. ( Dont worry generals. There will surely be fat consulting kickbacks from the buyers). The active duty docs could just be farmed out to big civilian hospitals to be recalled as needed for deployment. Or maybe some Blackwater type organization will start offering medical teams for hire. All it takes is money (in the right palms).

 

[Cooperd0g]

Back in 2000 as a naval flight student in Kingsville, TX I went camping over a weekend. There were holes in the tent and some fire ants got in and I was bit close to my eye. The swelling was such that my right eye was pretty well shut. On Monday morning I called my squadron to cancel my flight and I was reminded that students who cancel flights need to have a chit from medical and I had to bring it in before noon. I went to the clinic to see the flight surgeon as soon as it opened at 0730. I was told that they didn't do sick call any more and they didn't have any available appointments. Sick call was what I had known for the last 6 years, but I guess it was going away. Regardless I told the front desk dude that I was required to see the flight doc that morning. He just said he was sorry.

I just walked passed him through the doors and went to my flight doc's office anyway. The doc wrote my self expiring down chit and I went to the squadron. I remember later discussing the issue with the Commodore of the training air wing. Keep in mind that the ONLY reason for existence of NAS Kingsville is the two jet training squadrons. He was asking us for general feedback. I said "Why is it that a flight student can't see a flight doc same day when the command requires it given that the only purpose for this base to exist is to train the pilots?" He had no clue that it was even a problem and was pretty pissed off that it occurred.

Want to shut down for training? Fine, half the staff goes to training so the other half can keep the lab open or do whatever needs to be done and then swap out or get the other half done the next week or whatever. This **** isn't that hard.

Side story: as I went to turn my down chit into the squadron the commanding officer was giving them **** about losing sorties and scrutinizing the events. I heard him say "what the hell is wrong with this one?!" He walked out of the door, saw me and said "what the hell is ... HOLY CRAP what happened to your eye!? Okay, that's acceptable."

 

[WernickeDO]

Want to shut down for training? Fine, half the staff goes to training so the other half can keep the lab open or do whatever needs to be done and then swap out or get the other half done the next week or whatever. This **** isn't that hard.

Exactly: leave a skeleton crew behind to manage things. It might take longer than usual to get your labs drawn but at least you can get them done. The fact that they closed the whole lab and left no one behind suggests that this was about everyone getting their SERE module done so the OIC can claim 100% completion on mandatory training.

 

[Chonal Atresia]

That's great. Our entire facility is closed today, save for an emergency skeleton crew, for what amounts to a pep session on post. I just heard the hospital commander say that our access to care time is too high, and yet he initiated this debacle in which all of our clinics were closed today.

Unfortunately the ONLY power you have is the option to walk away at the end of your ADSO and flick 'em the bird. You have no power to make any changes. The beaurocratic machine cannot be stopped.

 

[HighPriest]

I guess the problem is the three month thing. We've never had less than a month's notice, which is how far our clinics book out.

It really isn't. The problem is that their concern is patient access to care, and yet they're closing down all of the clinics for a meeting with no instrinsic value, partly to tell us we need to improve access to care. No matter how you cut it, you've eliminated hundreds of appointments to do this. It's poor planning and poor management, not an issue of a heads up.

 

[HighPriest]

Want to shut down for training? Fine, half the staff goes to training so the other half can keep the lab open or do whatever needs to be done and then swap out or get the other half done the next week or whatever. This **** isn't that hard.

What? And make the command suite show up and give the same speech twice? Unthinkable!

 

[hooperg]

Hey Docs,

I've seen the oft-quoted "90%" statistic regarding military physician retention at the end of their ADSO. Does anyone have the source for this statistic?

Thanks.

 

[pgg]

I've seen the oft-quoted "90%" statistic regarding military physician retention at the end of their ADSO. Does anyone have the source for this statistic?

I remember first hearing that 10+ years ago. Have never seen officially released statistics.

Anecdotally ... I think retention has actually been a little better during the Obama years. Civilian pay has leveled or declined for some specialties. Civilian academic jobs have become much more competitive in recent years, which is surely due to less lucrative and/or fewer great opportunities in private practice. The military is more like academics than private practice. For some specialties the military is perhaps less unattractive now compared to civilian options. I think more are staying now, but not many more.

 

[Gastrapathy]

My graduating class from residency has retained 1/12. For IM, that's pretty dismal.

 

[Apollyon]

My graduating class from residency has retained 1/12. For IM, that's pretty dismal.

Hey, that's 8.33%!

 

[pgg]

My residency class of 09 has 5/6 still on AD. The 6th had prior service and retired a couple years ago.

 

[Gastrapathy]

My residency class of 09 has 5/6 still on AD. The 6th had prior service and retired a couple years ago.

No kidding. Why do you think that is the case?

 

[WernickeDO]

My residency class of 09 has 5/6 still on AD. The 6th had prior service and retired a couple years ago.

That's interesting, pgg you are anesthesia, right? I can see a high level of motivation to separate ASAP. Is your class an anomaly or is life just that much better in the Navy?

 

[pgg]

My class - probably an anomaly.

3/6 had prior service with time toward retirement.

1 had EFMP triplets and has stayed at a big med center the whole time. He also did an inservice fellowship.

1 I'm not sure why he stayed, married an AD nurse and she got out, but he stayed in. He also did an inservice fellowship. Did a tour in Japan.

And then there's me. I was all set to get out in 2014 but I did the math, and the Navy kept giving me everything I asked for, and I was making a killing moonlighting, and now I'm living the dream as a FTOS fellow. Still waiting for the catch but the Navy has been good for me.


3 more of my USUHS classmates did anesthesia at Bethesda. I think all 3 are still in. One was an academy grad and owed 12 to start with. Near as I can tell none ever left Bethesda, except for deployments.

There were a couple more of my USUHS classmates who did anesthesia at San Diego. I think all of them got out but I'm not sure.


The civilian anesthesia job market turned south a little 3-5 years ago. It's pretty easy for us to moonlight, most of the time, so the civilian-military pay gap isn't quite what it is for a lot of specialties.


Civilian interest in academic anesthesia jobs is way up in the last 5 years. Lots of groups being bought out. Partner tracks are trending longer and scarcer. A lot of us think the future is employed practice, either by the government or by huge MBA-run megagroups.

A ~10-15 year TIS military anesthesiologist on a MSP contract makes about $250-275K which isn't that far off a lot of academic jobs. Malpractice coverage is great. Workload isn't bad, mostly ... life at one of the big 3 probably isn't lot different than a clinical track civilian academic job. So why leave? The pension carrot is a good deal.

I'm not surprised a lot of anesthesiologists are turning 12 or 14 years into 20.

 

[HighPriest]

I was making a killing moonlighting

That makes a big difference. Of the anesthesia colleagues that I have (and emergency medicine as well), most of them have had a lot of opportunity to moonlight locally. A lot of them are off work at the military facility post call, and use that to moonlight, or they're doing it on weekends. That sort of thing is pretty rare for surgeons (moonlighting locally). I have to imagine that it's a huge incentive to stay because it helps balance the financial scale.

And, speaking as a non-anesthesiologist, I've had a lot of guys tell me that while they have to manage CRNAs in the military system, it's less of a headache than it is on the outside.

 

[pgg]

And, speaking as a non-anesthesiologist, I've had a lot of guys tell me that while they have to manage CRNAs in the military system, it's less of a headache than it is on the outside.

Yes. 100x yes to this.

In the military we're there to help and advise, and sometimes to bail out, but we don't sign their charts and we're never on the hook for anything they do during their cases.

I quit a moonlighting job after 4 days because they expected me to sign charts for CRNAs who gave lip service at best to my supervision/direction.

The military has its problems but shouldering CRNA liability isn't one of them.

I also find that military CRNAs tend to be a fair bit better than civilian ones, on the whole. The SRNA selection process is better and the training is better and they're just better people.

 

[HighPriest]

Yes. 100x yes to this.

In the military we're there to help and advise, and sometimes to bail out, but we don't sign their charts and we're never on the hook for anything they do during their cases.

I quit a moonlighting job after 4 days because they expected me to sign charts for CRNAs who gave lip service at best to my supervision/direction.

The military has its problems but shouldering CRNA liability isn't one of them.

I also find that military CRNAs tend to be a fair bit better than civilian ones, on the whole. The SRNA selection process is better and the training is better and they're just better people.

Our CRNAs are by and large very good. I have on occasion had some issues, but that is always true everywhere. More often, by far, they do a great job. And I stimulate the crap out of patients and airway cases make everyone nervous, so I feel that's a pretty good indicator.

 

[psychbender]

My experience with anesthesiology (Army) is the opposite of PGG regarding retention. Of the HPSP in my residency class, one left last year (3yr deal), two of us leave this year, one I lost track of, and one is extending for a year because he and his wife love their location (and so he's not deployed during the upcoming fellowship application season, as he was this past year). The Army USUHS all still have several years left in their commitments, and I don't think there were any non-USUHS guys from the Navy in my class. I mostly lost track of the Navy guys, but I know one got out at the first opportunity, despite remaining at one if the big Med Cens after residency.

 

[Gastrapathy]

I tried to remember the folks from the classes on either side of mine. I found several from the class after mine that are still in (approaching half) based on linkedin but only one from the class before me. Definitely could be missing people due to senility.

 

[Onefellswoop87]

Just had it happen to me. My son had a primary care appointment for a check up and shots for 3 days from now. Scheduled at least 4 weeks in advance. Got a call they are closing for the afternoon just that day this week. I think they said because training but in my frustration I didn't care about the reason on the phone. They had a few slots this week to be seen but first that worked with my or my wife's schedule was next week. Wrote a lengthy online complaint. Thanks Navy medical homeport clinic.

 

[Monty Python]

Just had it happen to me. My son had a primary care appointment for a check up and shots for 3 days from now. Scheduled at least 4 weeks in advance. Got a call they are closing for the afternoon just that day this week. I think they said because training but in my frustration I didn't care about the reason on the phone. They had a few slots this week to be seen but first that worked with my or my wife's schedule was next week. Wrote a lengthy online complaint. Thanks Navy medical homeport clinic.

Sorry and I feel your frustration. Probably the CO wants a bullet on their next FITREP about how his/her command was the first in BUMED with 100% completion of FY-17 TIP, AT/FP, and IA training. Patient care is a secondary priority.

 

[Matthew9Thirtyfive]

Just had it happen to me. My son had a primary care appointment for a check up and shots for 3 days from now. Scheduled at least 4 weeks in advance. Got a call they are closing for the afternoon just that day this week. I think they said because training but in my frustration I didn't care about the reason on the phone. They had a few slots this week to be seen but first that worked with my or my wife's schedule was next week. Wrote a lengthy online complaint. Thanks Navy medical homeport clinic.

That's insane. Makes me glad we have standard, but really am not looking forward to having to deal with that BS from the physician side if I get to go to med school.

 

[Perrotfish]

Wrote a lengthy online complaint.

Please don't do this. No matter who is actually responsible for the problem every ICE complaint gets some poor peon lectured on empathy. Could be the front desk staff, the nurse, the doc, or all three. Never ever the person who closed clinic, of course.

 

[Onefellswoop87]

Please don't do this. No matter who is actually responsible for the problem every ICE complaint gets some poor peon lectured on empathy. Could be the front desk staff, the nurse, the doc, or all three. Never ever the person who closed clinic, of course.

I understand not trying to kill the messenger. I tried my best to address that on the phone with the scheduler and in the complaint. I promise I'm not a scorched earth kinda guy, and I didn't just blast everyone/anyone in the clinic.

It's not an empathy problem at all. But it's a systems problem that does need to be addressed by the MTF. And as I understand it that's the whole purpose of the online complaint system.

 

[WernickeDO]

I understand not trying to kill the messenger. I tried my best to address that on the phone with the scheduler and in the complaint. I promise I'm not a scorched earth kinda guy, and I didn't just blast everyone/anyone in the clinic.

It's not an empathy problem at all. But it's a systems problem that does need to be addressed by the MTF. And as I understand it that's the whole purpose of the online complaint system.

Right, but the complaint system only applies to people who are low on the totem pole. E4's can write ICE complaints all day long about why I won't order them a sleep study for their circadian rhythm disturbance or why I won't give them a permanent profile for their phantom back pain, and I will get landed on from on high. But direct an ICE complaint toward a higher up and it will be some peon getting blasted and the complainer will face retaliation. All this open door policy bunk is an illusion.

 

[Perrotfish]

It's not an empathy problem at all. But it's a systems problem that does need to be addressed by the MTF. And as I understand it that's the whole purpose of the online complaint system.

It doesn't matter what that actual issue is or what you actually write. It will always be reframed as a empathy issue. Because if the HN at the front desk had just used a softer tone of voice, or whatever, then you wouldn't have minded having your appointment canceled with no notice.

 

[Monty Python]

Just had it happen to me. My son had a primary care appointment for a check up and shots for 3 days from now. Scheduled at least 4 weeks in advance. Got a call they are closing for the afternoon just that day this week. I think they said because training but in my frustration I didn't care about the reason on the phone. They had a few slots this week to be seen but first that worked with my or my wife's schedule was next week. Wrote a lengthy online complaint. Thanks Navy medical homeport clinic.

Not to worry ... just today, the new Navy SG came out with their strategic goals and other such mumbo-jumbo. Surely that will cause patient care metrics to skyrocket.

http://www.navy.mil/submit/display.asp?story_id=97670

 

[Gastrapathy]

Painful to read. Operation Deck Chair.

But don't worry, you are going to learn how to take care of patients from the line. I'm sure you'll be inspired to provide acceptable care.

 

[Onefellswoop87]

Please don't do this. No matter who is actually responsible for the problem every ICE complaint gets some poor peon lectured on empathy. Could be the front desk staff, the nurse, the doc, or all three. Never ever the person who closed clinic, of course.

Just had a level-headed discussion over the phone with the clinic department head about their scheduling practices, how they are changing going forward, and what specifically cause this SNAFU. I've met this OIC before in person so I trust his words. I don't believe my complaint or the discussion will result in empathy training, more NKO, or anything else like that.

 

[DD214_DOC]

Plot twist: Having to respond to ICE complaints also takes my time away from patients. Once the complaint is received by the OIC from patient advocacy (usually a couple days after submission) a response back to PA is required after the concern is investigated and the patient who filed contacted to discuss and respond. There is no time set aside for these. You cannot ignore them even if blatantly frivolous. So yes, I have wasted countless hours responding to complaints for things such as, "my doctor is refusing to treat me and is a disrespectful liar", which finishes with, "because he refuses to give me any refills on my S2 stimulant". Another was because a provider refused to prescribe meds; nevermind the provider was a LCSW. Can't forget the ones related to our clinic policy of closing at some point at the end of the day. I wish I was joking.

Personality disorder patients are notorious for using the ICE system as a vindictive tool to create lots of unnecessary additional work for docs and clinics that don't give them what they want. A few months ago I had one such pt filing one a day for almost two weeks. That was fun.


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[DD214_DOC]

Also, quite a bit of the top down nonsense can be blocked at the local clinic or dept level if your leadership is willing to take the heat and push back. I'm at my terminal rank, and so I do this often if I feel it's warranted. I have been able to protect my providers from getting stacked appointments with their durations reduced to meet the rvu demands, as it's pretty obvious any provider can manage only so many encounters a day before quality begins to diminish. My approach was to be ok with getting yelled at once a week for quite some time so I could actually review our processes, efficiency, coding, etc. for areas of improvement that could bump up productivity. Adding additional appts seemed to me an obvious last resort, but apparently a lot of clinics do this first.

Pushing back CAN be done if your leadership is willing to take the heat. Career guys or those with significant time left on their ADSO probably won't. Unfortunately, however, there are always some battles not worth fighting.


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[TurtleDO2012]

In terms of being closed for training and having access problems... Be careful what you wish for.

My clinic screams access all the time and in turn we are available every single minute. Just waiting for the inevitable lets be open on Saturday/later conversations like some other bases. Anyone who walks up to the counter is seen that day unless we can convince them to be seen at a later appointment. I have seen over 24 people in a day more than once or a full clinic before lunch. We have to plan our personal schedules 6 months in advance and if any changes 6 weeks or sooner the world collapses. Also we don't get any admin time in any real substantial consistent schedule, lots of lip service. If access isn't being met then it gets quickly shifted to open full clinic. If a fellow provider can't make it to clinic due to illness/pulled away for meeting/personal reason then everyone's else's schedule is fully opened to see those patients even if you had "admin time." Yeah we have meetings and try to get group training done and etc but that doesn't help me get my own personal work done/caught up on the varied online trainings I have to do for leave and etc. Morning and evening huddles which further eat up my free time and are basically cheerleading sessions or a repeat of some e-mail we all got.

Question for the group- Family Practice- Army

How many appointments do you see a week?
How many appointments a day?
Any consistent individual admin time?

 

[DD214_DOC]

In terms of being closed for training and having access problems... Be careful what you wish for.

My clinic screams access all the time and in turn we are available every single minute. Just waiting for the inevitable lets be open on Saturday/later conversations like some other bases. Anyone who walks up to the counter is seen that day unless we can convince them to be seen at a later appointment. I have seen over 24 people in a day more than once or a full clinic before lunch. We have to plan our personal schedules 6 months in advance and if any changes 6 weeks or sooner the world collapses. Also we don't get any admin time in any real substantial consistent schedule, lots of lip service. If access isn't being met then it gets quickly shifted to open full clinic. If a fellow provider can't make it to clinic due to illness/pulled away for meeting/personal reason then everyone's else's schedule is fully opened to see those patients even if you had "admin time." Yeah we have meetings and try to get group training done and etc but that doesn't help me get my own personal work done/caught up on the varied online trainings I have to do for leave and etc. Morning and evening huddles which further eat up my free time and are basically cheerleading sessions or a repeat of some e-mail we all got.

Question for the group- Family Practice- Army

How many appointments do you see a week?
How many appointments a day?
Any consistent individual admin time?

I'm going to assume you FP as well. That system is severely broken in so many ways. We are supposed to push a collaborative model of care due to the absurd shortage of providers in my specialty and lack of services. It really wasn't working very well, and nobody could understand why. Shortly I took over, my initial hunch was that nobody ever asked primary care if they even wanted such a thing. My assumption is that primary care is so incredibly overwhelmed and broken that they don't have time for anything, so whatever they can easily refer, they will. Unfortunately, this method burns them in the end for reasons I cannot get any to understand.

Also, why do some in primary care -- especially FNP -- simply refuse to prescribe even the most basic psych meds? Even if their patient is doing well and stable on it for a long time.

 

[Zenman1]

What do you expect when they can't even build a hospital? The new Irwin Army Community Hospital is really pretty. Groundbreaking occurred sometime in 2009 with planned opening in 2012. I think it was originally going to cost $334 million but wound up over $404 million due to contractor lawsuits and more than 357 safety violations. Apparently some contractors thought the design, including foundation, was defective, resulting in more cost and driving back the opening date.

Some of the stupidity I’m aware of are that drywall was installed while the building was still open to weather, leading to water damage and mold. Naturally, the drywall had to be replaced. I was told that the walls were put up in radiology, then someone figured out the MRI was not in place yet, requiring walls to be knocked down and then replaced after the MRI was installed. I also heard that some water pipes were tested, or steam, not sure, but somehow one or more of the operating rooms, including all equipment inside, was destroyed. There went another million or so dollars. Some floors and partitions did not provide fire protection.

I went down to the DFAC one day for the first time and noticed that traffic flow was horrible, with people walking both ways in a narrow passage way, with structural columns conveniently placed in the way. I then joined four other people at a table only to discover that some tables were smaller and four trays would not fit! The DFAC is on the ground floor and it is built like many hotels, where you can look up and see that it is open all the way to the top. This is very convenient if someone, God forbid, decided to kill themselves by jumping from the 4th floor, probably landing on some unlucky diner. There are also, for some unknown reason, rectangle openings on the floors, with a low railing around, which make it easy for someone to take a dive down multiple floors.

Recently, a video was made and posted on the hospital FB page about how to access the parking garage, which is for patients only. Apparently, there is a tortuous route to get to it.

Let’s move to behavioral health, on the 4th floor, which is my area. I won’t mention the unlocked opening out onto the 4th floor roof space, another convenient place to jump, as a lock has now been installed. At the old hospital we had 2 front desk clerks, most of the time, to handle patients for 8-9 providers. In the new hospital we have 2 front desk clerks, and only a slightly larger waiting room, to handle the addition of all the adolescent psychiatrists, psychologist, and social workers, all the marriage and family therapists, all of FAP, SUDCC (ASAP), and Combat Aviation Brigade nurse practitioner, psychologist, and social workers. Patients with PTSD or anxiety can’t tolerate the crowded waiting room, especially with kids running around.

My office is really pretty, but there is no desk space. However, there is plenty of storage space. For some reason, nothing can be placed on the walls for a year. Maybe the walls have a warranty, I don’t know. Three weeks now, and my phone doesn’t work. I used to have double monitors and a printer in my old office, which looked like crap, but did enable me to be more productive. I hear we are to get another monitor at some point, but where the heck is it going to go, hang from the ceiling? I now have to walk about 50 yards to a printer, which is used by many people, and try to find my printed material, hoping that someone else hasn’t picked it up. I find it sad that once the complimentary ink cartridge with the new printers ran out, someone figured out that replacements hadn’t been ordered! Someone forgot to order antiseptic hand cleaner for all the wall-mounted pumps…wait, there are no wall-mounted pumps!

I just find it incomprehensible that no one apparently gets input from staff when designing hospitals, or having it all set up and functional when staff move in. Why not have a group of people who have the responsibility of setting up all new military hospitals and know every fine detail about having it ready? Is it that difficult?

The views and opinions expressed in this post are solely those of the author who has plenty of common sense and intelligence, rendering him flabbergasted on a daily basis while working for the Army.

Today, I find out the hospital CDR says we are going to have an addictions IOP. I don't know where they are going to put it! Our one addictions specialist knew nothing about it and was never asked for his expert advice. Our command apparently doesn't care much for civilians, but if we were in charge things would be so much more efficient.

 

[HighPriest]

I'm going to assume you FP as well. That system is severely broken in so many ways. We are supposed to push a collaborative model of care due to the absurd shortage of providers in my specialty and lack of services. It really wasn't working very well, and nobody could understand why. Shortly I took over, my initial hunch was that nobody ever asked primary care if they even wanted such a thing. My assumption is that primary care is so incredibly overwhelmed and broken that they don't have time for anything, so whatever they can easily refer, they will. Unfortunately, this method burns them in the end for reasons I cannot get any to understand.

Also, why do some in primary care -- especially FNP -- simply refuse to prescribe even the most basic psych meds? Even if their patient is doing well and stable on it for a long time.

Psyche meds? Christ, I'd be happy if they'd prescribe an anti-histamine or Flonase to a 21 year old who takes nothing else and has seasonal allergies. Apparently CHCS is set up so that NPs and PAs can only older z-packs and Motrin for anything that walks through the door.

 

[DD214_DOC]

Psyche meds? Christ, I'd be happy if they'd prescribe an anti-histamine or Flonase to a 21 year old who takes nothing else and has seasonal allergies. Apparently CHCS is set up so that NPs and PAs can only older z-packs and Motrin for anything that walks through the door.

Hah. Admittedly the couple FNP who did try to manage a psych patient was an absolute clinical Hindenburg.

I have also caught 6 significant medical issues that primary care either completely missed or got completely wrong. I'm serious. I started a list for my own curiosity. I've really saved their ass a couple times. It's so bad I have had patients call ME first about medical concerns and even ask if it's possible for me to also be their pcm.


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[HighPriest]

Hah. Admittedly the couple FNP who did try to manage a psych patient was an absolute clinical Hindenburg.

I have also caught 6 significant medical issues that primary care either completely missed or got completely wrong. I'm serious. I started a list for my own curiosity. I've really saved their ass a couple times. It's so bad I have had patients call ME first about medical concerns and even ask if it's possible for me to also be their pcm.


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Right out of residency I got a consult for vertigo. Of course, per SOP the PCP heard the word "dizzy" and just sent them to ENT, end of exam. Well, otogenic vertigo is never an emergency so I saw the patient routinely (2 weeks). She showed up and my MSA comes in to tell me that it seems strange that when this woman gets dizzy she also has paresthesias and partial paralysis of her right army as well as dysarthria.....So her MRI was....bad....lots of infarcts...

At least once/week I get a consult for sinusitis in a patient who's complaints are unilateral headache lasting for hours, occurring more than once/week with photophobia and phonophobia which limits physical activity. I mean, they basically describe the clinical diagnosis of a migraine headache, they diagnose them with sinusitis (inaccurately), they do nothing to treat or prove sinusitis, and they send them to me where I get to tell them they've wasted their time and their PA is just trying to shovel water out of the boat.

Anyway, I really do attribute this to them being too overburdened and understaffed for the most part (there are terrible PCPs out there just like there are terrible ENTs.). But it can be frightening sometimes.

 

[Clap MD]

Personality disorder patients are notorious for using the ICE system as a vindictive tool to create lots of unnecessary additional work for docs and clinics that don't give them what they want.

Rule 8: They can always hurt you more.
-The Fat Man

 

[HighPriest]

What do you expect when they can't even build a hospital? The new Irwin Army Community Hospital is really pretty. Groundbreaking occurred sometime in 2009 with planned opening in 2012. I think it was originally going to cost $334 million but wound up over $404 million due to contractor lawsuits and more than 357 safety violations. Apparently some contractors thought the design, including foundation, was defective, resulting in more cost and driving back the opening date.

Some of the stupidity I’m aware of are that drywall was installed while the building was still open to weather, leading to water damage and mold. Naturally, the drywall had to be replaced. I was told that the walls were put up in radiology, then someone figured out the MRI was not in place yet, requiring walls to be knocked down and then replaced after the MRI was installed. I also heard that some water pipes were tested, or steam, not sure, but somehow one or more of the operating rooms, including all equipment inside, was destroyed. There went another million or so dollars. Some floors and partitions did not provide fire protection.

I went down to the DFAC one day for the first time and noticed that traffic flow was horrible, with people walking both ways in a narrow passage way, with structural columns conveniently placed in the way. I then joined four other people at a table only to discover that some tables were smaller and four trays would not fit! The DFAC is on the ground floor and it is built like many hotels, where you can look up and see that it is open all the way to the top. This is very convenient if someone, God forbid, decided to kill themselves by jumping from the 4th floor, probably landing on some unlucky diner. There are also, for some unknown reason, rectangle openings on the floors, with a low railing around, which make it easy for someone to take a dive down multiple floors.

Recently, a video was made and posted on the hospital FB page about how to access the parking garage, which is for patients only. Apparently, there is a tortuous route to get to it.

Let’s move to behavioral health, on the 4th floor, which is my area. I won’t mention the unlocked opening out onto the 4th floor roof space, another convenient place to jump, as a lock has now been installed. At the old hospital we had 2 front desk clerks, most of the time, to handle patients for 8-9 providers. In the new hospital we have 2 front desk clerks, and only a slightly larger waiting room, to handle the addition of all the adolescent psychiatrists, psychologist, and social workers, all the marriage and family therapists, all of FAP, SUDCC (ASAP), and Combat Aviation Brigade nurse practitioner, psychologist, and social workers. Patients with PTSD or anxiety can’t tolerate the crowded waiting room, especially with kids running around.

My office is really pretty, but there is no desk space. However, there is plenty of storage space. For some reason, nothing can be placed on the walls for a year. Maybe the walls have a warranty, I don’t know. Three weeks now, and my phone doesn’t work. I used to have double monitors and a printer in my old office, which looked like crap, but did enable me to be more productive. I hear we are to get another monitor at some point, but where the heck is it going to go, hang from the ceiling? I now have to walk about 50 yards to a printer, which is used by many people, and try to find my printed material, hoping that someone else hasn’t picked it up. I find it sad that once the complimentary ink cartridge with the new printers ran out, someone figured out that replacements hadn’t been ordered! Someone forgot to order antiseptic hand cleaner for all the wall-mounted pumps…wait, there are no wall-mounted pumps!

I just find it incomprehensible that no one apparently gets input from staff when designing hospitals, or having it all set up and functional when staff move in. Why not have a group of people who have the responsibility of setting up all new military hospitals and know every fine detail about having it ready? Is it that difficult?

The views and opinions expressed in this post are solely those of the author who has plenty of common sense and intelligence, rendering him flabbergasted on a daily basis while working for the Army.

Today, I find out the hospital CDR says we are going to have an addictions IOP. I don't know where they are going to put it! Our one addictions specialist knew nothing about it and was never asked for his expert advice. Our command apparently doesn't care much for civilians, but if we were in charge things would be so much more efficient.

Can confirm. That hospital had been suspended so many times it'll probably end up making your French fries. And for what its worth, they DID ask all of the clinic leaders what they thought of the layouts, but then they just summarily ignored every suggestion they got. Because an MSC officer and a Nurnel know more about your clinic that they've never been to than you do. As %&*CKED as it is, you'd think IACH would be the most popular girl at the prom. Hilariously, you've only scratched the surface here.

 

[Zenman1]

Can confirm. That hospital had been suspended so many times it'll probably end up making your French fries. And for what its worth, they DID ask all of the clinic leaders what they thought of the layouts, but then they just summarily ignored every suggestion they got. Because an MSC officer and a Nurnel know more about your clinic that they've never been to than you do. As %&*CKED as it is, you'd think IACH would be the most popular girl at the prom. Hilariously, you've only scratched the surface here.

That's what I figured. I'd like to know more dirt but no one tells me anything around here.

 

[TurtleDO2012]

I'm going to assume you FP as well. That system is severely broken in so many ways. We are supposed to push a collaborative model of care due to the absurd shortage of providers in my specialty and lack of services. It really wasn't working very well, and nobody could understand why. Shortly I took over, my initial hunch was that nobody ever asked primary care if they even wanted such a thing. My assumption is that primary care is so incredibly overwhelmed and broken that they don't have time for anything, so whatever they can easily refer, they will. Unfortunately, this method burns them in the end for reasons I cannot get any to understand.

Also, why do some in primary care -- especially FNP -- simply refuse to prescribe even the most basic psych meds? Even if their patient is doing well and stable on it for a long time.

Living in Primary Care Purgatory treading water and overall just getting fed up. Tired of all the focus on the complaints from the whiny few or concern someone could complain. Guess what, they can whine all day long I didn't walk them in because they missed an appointment. They have literally no power accept what the command wants to give by responding to those petty complaints. Tired of the excessive concern from the top about access. Seeing 85 patients a week generates a bunch of labs and etc that have to be followed up and when patients can use Army Secure Messaging Service (relay health) like twitter and send me personal emails eats time. Department Chief takes rigid approach to changes and no backbone. Most of the leaders are in terminal ranks so what are they all chasing? Make your current staff slightly happy.

 

[DD214_DOC]

Living in Primary Care Purgatory treading water and overall just getting fed up. Tired of all the focus on the complaints from the whiny few or concern someone could complain. Guess what, they can whine all day long I didn't walk them in because they missed an appointment. They have literally no power accept what the command wants to give by responding to those petty complaints. Tired of the excessive concern from the top about access. Seeing 85 patients a week generates a bunch of labs and etc that have to be followed up and when patients can use Army Secure Messaging Service (relay health) like twitter and send me personal emails eats time. Department Chief takes rigid approach to changes and no backbone. Most of the leaders are in terminal ranks so what are they all chasing? Make your current staff slightly happy.

As I suspected. It's easy to disrupt the madness. Just push back. The whole concept of setting limits and boundaries with patients isn't important only for psych. It's important in every clinic to both preserve quality care and protect the individual providers from undue stress, burnout, liability, and low morale.

I don't believe the role of a leader is to appease those above him, especially at the expense of his subordinates, or to care only about self-interest and career advancement. I view my obligation as a leader as, you know, leading, and taking care of those I am responsible for, even if doing so may not be in my best interests. Fortunately, my dept head is basically my doppleganger and equally pragmatic, so I have been supported in my approach.