Walter Reed: lets clear up some of this BS

[Mirror Form]

As a care provider at WRAMC, I'm pretty pissed about how the media is portraying things. It's makes me realize that you honestly cannot believe anything you read in the MSM these days.

I agree that some of the dilapidated housing was a major issue, and it's great that got resolved. I'm not surprised it blew up in our face. The medical evaluation board system (all admin, no healthcare) is also a major issue that needs to be resolved. It's too lenghty and a lot of soldiers who don't hire lawyers get screwed. Absolutely unacceptable.

That said, the media is making the extrapolation that the healthcare is also poor at WR. I will say that I've never seen an OIF soldier not get prompt surgery (including elective plastic procedures) unless there are very good reasons (eg not showing up for pre op appt's repeatedly). I've seen no good evidence presented by the media that in anyway makes WR's healthcare out to be worse than an standard civilian hospital. Yet every news article lately has been condemning the healthcare w/o any real evidence to back it up. It's absolutely ridiculous.

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[resxn]

Being in a lowly MTF myself, I would have to believe you're correct in that the medical care provided by the staff is as prompt and as good as one would find in a civilian institution. I would say that I provide at least as good if not better surgical care to my patients as any ENT in the community.

HOWEVER, I think a lot of the reports that we see in the news condemn the "care" when in reality it's the garbage of the system that should be condemmed. It's the system, not the provider. The docs are good if not great, but the system is a mess.

Those who are using this time to speak out are complaining not about the quality of the physicians or nurses (for the most part), but about the lines, the waits, the paperwork jams, the facilities, the equipment, etc, etc, etc. These are all out of the control of the end-users, the doctor-patient relationship, but they certainly affect all aspects of that interaction.

As a provider at WRAMC I don't blame you for defending the providers. Yet, I do not have a problem with the stories coming out because it is really the one avenue we've had in the last 5 years to even bring to light the problems we've complained about. No provider heads will role unless they're more administrative heads than truly pt care noggins.

I personally welcome all crticism because it is soooooo easy to deflect the anger toward the true culprit. And that's what's needed to make really effective changes.

 

[USAFdoc]

Being in a lowly MTF myself, I would have to believe you're correct in that the medical care provided by the staff is as prompt and as good as one would find in a civilian institution. I would say that I provide at least as good if not better surgical care to my patients as any ENT in the community.

HOWEVER, I think a lot of the reports that we see in the news condemn the "care" when in reality it's the garbage of the system that should be condemmed. It's the system, not the provider. The docs are good if not great, but the system is a mess.

Those who are using this time to speak out are complaining not about the quality of the physicians or nurses (for the most part), but about the lines, the waits, the paperwork jams, the facilities, the equipment, etc, etc, etc. These are all out of the control of the end-users, the doctor-patient relationship, but they certainly affect all aspects of that interaction.

As a provider at WRAMC I don't blame you for defending the providers. Yet, I do not have a problem with the stories coming out because it is really the one avenue we've had in the last 5 years to even bring to light the problems we've complained about. No provider heads will role unless they're more administrative heads than truly pt care noggins.

I personally welcome all crticism because it is soooooo easy to deflect the anger toward the true culprit. And that's what's needed to make really effective changes.

I agree. In general, the docs/nurses are good. It is the system/admin/manning/beurocracy that is completely UNSAT in many instances. And why is that? Because the people in the civilian world that would not allow that level of unsat/redtape/low manning/admin fiasco...........the physicians, have NO say, and no leverage to control those things. Milmed in micromanaged and mismanaged ad nauseum.

This will not change until the system of admin changes and those who have the best interests of patients and those who have the most accurate perspective on healthcare system conditions have some say so.

the appointed "commission" to look into things will change nothing unless the above changes are made.

 

[R-Me-Doc]

Not to sound too self-centered, but it's going to be interesting to see how all this impacts assignments/careers of residents coming out of WRAMC, as well as jobs for WRAMC or other military-trained docs leaving the service for the civilian world. Frankly, I am right now so, so happy not to have done my residency or ever worked at WRAMC. This paints everyone associated with Army medicine with the same bad mark, but boy, I especially sure wouldn't want to be entering the civilian job market right now with a CV that had WRAMC residency training or staff service listed on it . . .

X-RMD

 

[mitchconnie]

I've seen no good evidence presented by the media that in anyway makes WR's healthcare out to be worse than an standard civilian hospital. Yet every news article lately has been condemning the healthcare w/o any real evidence to back it up. It's absolutely ridiculous.

I agree 100% that the medical professionals and acute care are not a part of the problem, but it seems to me that the vast majority of the negative coverage so far has been focused on the leadership, support staff, and contractors. This is entirely appropriate. My observation is that the support staff are frequently incompetent, the clinics badly undermanned, the contracting system a complete fiasco, and the bureaucratic hassle factor incredibly high. As with many military facilities, the leadership has always seemed to be completely detached from the reality on the ground.

But I will say that I don’t think that WRAMC is in any way unique in the NCA and in that regard the coverage is unfair. Malcolm Grow Medical Center (Andrews AFB) is a joke of a hospital, which avoids scrutiny only because they do almost no serious inpatient care. The NNMC also seems badly undermanned and under equipped, at least in the department where I have worked. Walter Reed probably gets most of the flak because it has the largest patient load and the most visually unattractive facilities. You have to admit that even the main hospital does look pretty run-down, and I have seen cockroaches in the locker rooms more than once.

As far as getting a civilian job is concerned, I think most employers will be able to differentiate between the care provided by a physician and the Army’s administrative buffoonery. You might not want to hang that picture of WRAMC on the wall in your waiting room though.

 

[Dr. Dukes]

HOWEVER, I think a lot of the reports that we see in the news condemn the "care" when in reality it's the garbage of the system that should be condemmed. It's the system, not the provider. The docs are good if not great, but the system is a mess.

I think the point here comes down to your definition of "care". On one hand, medical care can be defined as the specific therapeutic intervention a patient recieves, whether that intervention is standard of care, how the patient progresses after a given intervention, etc. I don't think anyone disagrees that by this definition Walter Reed is exceptional.

However, there is another aspect of medical "care" that I think needs to be considered, and that is how easy it is for a patient to navigate the health care system, to speak to the right people at the right time, and stuff like that. The article in the Post, and everything that came after that, take issue with this "care" at Walter Reed. The problem isn't that the soldiers/sailors/airmen/marines at Walter Reed don't recieve good acute inpatient care, it is that the outpatient care system (housing, appointments, accessibility...) needs work.

Luckily, I think it is much easier to fix the second kinda of care than it is to fix the first. If the inpatient care were the problem the Army would have to re-train all the docs/nurses, which would take forever, be very expensive, and be much more embarassing. As it is now, (I think/hope) that the administration at Walter Reed and elsewhere will be so embarassed by what has been exposed that all the outpatient "stuff" will be changed (and hopefully perfected) very soon.

 

[Mirror Form]

The problem isn't that the soldiers/sailors/airmen/marines at Walter Reed don't recieve good acute inpatient care, it is that the outpatient care system (housing, appointments, accessibility...) needs work.

That's the exact BS opinion one would get form reading the news. First of all, HOUSING is not a healthcare issue. So stop parroting the crap that the media keeps doing by using healthcare and housing in the same sentence as if they're intimately correlated. Housing and medical care are completely separate issues. Second, all any outpatient OIF soldier has to do is walk (or wheel) into any clinic and they'll be given an appointment for a prompt time. They're literally treated like VIP's by most outpatient clinics. They'd never get half the attention if they had the same injuries from a car accident and presented to a typical state training hospital as outpatients. The only reason any of them don't have access to care is b/c they didn't bother doing the slightest thing to pursue it.

Actually, it's kind of ridiculous how closely the clinic i work in follows most of our OIF outpatients. We have a huge list and if any OIF patients miss their outpatient appointments (happens all the time) we have to start calling them and playing detective to track them down. That's been going on since WAY before any of this recent scandal stuff happened.

 

[Mirror Form]

I agree 100% that the medical professionals and acute care are not a part of the problem, but it seems to me that the vast majority of the negative coverage so far has been focused on the leadership, support staff, and contractors. This is entirely appropriate.

Initially that was case, and it didn't bother me. But lately all of the news stories have switched gears to simply reporting on the "poor care" that Walter Reed Medical Center provides for the OIF soldiers. This isn't appropriate, it's crap.

And if you think I'm pissed off, a lot of my patients who are OIF are even more pissed about it. They know that a lot of this is intentional misreporting by the media. That is, just typical MSM BS of trying to sell papers and also jumping on any opportunity to drag the military's name through the mud. One guy told me him and a good number of other OIF patients had been trying to tell their positive stories to the media. Big surprise though, no takers.

 

[Mirror Form]

The docs are good if not great, but the system is a mess.

I agree that the system is a mess. But OIF soldiers get such a high priority for everything that I don't understand how any of them could possibly have trouble getting access to care.

 

[BigNavyPedsGuy]

First of all, HOUSING is not a healthcare issue. So stop parroting the crap that the media keeps doing by using healthcare and housing in the same sentence as if they're intimately correlated. Housing and medical care are completely separate issues.

They're different to you, but not to patients. The entire hospital experience is healthcare to the patient. From nursing, to beds, to TV programming, to mold and roaches in their shower. That's all healthcare to patients.

 

[Mirror Form]

They're different to you, but not to patients. The entire hospital experience is healthcare to the patient. From nursing, to beds, to TV programming, to mold and roaches in their shower. That's all healthcare to patients.

So, you're saying that the medical care at a hospital should be associated with the type of housing provided by the admin? How many hospitals provide barracks for their outpatients? This isn't a healthcare issue. And btw, the people in building 18 were not in some sort of critical medical condition. They were just guys who would have been living at home if they were civilians. So it's not like they were helpless to clean the mold off of the shower wall. I mean heck, that's what I would do. The roaches part is pretty nasty, but it's not like that's the only building in DC with that problem. Now don't get me wrong, I'm not saying that the dilapidated housing was fine. It wasn't. But to associate a run down off-post barracks with Walter Reed's healthcare is quite a stretch.

 

[Dr. Dukes]

They're different to you, but not to patients. The entire hospital experience is healthcare to the patient. From nursing, to beds, to TV programming, to mold and roaches in their shower. That's all healthcare to patients.

Thats the point I was trying to make. Docs think healthcare is simply diagnosis, intervention, and treatment. Patients see healthcare as everything from when you get out of the cab at the hospital entrance to when you get back in the cab to leave. This problem is especially compounded by people who are in "outpatient" clinics (what % of Walter Reed outpatients are actually from greater DC), and who have to live in the outpatient housing. They are only in DC to recieve their healthcare, so to them housing is part of the whole thing. To the doc, as long as the patient recieves the correct treatment at the correct time, all is well and good. To the patient, all is well and good IF AND ONLY IF they recieve the correct medical treatment and the correct personal treatment at the correct time.

 

[R-Me-Doc]

First of all, HOUSING is not a healthcare issue. So stop parroting the crap that the media keeps doing by using healthcare and housing in the same sentence as if they're intimately correlated. Housing and medical care are completely separate issues.

Hmm, so hospital physical facilities are not part of healthcare? So then it would be OK to keep patients in a hospital with rats/mold/holes-in-the-ceiling because the condition of the room is not "health care"? OK, try telling that to any patient or hospital accreditation organization. I think you'd get some interesting looks. And remember that patients at WRAMC (even outpatients) are there because the Army says they have to be. Therefore, it is incumbent on the Army, through it's subordinate medical activity, to maintain adequate facilities to house them.

The only reason any of them don't have access to care is b/c they didn't bother doing the slightest thing to pursue it.

Keep in mind that half these patients are brain damaged and probably can't think straight enough to make or keep their own appointments.

But OIF soldiers get such a high priority for everything that I don't understand how any of them could possibly have trouble getting access to care

Sure, but is it the right care? Maybe WRAMC is better off than some other places, but if you go to smaller MEDDACs, people can wait months for off-post appts with civilian docs because the MEDDAC doesn't have the specialty care they need.

Overall, I agree with Bobcat. You may think "care" starts and stops with the guy in the white coat sticking needles into someone, but the patient sees the big picture, and that's where things have fallen apart. If you go to a restaurant and have 5-star-tasting food but the waiter keeps spilling crap all over you and there are rats sharing your table, what's your overall impression gonna be?

 

[Mirror Form]

As far as getting a civilian job is concerned, I think most employers will be able to differentiate between the care provided by a physician and the Army’s administrative buffoonery. You might not want to hang that picture of WRAMC on the wall in your waiting room though.

I actually disagree with you on this point. It'll could easly have a significant impact on people applying for both jobs and fellowship positions.

 

[Dr. Dukes]

Overall, I agree with Bobcat. You may think "care" starts and stops with the guy in the white coat sticking needles into someone, but the patient sees the big picture, and that's where things have fallen apart. If you go to a restaurant and have 5-star-tasting food but the waiter keeps spilling crap all over you and there are rats sharing your table, what's your overall impression gonna be?

Why is it that people always say what I mean much more eloquently than I do?

 

[Mirror Form]

Hmm, so hospital physical facilities are not part of healthcare? So then it would be OK to keep patients in a hospital with rats/mold/holes-in-the-ceiling because the condition of the room is not "health care"? OK, try telling that to any patient or hospital accreditation organization. I think you'd get some interesting looks.

Hospital facilities? Building 18 is under the same command as Walter Reed, but it's hardly part of it. It's an OFF-POST barracks. I think you'd get some interesting looks if if you asked any civilian hospital about the type of housing they keep their out-patients in. Obviously they don't worry about that b/c it's not something hospitals take care of. And furthermore, WRAMC always does great with JACHO inspections (not that I have a high opinion of them).

And remember that patients at WRAMC (even outpatients) are there because the Army says they have to be. Therefore, it is incumbent on the Army, through it's subordinate medical activity, to maintain adequate facilities to house them.

Agreed. It was definitely a failure of the Army's Admin. This has nothing to do with the healthcare other than some of the top admin positions are in charge of both.

Keep in mind that half these patients are brain damaged and probably can't think straight enough to make or keep their own appointments.

There are a lot of TBI's. But most can write down appt days and show up. Second, most have the army paying to have their families stay there too. So it's strange when you have the patient and their spouse, yet neither can ever remember to make it to the f/u 9/10 times. Well not really, but it is strange that they then later complain about having to wait a long time for their elective surgery.

Sure, but is it the right care? Maybe WRAMC is better off than some other places, but if you go to smaller MEDDACs, people can wait months for off-post appts with civilian docs because the MEDDAC doesn't have the specialty care they need.

Is it the right care? Well if it's not, they'll be referred to the correct specialty. You second point has nothing to do with Walter Reed.

Overall, I agree with Bobcat. You may think "care" starts and stops with the guy in the white coat sticking needles into someone, but the patient sees the big picture, and that's where things have fallen apart. If you go to a restaurant and have 5-star-tasting food but the waiter keeps spilling crap all over you and there are rats sharing your table, what's your overall impression gonna be?

I agree that the patient see's the big picture of how the army treats them. They definitely got screwed in terms of housing / admin by the army. But they received good healthcare. So it's ridiculous to bust on the hospital's healthcare for poor housing / medical evaluation board issues. That's my whole point. Yet most people think it's great to criticize Walter Reed's healthcare even though we so far have zero legitimate examples.

 

[Mirror Form]

To the patient, all is well and good IF AND ONLY IF they recieve the correct medical treatment and the correct personal treatment at the correct time.

Yes, but soldiers (and unfortunately esp enlisted) receive poor personal treatment from the Army all the time. I agree that the housing was crap. Being forced to live in a crappy run down barracks is part of neglect from the Army, not from Healthcare system.

 

[BigNavyPedsGuy]

Yes, but soldiers (and unfortunately esp enlisted) receive poor personal treatment from the Army all the time. I agree that the housing was crap. Being forced to live in a crappy run down barracks is part of neglect from the Army, not from Healthcare system.

It was under Walter Reed's command. Therefore it IS part of the Army healthcare system

 

[R-Me-Doc]

Why is it that people always say what I mean much more eloquently than I do?

Guess I just had more time to waste today to think about it!!!

 

[Dr. Dukes]

Guess I just had more time to waste today to think about it!!!

I donno, I had a whole lot of time to waste today. I hate protocols (specifically Northern blots) that take ALL day to run with very little hands on time but even less time away from my desk.

However, I suppose when I'm memorizing the brachial plexus next fall I will wish I was doing Northerns.

As they say, the grass is always greener...

 

[Mirror Form]

It was under Walter Reed's command. Therefore it IS part of the Army healthcare system

You have a funny definition of healthcare. Walter Reed is a military facility that does more than just healthcare. If med corp troops are deployed and get their orders and housing screwed up, is would that be indicative of poor military healthcare for patients?

We're being blamed for military issues that don't exist in the civilian sector and aren't considered to be part of a typical healthcare system. These are army issues, not healthcare issues. And as I said before, so far I've seen no legitimate examples from the media of poor healthcare.

 

[Dr. Dukes]

We're being blamed for military issues that don't exist in the civilian sector and aren't considered to be part of a typical healthcare system. These are army issues, not healthcare issues.

Yes and no. They aren't healthcare in that a disgusting room has nothing to do with a TBI.

However, a disgusting room has everything to do with quality of life. Numerous studies have shown that all else being equal, patients with better quality of life have better recoveries. Considering physicians are in the business of helping recover from whatever ails them, a disgusting room in hospital provided housing can be fairly lumped in with the hospital.

Additionally, these soldiers were only in Building 18 because they were being see in Walter Reed's outpatient clinic. If these soldiers had been stationed at Fort Bragg (to pick a random base) in disgusting housing and was being treated as an outpatient at Womack, the housing situation would not be the fault of the people at Womack. However, because soldiers in Building 18 were ONLY THERE TO RECIEVE MEDICAL TREATMENT, the situation of the housing falls under the purview of the people at Walter Reed.

To expand on R-Me-Doc's analogy, a rat at your table in a 5 star restaurant is the fault of the restaurant, while a rat at your table in the food court at a mall is not the fault of the specific place you got your food at the mall.

 

[IgD]

First of all, HOUSING is not a healthcare issue.

It's not a housing issue. Building 18 was a medical hold.

 

[IgD]

Mirror Form, I appreciate your frustration but I think you aren't being objective about the situation. Being defensive about it just makes the situation looks worse.

 

[Mirror Form]

Yes and no. They aren't healthcare in that a disgusting room has nothing to do with a TBI.

However, a disgusting room has everything to do with quality of life. Numerous studies have shown that all else being equal, patients with better quality of life have better recoveries.

Better recoveries? These aren't actively sick patients in the hospital. These are patients who have been completley stabilized and are awaiting a medical board or some elective surgery down the road. Regardless, I agree that the rooms were unacceptable. But there weren't the healthcare disaster that they're being made out to be.

Considering physicians are in the business of helping recover from whatever ails them, a disgusting room in hospital provided housing can be fairly lumped in with the hospital.

I'm not defending Walter Reed's admin from the housing. However, the housing didn't have any significant impact on patient care. It just sucked for the guys who were stationed there and it BS on the part of military admin.

Additionally, these soldiers were only in Building 18 because they were being see in Walter Reed's outpatient clinic. If these soldiers had been stationed at Fort Bragg (to pick a random base) in disgusting housing and was being treated as an outpatient at Womack, the housing situation would not be the fault of the people at Womack. However, because soldiers in Building 18 were ONLY THERE TO RECIEVE MEDICAL TREATMENT, the situation of the housing falls under the purview of the people at Walter Reed.

1. Many were not only there to receive medical tx, many were there just waiting for their medical evaluation boards to be processed.

2. They were attached / assigned to a med hold unit at Walter Reed. THIS IS A MILITARY UNIT. True, it is under Walter Reed's command. However, except for the very senior leadership it's mostly a different Chain of command from the actual hospital (versus all the military offices surrounding it).

To expand on R-Me-Doc's analogy, a rat at your table in a 5 star restaurant is the fault of the restaurant, while a rat at your table in the food court at a mall is not the fault of the specific place you got your food at the mall.

To take your analogy one step further, the rat would be in the hotel that the five star restaurant is attached to. When the media find it, they start reporting about the rat in the restaurant.

 

[HumptyDumptyMil]

You have a funny definition of healthcare. Walter Reed is a military facility that does more than just healthcare. If med corp troops are deployed and get their orders and housing screwed up, is would that be indicative of poor military healthcare for patients?

We're being blamed for military issues that don't exist in the civilian sector and aren't considered to be part of a typical healthcare system. These are army issues, not healthcare issues. And as I said before, so far I've seen no legitimate examples from the media of poor healthcare.

Housing seems to be the biggest issue at Walter Reed right now, but there has been talk about other specific healthcare issues discussed over and over again on this forum. Are you saying that Walter Reed does not have these issues as much as other military facilities?

I think the media is right in portraying military medicine, as a whole, is not up to par. Isnt that what a majority of the people on this site have been preaching for some time?

If there are articles bashing the physicians/clinical staff specifically, I don't think that is accurate, but if they are talking about the administrative paperwork, red tape, long lines, etc. I see them as no different than the people on this forum complaining of the same exact things.

 

[Mirror Form]

Mirror Form, I appreciate your frustration but I think you aren't being objective about the situation. Being defensive about it just makes the situation looks worse.

I've been very straightforward in regard to the fact that patient care has not been compromised. yet, the media has been portraying things in that light. So far, no one's shown an example of it. So fine, please give me an objective example of patient care that has been compromised. Otherwise, what's is your criticism of Walter Reed's hospital? We know the Walter Reed admin is fubar and has been for quite sometime.

 

[Mirror Form]

Housing seems to be the biggest issue at Walter Reed right now, but there has been talk about other specific healthcare issues discussed over and over again on this forum. Are you saying that Walter Reed does not have these issues as much as other military facilities?

It would help if you were more specific. Most people complain about GMO's acting as PCM's w/o support. This definitely does not happen at Walter Reed. Another issues is that it's also hard to get appointments for many patients. This isn't the case for OIF soldiers though b/c they get priority for appointments.

I think the media is right in portraying military medicine, as a whole, is not up to par. Isnt that what a majority of the people on this site have been preaching for some time?

Yes, and I usually agree with them. But while military med had a lot of problems, the OIF patients have been getting great care. And once again, you're not providing any real examples. It's more of the same vague stuff.

If there are articles bashing the physicians/clinical staff specifically, I don't think that is accurate, but if they are talking about the administrative paperwork, red tape, long lines, etc. I see them as no different than the people on this forum complaining of the same exact things.

The articles are lumping the red tap into the health care system and trying to extrapolate that the poor housing is assocaited with poor patient care. That is what I disagree with.

 

[Mirror Form]

It's not a housing issue. Building 18 was a medical hold.

Medical hold is a military unit, not a building. It's run by military officers / NCO's, and it supposed to be like any other military unit (of course it's run much more poorly). Most people at Walter Reed's medical hold are not at building 18. Soldiers are either attached to the med hold temporarily or removed from their previous unit and assigned to it.

 

[mac61]

You have a funny definition of healthcare. it's not the same thing as the med corp. If med corp troops are deployed and get their orders and housing screwed up, is that what you would consider the military "healthcare system?" Would that be indicative of poor healthcare at walter reed?

First, there is a flaw in your logic: AMEDD soldiers who are being deployed into substandard housing are being deployed to do thier job, not to receive medical care.

These soldiers are assigned to WRAMC because the are on administrative hold DIRECTLY because of medical problems encountered in the GWOT for which they are still receiving tx. In effect, they are being "deployed" to WRAMC for the mission of receiving care. There are few places in the world where a soldier can be put into a med-hold status for longer than 90 days while receiving tx, WRAMC is at the center of this. If this issue were purely administrative, and not related to healthcare, the soldiers would be shipped to thier owning unit and admin would be handled there as with any MMRB. I would bet that most soldiers would like to do exactly that.

Your inability to make this separation is frightening. Would you also discharge a patient who can't execute your treatment plan themselves at home? Social Hx is in that whole H&P thingy for a reason: Living situation is an important part of healthcare. (Go ahead, let the "You're only a medical student" comments fly, I'm used to it here.)

I truly hope that this attention on WRAMC, which I didn't hear anything about on my local station today, does 2 things:

1) Continues to catch the eye of the media. Unfortunately the only thing that gets media attention is bad things happening to people. This is why we were hit hard until people got fired, and it's already backing off. Same thing happened in Bosnia '95. We deployed, it was on the news everyday for a week. No soldiers were dying they packed up and went home....IMHO, there needs to be at least 1 more administrative casualty, doubt its gonna happen, but maybe it will extend media attention.

2) Gets the public a real picture of how screwed up the beuracracies of milmed and the military in general are. As I work to get into a system that is infamous for poor healthcare, despite the reality of the situation, I truly hope that the quality of care (in the treatment sense) is separated from the quality of care in the admin sense. I hate that when I tell an average person (non-physician) that I am training in the military system and they automatically assume that my training is substandard, based largely on opinion that reflects not the physicians, but the system. As a soldier, I never had a problem with ANY care I received, but getting that care was a completely different, and much more arduous task.

 

[HumptyDumptyMil]

It would help if you were more specific. Most people complain about GMO's acting as PCM's w/o support. This definitely does not happen at Walter Reed. Another issues is that it's also hard to get appointments for many patients. This isn't the case for OIF soldiers though b/c they get priority for appointments.



Yes, and I usually agree with them. But while military med had a lot of problems, the OIF patients have been getting great care. And once again, you're not providing any real examples. It's more of the same vague stuff.



The articles are lumping the red tap into the health care system and trying to extrapolate that the poor housing is assocaited with poor patient care. That is what I disagree with.

Ok, I can't give you specific examples. I dont know enough about the whole situation. It's good to hear that the patient care is good at Walter Reed.

My next question is, do you think that the public would have paid much attention if this was portrayed as just another military administrative issue, and not a healthcare issue? Using the word "healthcare" seems like it will grab people's attention more than "administrative".
I don't think the changes we have seen already would not have been executed so quickly if this was just portrayed as another administrative issue, like a shortage of funds to adequately equip soldiers.

 

[BigNavyPedsGuy]

Otherwise, what's is your criticism of Walter Reed's hospital? We know the Walter Reed admin is fubar and has been for quite sometime.

Then what do you keep arguing about?

 

[Mirror Form]

First, there is a flaw in your logic: AMEDD soldiers who are being deployed into substandard housing are being deployed to do thier job, not to receive medical care.

These soldiers are assigned to WRAMC because the are on administrative hold DIRECTLY because of medical problems encountered in the GWOT for which they are still receiving tx. In effect, they are being "deployed" to WRAMC for the mission of receiving care.

Yes, and they receive care. A few just got crappy housing after they were stablized (not surprising considering that this is the army). I agree that the housing sucks and should have been fixed long ago. But it's still outside of what a normal hospital does and is not indicative of a hospital's quality of medical care.

There are few places in the world where a soldier can be put into a med-hold status for longer than 90 days while receiving tx, WRAMC is at the center of this. If this issue were purely administrative, and not related to healthcare, the soldiers would be shipped to thier owning unit and admin would be handled there as with any MMRB. I would bet that most soldiers would like to do exactly that.

Some soldiers are shipped back to their units. However, we have plenty who we seem to never be able to get out of here. For one thing, after they're assigned to med hold (instead of attached) they lose their unit and can't easily just be sent back. Then they get stuck here for their board.

Many do want to go back, but we do have a problem with a minority who will do whatever it takes to stay in med hold. It's full pay, no work, free housing (most people weren't stuck in building 18). Actually, a large number of single male soldiers seem to have at least a little bit of secondary gain on that issue. That's why the admin was trying to make med hold have more formations, etc.

Your inability to make this separation is frightening. Would you also discharge a patient who can't execute your treatment plan themselves at home? Social Hx is in that whole H&P thingy for a reason: Living situation is an important part of healthcare. (Go ahead, let the "You're only a medical student" comments fly, I'm used to it here.)

If the soldiers have huge tbi's that make it so they can't resposibley live by themselves, then they shouldn't be at building 18. I agree with that, but that's not the majority of what I've been hearing about. Most people there were perfectly competent.

I truly hope that this attention on WRAMC, which I didn't hear anything about on my local station today, does 2 things:

1) Continues to catch the eye of the media. Unfortunately the only thing that gets media attention is bad things happening to people. This is why we were hit hard until people got fired, and it's already backing off. Same thing happened in Bosnia '95. We deployed, it was on the news everyday for a week. No soldiers were dying they packed up and went home....IMHO, there needs to be at least 1 more administrative casualty, doubt its gonna happen, but maybe it will extend media attention.

While I'm not opposed to this, it's a bad reason to draw the hospital's name through the mud.

2) Gets the public a real picture of how screwed up the beuracracies of milmed and the military in general are. As I work to get into a system that is infamous for poor healthcare, despite the reality of the situation, I truly hope that the quality of care (in the treatment sense) is separated from the quality of care in the admin sense. I hate that when I tell an average person (non-physician) that I am training in the military system and they automatically assume that my training is substandard, based largely on opinion that reflects not the physicians, but the system. As a soldier, I never had a problem with ANY care I received, but getting that care was a completely different, and much more arduous task.

Unfortunatley, the separation of healthcare and beuracracy lasted about two days. Then the media did their best to confuse the two and make sure to say it enough times that it became true despite no evidence.

 

[Mirror Form]

Then what do you keep arguing about?

I'm arguing that from a patient care standpoint, OIF patients, both in and out patients, have been getting good care. Whereas the media portrays them as having poor healthcare.

 

[IgD]

I'm arguing that from a patient care standpoint, OIF patients, both in and out patients, have been getting good care. Whereas the media portrays them as having poor healthcare.

If by care you mean just the attention/treatment a patient gets during a scheduled appointment or procedure I would agree with what you are saying.

Unfortunately "care" has a much broader definition and encompasses accessibility to care (scheduling, appointment wait times, doctor messages), access to specialty care, conditions in medical hold, medical board processing, pharmacy wait times and availability of pharmaceuticals. There is no way that any reasonable person can conclude that WRAMC has all those things.

 

[R-Me-Doc]

If by care you mean just the attention/treatment a patient gets during a scheduled appointment or procedure I would agree with what you are saying.

Unfortunately "care" has a much broader definition and encompasses accessibility to care (scheduling, appointment wait times, doctor messages), access to specialty care, conditions in medical hold, medical board processing, pharmacy wait times and availability of pharmaceuticals. There is no way that any reasonable person can conclude that WRAMC has all those things.

While I often disagree with IgD, I think he hits the nail on the head here. Nice point; I think this about wraps it all up.

On another note, this can all be a big lesson in how you need to be really, really careful in choosing the words you use to describe something. Who wants to bet that if it was just called "Holding" or "Soldier Holding" instead of "Medical Holding," there would never be the problem of equating "bad housing" with "bad medical care." Perhaps the Army has dug it's own lexographical hole? Wouldn't be the first time . . .

X-RMD

 

[Mirror Form]

Unfortunately "care" has a much broader definition and encompasses accessibility to care (scheduling, appointment wait times, doctor messages), access to specialty care,

But this is where the media is still FOS. The OIF patients have plenty of access to care and especially access to specialty care. If an OIF soldier shows up at our front desk asking for a non-urgent appt, the expectation in my clinic has been that they're seen in 72 hours. That's pretty darn good. Now, there has a been a problem with some unfriendly secretaries telling oif soldiers differently. I'll admit that, but overall the access is good. Appointment wait times are a problem, but that's a problem across the board in teaching hospitals. I think we're worse dueto OIF and having been unable to hire much support. But long wait times are simply an inconvenience, nothing more.

conditions in medical hold, medical board processing, pharmacy wait times and availability of pharmaceuticals. There is no way that any reasonable person can conclude that WRAMC has all those things.

The long wait time at our pharmacy is also an inconvenience which is unfortunate, but is simply the result of socialized healthcare. I don't see why anybody is surprised by it. And it's been that way at most large military and VA pharmacies for eternity. As far as conditions and med hold and med board processing, those were definitley issues that needed to be fixed. But my point is that they aren't part of what typical healthcare is. They're army issues that the army leadership screwed up. Other than a few top administrators, it's not part of medical care. It's not what hospitals do.

 

[Galo]

If by care you mean just the attention/treatment a patient gets during a scheduled appointment or procedure I would agree with what you are saying.

Unfortunately "care" has a much broader definition and encompasses accessibility to care (scheduling, appointment wait times, doctor messages), access to specialty care, conditions in medical hold, medical board processing, pharmacy wait times and availability of pharmaceuticals. There is no way that any reasonable person can conclude that WRAMC has all those things.

Props Idg, I really think you're getting where we've been coming from for a long time. This is a keenly insightful statement, and one that I just do not think mirror form gets.

Mirror Form, you seem to be the only one offended by this scrutiny of Walter Reed. You may work there, and give 110% to your patients, and know others who do, but YOU alone are not the problem. There is no physician that can take care of all aspects of care an injured soldier needs, and that is the problem throughout military medicine. The support system is completely destroyed because of multiple reason, some of which are money, lack of trained staff, but the single most important one is POOR LEADERSHIP. I do not think anyone is attacking you. The mainstream media has just brought our for a brief review, (it will die down and things go back to normal soon), the problems that our soldiers are facing in getting and completing their care.

Although we did not have mold or rats at WP, I had no support to do my job the the best of my ability, and yes I think patient care suffered because of it.

 

[R-Me-Doc]

The long wait time at our pharmacy is also an inconvenience which is unfortunate, but is simply the result of socialized healthcare.

R-i-i-i-i-ight. "Socialized healthcare" is why Wal-Mart and CVS also tell me to come back in 4 hours for my Rx. Gimme a break.

X-RMD

 

[Chinorean]

Did anyone read the article in Newsweek about Walter Reed? I understand the idea of inaccurate reporting and media misrepresentation, but it seemed that there are a good deal of unhappy soldiers/veterans who are receiving poor care and being put on waiting lists to get an appointment. So for the people defending Walter Reed, are the interviewed soldiers lying?

 

[ExNavyRad]

Just out of curiosity, was this infamous Bldg. 18 once called the "Walter Reed Inn" back in the '90's?

ExNavyRad

 

[Ex-44E3A]

"Socialized healthcare" is why Wal-Mart and CVS also tell me to come back in 4 hours for my Rx

I can't say I've replicated that experience. I was at CVS two days ago, and they filled my Valtrex in 15 minutes flat (did I say Valtrex? I meant amoxicillin...).

 

[AF M4]

"I can't say I've replicated that experience. I was at CVS two days ago, and they filled my Valtrex in 15 minutes flat (did I say Valtrex? I meant amoxicillin...)."

Lol....I've got a buddy who works in a pharmacy who says they always push those orders to the front of the list. They don't want you to have time to use the bathroom.

 

[alpha62]

Here is the wounded warrior they've elected as their poster child....

http://www.cnn.com/video/partners/c...video/us/2007/03/09/simon.fort.lewis.care.cnn

 

[Whodathunkit]

I've wondered how this story was going to pan out. I've deliberately avoiding reading/listening to any of the stories. Until now. I just watched that video. It's no surprise that they were able to find a "poster child" to speak on CNN. A CHRONIC PAIN PATIENT. You want drama, you'll get it with those guys(er...gals).

I'm a new civilian physician working in a VA hospital. I chose to work in the VA. I am not an IMG who couldn't find work elsewhere. My license is squeaky clean. I could EASILY make twice as much in private practice than I could working here at the VA. So why did I join up? Sure, having medical malpractice taken care of is great. Not working till 8PM at night, and feeling that I have to cram as many patients into my schedule to make overhead is a good feeling. Ultimately however, it was my way of giving back to my country. My civil service(for a few years anyway).

So it's disheartening when you hear the media basically push all this propaganda.

Sure the VA system has it's problems. Yes, there is bureaucratic bull**** and paperwork-paperwork-paperwork. But in the end, I'd take working in this setting than a poor county hospital. The computer system(CPRS) that eliminates papercharting and allows me to look up records from a veteran from another state is awesome. A crosschecking-medication input system that alerts you to possible drug interactions and makes you double check drug dosing helps ensure patient safety. Overall, it is a system that many hospitals would benefit from mirroring in some aspects. But the media doesn't want to report on that.

The OIF/OEF veterans are treated like VIPs in our hospital too. They just show up, and they get an appt that another vet has had to wait 1-2 months for. Some do need our urgent attention, and some...well....they could have waited. I've had some that are legitimately injured and I try my best to get them the best care and enroll them in the system(as I do to ALL the vets), and there are some with just as vague(sometimes borderline somatisizing) complaints that I have no idea what to do with.

The VA hospital has promised it's veterans care. No matter what the issue. I have admitted patients that intentionally inject their legs with drugs and let them fester so that they can get admitted. I've had vets demand I treat their pain but refuse to acknowledge their substance abuse problems(and refuse a referral to an outpatient substance abuse program). I've had vets walk in the cafeteria and chit chat with their friends, but when they show up to clinic, they are in a wheelchair and writhing in pain. And despite all of this, I am required to treat them as I would treat any other vet. This is not private practice where you could discharge a patient from your clinic for noncompliance. So we do as best we can to deal with the medical(as well as psychosocial) issues. Which is not easy.

I, as most people in medicine, don't do their job so they can get a pat on the back or an expression of appreciation. It comes infrequently, but when it does, it really gives you a warm feeling.

The media is doing a huge disservice(and disrepect) to all the military and civilian providers in the VA healthcare system. And they should be ashamed at themselves for promoting such sensationalism.

 

[USAFdoc]

I've wondered how this story was going to pan out. I've deliberately avoiding reading/listening to any of the stories. Until now. I just watched that video. It's no surprise that they were able to find a "poster child" to speak on CNN. A CHRONIC PAIN PATIENT. You want drama, you'll get it with those guys(er...gals).

I'm a new civilian physician working in a VA hospital. I chose to work in the VA. I am not an IMG who couldn't find work elsewhere. My license is squeaky clean. I could EASILY make twice as much in private practice than I could working here at the VA. So why did I join up? Sure, having medical malpractice taken care of is great. Not working till 8PM at night, and feeling that I have to cram as many patients into my schedule to make overhead is a good feeling. Ultimately however, it was my way of giving back to my country. My civil service(for a few years anyway).

So it's disheartening when you hear the media basically push all this propaganda.

Sure the VA system has it's problems. Yes, there is bureaucratic bull**** and paperwork-paperwork-paperwork. But in the end, I'd take working in this setting than a poor county hospital. The computer system(CPRS) that eliminates papercharting and allows me to look up records from a veteran from another state is awesome. A crosschecking-medication input system that alerts you to possible drug interactions and makes you double check drug dosing helps ensure patient safety. Overall, it is a system that many hospitals would benefit from mirroring in some aspects. But the media doesn't want to report on that.

The OIF/OEF veterans are treated like VIPs in our hospital too. They just show up, and they get an appt that another vet has had to wait 1-2 months for. Some do need our urgent attention, and some...well....they could have waited. I've had some that are legitimately injured and I try my best to get them the best care and enroll them in the system(as I do to ALL the vets), and there are some with just as vague(sometimes borderline somatisizing) complaints that I have no idea what to do with.

The VA hospital has promised it's veterans care. No matter what the issue. I have admitted patients that intentionally inject their legs with drugs and let them fester so that they can get admitted. I've had vets demand I treat their pain but refuse to acknowledge their substance abuse problems(and refuse a referral to an outpatient substance abuse program). I've had vets walk in the cafeteria and chit chat with their friends, but when they show up to clinic, they are in a wheelchair and writhing in pain. And despite all of this, I am required to treat them as I would treat any other vet. This is not private practice where you could discharge a patient from your clinic for noncompliance. So we do as best we can to deal with the medical(as well as psychosocial) issues. Which is not easy.

I, as most people in medicine, don't do their job so they can get a pat on the back or an expression of appreciation. It comes infrequently, but when it does, it really gives you a warm feeling.

The media is doing a huge disservice(and disrepect) to all the military and civilian providers in the VA healthcare system. And they should be ashamed at themselves for promoting such sensationalism.

1. thank you for the job you do for our veterans
2. what do you think would happen to your clinic, and all other clinics like yours if you and all docs/staff were obligated to stay fro 4 years no matter how poor conditions got, and you had no say in how the clinic was run (in fact, not even invited to meetings)?
3. I believe the media is doing a disservice if they present the problems as being a problems with the nurses/docs.
4. The media is doing a tremendous service otherwise at shedding light on this important topic.
5. One of the only things our service SURGEON GENERALs have proven they manage well, is a COVER UP. They have managed to keep what the media is now showing a secret for 10 years.

 

[resxn]

1. thank you for the job you do for our veterans
2. what do you think would happen to your clinic, and all other clinics like yours if you and all docs/staff were obligated to stay fro 4 years no matter how poor conditions got, and you had no say in how the clinic was run (in fact, not even invited to meetings)?
3. I believe the media is doing a disservice if they present the problems as being a problems with the nurses/docs.
4. The media is doing a tremendous service otherwise at shedding light on this important topic.
5. One of the only things our service SURGEON GENERALs have proven they manage well, is a COVER UP. They have managed to keep what the media is now showing a secret for 10 years.

The only disservice I could see is not bringing this up. Sensationalism, whether appropriate or not in other (and most) situations, is necessary here if only to get momentum moving in the right direction. I welcome all the news stories sensation or not.

Those who are doing their best to provide care are not going to suffer for this. It's those that have prevented the provision of that care or failed to support it that will be eviscerated--and rightfully so.

 

[basicscikills]

The only disservice I could see is not bringing this up. Sensationalism, whether appropriate or not in other (and most) situations, is necessary here if only to get momentum moving in the right direction. I welcome all the news stories sensation or not.

Those who are doing their best to provide care are not going to suffer for this. It's those that have prevented the provision of that care or failed to support it that will be eviscerated--and rightfully so.

I understand the frustration with the way the media is reporting this story. Still, that's what the media does. It's a sensationalistic enterprise that's devoted to selling papers and garnering ratings. Unfortunately, the major media outlets have decided that the public isn't interested in the objective reporting of real news...witness the unbelievable interest in Anna Nichole Smith's demise.

I'm happy that attention is being drawn to the state of the VA and hopefully milmed in general, but wish it could be done in a responsible way. Sadly, the fingerpointing has already started on capitol hill and what we're likely to get is a big folder full of recommendations from committees that ultimately will fail to address the central problems: too much paperwork, lack of incentives for recruitment and retaining good physicians, and a system that's been gutted in times of peace and was in no way prepared for a time of war. I can only hope that doesn't happen and that mature, sensible discourse will take place that will produce an efficient and effective milmed system...wait, wait. I forgot we're talking about folks that can't go to the bathroom without posing for a news camera.

 

[alpha62]

Some how, I think the true vectors of this illness are going to escape....

Nurse Management types, MSC officers.

They're just like cockroaches.... they were here before us, they'll be here after us, they hide in cracks and corners out of the light... and they're immune to high dose radiation.

 

[megadon]

Congratulations you Army guys, you've got a new temporary surgeon general. A nurse! Guess it's back to the civil war days when the only qualification to be a battlefield doc was you were good with a hacksaw.