The Daily Item, Sunbury, PA

Gary Grossman

June 1, 2014

Doctors following orders

Once upon a time, I worked in a cubicle farm amid doctors and nurses who greatly admired the Veteran Health Administration for its innovative approach to patient safety.

I was a technical medical writer, but the others were medical people who supposedly could recognize professionalism and quality in the delivery of health care.

In those days, around the turn of the century, the VA was experimenting with bedside computers that could analyze the dosage and mix of medical prescriptions to avoid harmful combinations.

An explosion in drug therapy had long outrun the individual human being’s ability to master all potentially toxic combinations of the variables involved. A famous journalist had been killed by poor care for her cancer by a leading medical center. A health system out west had made a name for itself by producing a study that showed more Americans died from medical errors than from motor vehicle accidents.

Patient safety was a hot topic then.

One of my jobs was to help organize and write about a regional convention with national speakers, which would attract medical professionals because they could receive approved credits for continuing education and a decent lunch. Plus, the event broke even and fulfilled some requirement in a federal contract.  

So the VA’s approach was timely, promising and unexpected. For even then, the VA was not known as a destination for the best and brightest graduates of America’s top medical schools. To find that sector of health care delivery on the cutting edge of something progressive and promising was remarkable, and so people remarked.

Between then and now, there have been two wars, nearly a decade and a half of wear on aging veterans of previous wars and redefinitions of PTSD and Agent Orange health care eligibility. So the mystery of the VA slide backward is not without clues.

This is not to excuse falsification of data, mistreatment of the war wounded, the tragedy of death through neglect or any of the horrors that are making headlines these days.

But the shock, dismay and outrage being staged for the cameras are bundled reactions that must be less about revelations in the news than another instance in which Congress members deflect attention from having been caught doing what they do most, which is nothing.

Anyone mildly in touch with his or her district (or state) would have heard by now some tales of the struggle veterans have accessing their health care.

I have worked in a half dozen community newspapers and read maybe a gazillion more in this working lifetime. In nearly every one, I have found regular stories, calendar items and news briefs about the need for volunteers to drive vets to clinics, the difficulties of getting to hospitals, the long waits between appointments and other indications that the system is overworked, understaffed or otherwise whelmed by its mission.

I know it. Most of you know it. Almost everyone working in health care knows it. Public figures from mayors to council members to state representatives and honest members of Congress know it. There are decades of hearings, updated laws, expanded budgets and occasional inspections, some of which produced solutions that actually made matters worse.

In the weeks since the scandal of double bookkeeping among VA administrators broke, posturing has produced little in the way of understanding. There are hints that the resources were inadequate, the rewards were for data development and the verifications and validations were few.

What is not clear is whether the system was simply overwhelmed or that it had been overwhelmed for so long that it became benumbed to the effects of coping through deception. Possibly both.

Against such odds, it is tough enough to run an honest shop in civilian life, where people listen, adjust and accommodate.

By their nature, military organizations command results and punish failure. Communications include orders and obedience. Human beings attempt the impossible or die trying. Truth is among the  first casualties of war for a reason.

Before this VA scandal is swept to the back pages, is seems worthwhile to wonder if the way the military works is designed to sustain well being and tell the truth, two hallmarks of health care.

Gary Grossman is the publisher of The Daily Item and The Danville News.

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Gary Grossman
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