The Department of Veterans Affairs Part II (Scheduling and Specialty Clinics)

     As in part one I will cover the topic as best as I can without going overboard. In this part I am going to cover the VA’s scheduling, speciality clinics and some ways these area can be vastly improved.
     If you actually survive the VA’s screening system and are rated to a point the VA is willing to provide you medical care you have to be assigned a primary care physician (PCP).  Most of the time this point is not a huge issue. The issue that we run into far more oft than not is that these doctors are so overloaded that it can literally take months to get in. There have been several times that I was really sick and needed antibiotics. When I called to get an appointment with my PCP I was told directly to go to the emergency room because they were unable to get an appointment for me. What really sucked about that is I’m already sick then have to go spend half the day sitting in the waiting room and the other half in a room waiting for the doctor. I often waited until 1 or 2 in the morning just so it would go faster.
     The VA also had many specialty clinics, i.e. dermatology, radiology, podiatrist and so on. Some of these clinics are outstanding. Others are absolutely horrible. They aren’t necessarily horrible because the doctors, residents and nurses are bad. It is more that it is next to impossible to get scheduled. I will give three examples. One good and the other two are absolutely ridiculous.
     Example number one. I had an EGD done in April 2014, that is a procedure where they shove a Canberra down your throat to see what is going on. This procedure takes about 20 minutes plus sedation and recovery. I was supposed to have a follow up EGD at the end of September because they didn’t like what they saw. Once I moved to Oregon in August I went to schedule the procedure and the doctors here decided it did not need to be done. About a month later I was in the emergency rim twice in 5 days because of severe abdominal pain. It took the VA another month to get me in to have the EGD done, then they didn’t sedate me well enough so I had a hard time and they did the procedure. Then they had to redo it.
     The VA is not all bad this story doesn’t reveal that however. I am Bi-Polar type 1, along with some other tags that psychiatrists have tagged me with over the years. I have been hospitalized, voluntarily, more times than I like to admit over the years. Without the VA hospitalization and my meds would be a nice thought; however, very unrealistic. You would think, since I have been in the VA system forover a decade now, that when I moved to Oregon I would be able to get refillson my medications until they found me a psychiatrist. When I went to the VA hospital in Portland to be assigned a psychiatrist and get a refill on my meds I was told that because I am new to the Oregon VA system that I would have to have my meds refilled and shipped from Salt Lake City Utah. That is absolutely ludicrous. The VA is a government agency so why aren’t they all on the same page. In November I admitted myself into the Portland VA’S psychiatric ward because I was nearly out of meds. I had no refills left. I also still did not have a psychiatrist. VA rules state after a hospital stay they have to get you an appointment with a psychiatrist within 30 days. Why on earth would this be the route I have to take to get the help I needed and asked for months before. The VA, the Secretary of the VA and President Obama all said they are hiring a bunch of new doctors, psychiatrists and psychologists to help lower the veteran suicide rates. When is this going to happen, 2055? Unfortunatelythis measure may help but it won’t fix anything. Whether you like this statement or not if someone wants to kill themselves they ARE GOING to do it. Anything sort of putting them in a straight jacket, an institution or both they will find a way. Oh and the suicide prevention hotline and the Portland VA psychiatric inpatient unit are a kin to a bad joke. I will cover that in the next part.
     The one good story I have, and given what is entailed in it, makes the other two stories look even worse. On the way back to Salt Lake City from Cedar City (southern Utah) I broke my ankle. They put me in a boot and on cruces then set me up with podiatry. I broke the same ankle again a few weeks later. After it finally healed they took x-rays and discovered that a lot of my ankle problems were a lot because of genetics. They said they could fix it by song a complete ankle reconstruction. What they did was cut the heel bone in half reposition it and put screws and pins in to hold it there. They also made and repaired some ligaments and tendons. They did this procedure to both ankles. I have to say it had made things much better especially since I love to be active and have kids. This whole experience with podiatry to fix this was fast, well explained and executed without a ton of hick ups or excuses why they couldn’t do it.
     The VA has some major problems that need immediate attention. On of the biggest problems I have is the fact that the various VA hospitals in this country are not on the same page it seems anywhere. For those patients that have medications that they have to take daily they need to be able to get those medications. Granted not all veterans move to different states; however, when I went to get my refills they have me a hard time about even getting a 10 or 14 day supply. One of my medications they didn’t even want to refill. So if a veteran goes out of state on vacation and forgets, looses or doesn’t have enough of their meds what do they do? With the specialty clinics the VA has got to provide an option to be seen outside the VA to ease some of the pressure off of the VA clinics. I had to have x-rays and a cat scan. I live almost four hours from the Portland VA hospital. They do not have a contract with anyone local so to get those images done I had to drive to Portland. My current psychiatrist abs psychologist are 105 miles from me. The VA developed the veterans choice program to help veterans that don’t have a clinic within 40 miles of them. You would think that my need for psychiatric care would qualify me to use this option. 105>40. They said I can’t use this profitable for my psychiatric care because the clinic that my primary care physician is at is only 15 miles away but offers no psychiatric services. Some sites have an option of meeting with your psychiatric doctors over Web cam at clinics. I am one who wants to have face to face conversation. Psychiatric care, one, is more comfortable and easier when you can deal with the topics you discuss in person especially with psychologists. Two, typically in person it is easier to know what is happening in the office and it is far easier to build the trust you have to have with your doctori n person. President Obama had an idea in the beginning of his presidency. He wanted to basically give veterans private insurance in lieu of the VA. I think the VA needs a lot of help. I believe, even with all the problems, the VA is a good organization and does benefit most of the veterans it serves. I also believe that I was wrong about President Obama’s idea of some kind of privatized insurance program for veterans to use when they have an issue that needs attention and the VA is telling them it will be a month, 3 months, 6 months or further away before the veteran can get help. More to come. Next up is the VA’s inconsistency in their inpatient care and the suicide prevention hotline.