I've come to realize that the most interesting things that happen at the VA are things I can't talk about. Ethics and patient confidentiality prevent me from sharing the best stories.
Maybe when I am 80 and don't care what happens to me anymore, I'll release a book.
Suffice it to say, most veterans are fantastic people, and I have a genuine love for them. Just a few of them are crazy sons of bitches and demand more than they deserve. But it really is only a few. The overwhelming majority are people who should be honored, appreciated and thanked, and providing their medical care is the least we can do for them as a nation.
The government is mostly pretty good to work for. I could never go back to the private sector. The private sector is driven by greed and profit. At least at the VA, I am only driven by quality patient care. And the statsitics, but mostly quality patient care.
At this rate, I don't know if I will ever post on this blog again. But if you like literature, check out my other two blogs.
Friday, November 19, 2010
Thursday, July 8, 2010
Service Connections – VA Medical Care vs. Compensation and Pension
My posts on this blog so far have all been of a philosophical nature. This one is not. This is meant to be informative, and is written for the veteran who is looking to establish care with the VA, or to establish a service connection.
I often encounter confusion from the veterans regarding these issues. The VA offers both, and they are separate services offered by the same institution, at the same location. I can understand the confusion.
By far, the biggest and most expensive thing that the VA does is to provide ongoing medical care to our nation’s veterans. I believe we should. That is why I work for the VA. I believe in what I do. But the VA does a lot of other things, too; burials, home loans, college money, and granting service connected disabilities. It just so happens that the service connected issues are also run through the healthcare system, whereas other VA benefits are not.
I am family medicine trained and board certified. So I am a primary care physician for the VA. I am one of the front line generalists that the patients see for management of a wide variety of chronic and acute medical conditions. During the last four years of working here, I have had quite a few new patients come to me confused about why they are here. They thought they were here to establish a service connected injury or illness. That isn’t what I do, primarily.
If you have an ongoing illness or injury that you sustained because of your active military duty, you might be able to have that condition officially recognize by the VA as a “service connection.” In order to have the VA formally recognize a service connection, you have to go through a particular process. First you talk to a service officer. This may be though AMVETS, DAV, VFW, or any number of other veterans’ service organizations. Your representative form this organization will help you fill out and submit the necessary paperwork to initiate the process.
Once this is complete, you will be given an appointment to see a physician who will evaluate your claims. This is called a “Compensation and Pension” exam (C&P). It just so happens that I do these, too, although it is a small percentage of physicians who both provide routine medical care and are involved in the C&P process.
Ironically, quite a few times I have had patients come in for their C&P exam, only to find that they wanted and thought they were coming in to establish care for routine medical care.
After the C&P exam, all paper work is submitted to a board. The board decides the outcome of the request, not the medical provider.
Why would a veteran need to do this? There are a number of reasons. One is the claim my warrant a small amount of income. There may be compensation for some illnesses and injuries, depending on how severe they are, and how well you can prove they are directly as the restful of military service. Another is that it may help to qualify you for routine medical care. Yet another is that it may affect how much you pay for routine medical care at the VA, in terms of your copays.
If you are eligible for medical care through the VA but have not established yourself as a patient, call your local VA to find out how to become established. You will have to have an initial visit where you will be assigned to a PCP, and they will review your medical history, medications, give you a complete physical, and draw labs. This visit is called a “10/10.” Honestly, I don’t know why it is. I think it has to do with an archaic paper form. The VA medical records are entirely electronic at this point.
If you are a vet who is trying to establish care, or seeking to establish a service connection, and if you have an appointment pending, please make sure that you have the correct type of appointment. If you are looking to establish care, you need a 10/10.
If you are looking to establish a service connection, you need a C&P. these are entirely different exams, usually performed by entirely different people, and managed by mostly different systems.
I often encounter confusion from the veterans regarding these issues. The VA offers both, and they are separate services offered by the same institution, at the same location. I can understand the confusion.
By far, the biggest and most expensive thing that the VA does is to provide ongoing medical care to our nation’s veterans. I believe we should. That is why I work for the VA. I believe in what I do. But the VA does a lot of other things, too; burials, home loans, college money, and granting service connected disabilities. It just so happens that the service connected issues are also run through the healthcare system, whereas other VA benefits are not.
I am family medicine trained and board certified. So I am a primary care physician for the VA. I am one of the front line generalists that the patients see for management of a wide variety of chronic and acute medical conditions. During the last four years of working here, I have had quite a few new patients come to me confused about why they are here. They thought they were here to establish a service connected injury or illness. That isn’t what I do, primarily.
If you have an ongoing illness or injury that you sustained because of your active military duty, you might be able to have that condition officially recognize by the VA as a “service connection.” In order to have the VA formally recognize a service connection, you have to go through a particular process. First you talk to a service officer. This may be though AMVETS, DAV, VFW, or any number of other veterans’ service organizations. Your representative form this organization will help you fill out and submit the necessary paperwork to initiate the process.
Once this is complete, you will be given an appointment to see a physician who will evaluate your claims. This is called a “Compensation and Pension” exam (C&P). It just so happens that I do these, too, although it is a small percentage of physicians who both provide routine medical care and are involved in the C&P process.
Ironically, quite a few times I have had patients come in for their C&P exam, only to find that they wanted and thought they were coming in to establish care for routine medical care.
After the C&P exam, all paper work is submitted to a board. The board decides the outcome of the request, not the medical provider.
Why would a veteran need to do this? There are a number of reasons. One is the claim my warrant a small amount of income. There may be compensation for some illnesses and injuries, depending on how severe they are, and how well you can prove they are directly as the restful of military service. Another is that it may help to qualify you for routine medical care. Yet another is that it may affect how much you pay for routine medical care at the VA, in terms of your copays.
If you are eligible for medical care through the VA but have not established yourself as a patient, call your local VA to find out how to become established. You will have to have an initial visit where you will be assigned to a PCP, and they will review your medical history, medications, give you a complete physical, and draw labs. This visit is called a “10/10.” Honestly, I don’t know why it is. I think it has to do with an archaic paper form. The VA medical records are entirely electronic at this point.
If you are a vet who is trying to establish care, or seeking to establish a service connection, and if you have an appointment pending, please make sure that you have the correct type of appointment. If you are looking to establish care, you need a 10/10.
If you are looking to establish a service connection, you need a C&P. these are entirely different exams, usually performed by entirely different people, and managed by mostly different systems.
Saturday, July 3, 2010
Perfect Lives -- a National Change in Perspective on Personal Responsibility
I have had the unfortunate privilege to be a witness to a shift in our nation’s perspective of personal responsibility. I have had the great pleasure of knowing and taking care of hundreds of WWII vets. These old men and women almost invariably have an attitude that nobody owes them anything. I can change their blood pressure medicine and they are disproportionately grateful that I took the time to care, or that the government is willing to spend an extra penny a day, literally, on this new dose. I have guys from WWII with disfigured faces and missing limbs, who as sure as they live and breathe, believe that this was a price worth paying to defend their country. They are still not asking what their country can do for them.
Fast-forward to today’s veteran. Don’t get me wrong; I appreciate the risks and sacrifices that these young men and women are making; going to war in deserts to try to keep us safe from terrorists, in wars that no one can really prove are making a difference (albeit we all hope they are). I mourn, too, for the lives that are lost. But there is a big difference in the attitude.
Seriously, let’s compare these two scenarios: 1. A man is willing to sacrifice his life, his limbs, his future with no expectation whatsoever of compensation. 2. A man is willing to make the same sacrifices with the full expectation that if anything happens to him, he will be taken care of for the rest of his life.
Who am I to criticize? I am grateful for the men and women who go to war for us. I never joined the military, because I never wanted that kind of a risk. Ironically, I am a bit of a pacifist, although I firmly support national defense. But seriously, the magnitude of those two sacrifices are not the same.
Does that mean that I don’t think we should take care of our injured? No, not at all. I whole-heartedly believe that if we put our young men and women in harm’s way, then we owe it to take care of them. It is one of the reasons I chose to work for the V.A. The troublesome issue is the attitude of the recipient.
The majority of the young men and women coming to the VA as new vets are smart, hard-working and earnest individuals. Unfortunately, it is my experience that the expectations have changed. Whereas 98% of the WWII vets expect nothing, about a third of the new young veterans expect everything. They can have minor ailments, such as an annoying persistent tendonitis, and expect disability, or demand an MRI when it is not indicated and would serve no purpose. I have old guys in their 80’s who have never asked for a thing in return for major injuries, and young guys who want the world for minor ailments. The new vets are often late for their appointments, or don’t show and expect speedy treatment anyway.
It’s not just the veterans. This is reflective of a broader change in our national thinking. It’s a lack of personal responsibility. Got chronic back pain? Go on disability -- why work? Something went wrong? Sue somebody. Nothing should ever go wrong. Nothing should ever go wrong with your life or your health. If it isn’t perfect, then it is somebody else’s fault. And if it is somebody else’s fault, then get a lawyer.
I hope that this trend changes. If we continue to think this way, it will be our downfall. We must be responsible for our own actions. Everyone should feel compelled to contribute to society, to do at least some kind of work. We have to stop demanding that our lives be perfect.
Fast-forward to today’s veteran. Don’t get me wrong; I appreciate the risks and sacrifices that these young men and women are making; going to war in deserts to try to keep us safe from terrorists, in wars that no one can really prove are making a difference (albeit we all hope they are). I mourn, too, for the lives that are lost. But there is a big difference in the attitude.
Seriously, let’s compare these two scenarios: 1. A man is willing to sacrifice his life, his limbs, his future with no expectation whatsoever of compensation. 2. A man is willing to make the same sacrifices with the full expectation that if anything happens to him, he will be taken care of for the rest of his life.
Who am I to criticize? I am grateful for the men and women who go to war for us. I never joined the military, because I never wanted that kind of a risk. Ironically, I am a bit of a pacifist, although I firmly support national defense. But seriously, the magnitude of those two sacrifices are not the same.
Does that mean that I don’t think we should take care of our injured? No, not at all. I whole-heartedly believe that if we put our young men and women in harm’s way, then we owe it to take care of them. It is one of the reasons I chose to work for the V.A. The troublesome issue is the attitude of the recipient.
The majority of the young men and women coming to the VA as new vets are smart, hard-working and earnest individuals. Unfortunately, it is my experience that the expectations have changed. Whereas 98% of the WWII vets expect nothing, about a third of the new young veterans expect everything. They can have minor ailments, such as an annoying persistent tendonitis, and expect disability, or demand an MRI when it is not indicated and would serve no purpose. I have old guys in their 80’s who have never asked for a thing in return for major injuries, and young guys who want the world for minor ailments. The new vets are often late for their appointments, or don’t show and expect speedy treatment anyway.
It’s not just the veterans. This is reflective of a broader change in our national thinking. It’s a lack of personal responsibility. Got chronic back pain? Go on disability -- why work? Something went wrong? Sue somebody. Nothing should ever go wrong. Nothing should ever go wrong with your life or your health. If it isn’t perfect, then it is somebody else’s fault. And if it is somebody else’s fault, then get a lawyer.
I hope that this trend changes. If we continue to think this way, it will be our downfall. We must be responsible for our own actions. Everyone should feel compelled to contribute to society, to do at least some kind of work. We have to stop demanding that our lives be perfect.
Wednesday, June 9, 2010
The Unseen Costs of War
I understand the need for any nation to defend itself, to protect its borders. I am not opposed to self-defense. I think it is important to support the men and women who volunteer to serve bravely in our national defense, whether or not you believe in the reasons our politicians send us into war. That is one of the reasons I work for the VA.
That being said, I don’t think anyone really can comprehend the full cost of a war. I wish someone would account for the entirety of what it costs us as a nation before we go to war. I wish someone would pick a war, any war, and in retrospect count everything that it had cost us to engage.
And what are the costs of war? Well, there are the obvious; the financial expenditures. The manpower, the training, the equipment, the high tech weaponry, ships, jets, tanks, and so on. Transport is expensive. Feeding and housing the troops requires a large constant cash flow, and who knows how much administrative costs there are to keep track of everything?
How about the costs of international relations? Is America better off globally after a war? Do we cause too many other nations to hate us? Do we cause just the wrong nations to hate us? Or do we gain important allies, gain the trust of the international communities? Do we improve or degrade our potential for international trade, for peaceful relations?
How about the costs of human lives, and how do you measure that? How do you value that? The loss of sons and daughter, mothers and fathers. Brave, strong, smart men and women.
Obviously, what I see that a lot of people don’t is the medical costs of war. Certainly, there are incalculable costs of medical treatment at the battle field and in recovery. But what about the costs of the years and decades of treatment?
Decades of treating diabetes caused by agent orange, leading to amputations and early onset heart disease. Decades of treating PTSD and the loss of that person's productivity. I am still treating WWII vets. That means you and I as taxpayers are still paying for WWII. I studies history, I understand that WWII changed our world, I understand that we had to do it, and I know it was worth it. But I'll bet most people don't consider that we are still paying for it. We are still paying for it as long as VA doctors are seeing WWII vets.
I see millions of dollars of loss in terms of ongoing medical care, and I am only one doctor. It doesn’t take a PhD in sociology to expand from there and see the loss of contribution to society due to serious medical or psychiatric illness as the result of war. A women that might have discovered the cure to cancer, a man that might have been the next Thomas Edison or Steve Jobs. If only.
People who could have contributed to the work force, to education, entertainment, invention. Lost to illness. What of these loss of wages? What of this loss to their family? Loss of stability and confidence. Loss of a strong father to raise his sons, to be an example. Men and women with PTSD who struggle to make human bonds with their families. What is the cost to a family over the decades, and how does this affect our children?
How can anyone count these losses?
I know that sometimes war is necessary. But we need to be in it only when it is. I'm not sure our nation is better off for war. I'm not sure humanity is better off.
That being said, I don’t think anyone really can comprehend the full cost of a war. I wish someone would account for the entirety of what it costs us as a nation before we go to war. I wish someone would pick a war, any war, and in retrospect count everything that it had cost us to engage.
And what are the costs of war? Well, there are the obvious; the financial expenditures. The manpower, the training, the equipment, the high tech weaponry, ships, jets, tanks, and so on. Transport is expensive. Feeding and housing the troops requires a large constant cash flow, and who knows how much administrative costs there are to keep track of everything?
How about the costs of international relations? Is America better off globally after a war? Do we cause too many other nations to hate us? Do we cause just the wrong nations to hate us? Or do we gain important allies, gain the trust of the international communities? Do we improve or degrade our potential for international trade, for peaceful relations?
How about the costs of human lives, and how do you measure that? How do you value that? The loss of sons and daughter, mothers and fathers. Brave, strong, smart men and women.
Obviously, what I see that a lot of people don’t is the medical costs of war. Certainly, there are incalculable costs of medical treatment at the battle field and in recovery. But what about the costs of the years and decades of treatment?
Decades of treating diabetes caused by agent orange, leading to amputations and early onset heart disease. Decades of treating PTSD and the loss of that person's productivity. I am still treating WWII vets. That means you and I as taxpayers are still paying for WWII. I studies history, I understand that WWII changed our world, I understand that we had to do it, and I know it was worth it. But I'll bet most people don't consider that we are still paying for it. We are still paying for it as long as VA doctors are seeing WWII vets.
I see millions of dollars of loss in terms of ongoing medical care, and I am only one doctor. It doesn’t take a PhD in sociology to expand from there and see the loss of contribution to society due to serious medical or psychiatric illness as the result of war. A women that might have discovered the cure to cancer, a man that might have been the next Thomas Edison or Steve Jobs. If only.
People who could have contributed to the work force, to education, entertainment, invention. Lost to illness. What of these loss of wages? What of this loss to their family? Loss of stability and confidence. Loss of a strong father to raise his sons, to be an example. Men and women with PTSD who struggle to make human bonds with their families. What is the cost to a family over the decades, and how does this affect our children?
How can anyone count these losses?
I know that sometimes war is necessary. But we need to be in it only when it is. I'm not sure our nation is better off for war. I'm not sure humanity is better off.
Thursday, June 3, 2010
Vietnam Veterans – Kindred Pain
Over the past few years I've noticed that Vietnam veterans tend to identify with Iraqi veterans. Now that the conflict in Iraq is winding down, I am not seeing this as much, but during the height of our involvement in the war in Iraq, I would get frequent inquiries from Vietnam vets about how the Iraqi vets are doing.
Are they having PTSD? Are they coming back ‘messed up?’ Are they getting the help they need? What sorts of medical problems are they coming home with?
This is an interesting phenomenon for a lot of reasons. One is that the Vietnam vets are not a group that has traditionally projected their feelings and experiences to other groups of veterans. They have a tendency to keep their own suffering to themselves and as a result, are not known for reaching out to other generations. Not that they lack empathy; it just that their extra dose of empathy towards the Iraqi soldiers is noteworthy.
Why is this? Is it because both wars were so wildly unpopular, and the Vietnam vet has so many unresolved issues in regards to this? They were so poorly treated when they returned, do they worry about how the Iraqi vet will be received when they return home? Is it the similarities in the wars; not knowing where the next guerrilla attack from the jungle will come out of, not knowing when the next IED buried in the sand will blow up your convoy and set you up for an ambush? Thus, the Vietnam Vet feels a special kindred to the nature of this war.
I think all of these play a role.
Vietnam is not an era we look back on proudly as a nation. Unfortunately, there are a lot of similarities between these wars. It is likely that in the decades to come, we will not look back with national pride on the Iraqi war. I’m not here to argue one way or another on whether we should have gone to war with Iraq in this Millennia. That’s history now. And I certainly do not claim that we did not/do not need to wage war on terror. I’m just saying that some of that national self-doubt is present in this war, as it was in Vietnam.
I also don’t mean to stereotype all Vietnam vets. There are many different personalities and problems to the Vietnam vet, and they do not all fit in a box. In fact, I will probably write a post on it down the road. But there are some patterns and generalities I am in a special position to notice.
Maybe this outreach to the Iraqi vet will be therapeutic for the Vietnam vet.
I am glad that we learned as a nation, that even if we hate the war, we do not hate the soldier. I’m glad their homecoming is different from the homecoming of the Vietnam vet, and I am pretty sure the Vietnam vet is glad of that too.
Monday, May 31, 2010
The WWII Vet
When I started at the VA four years ago, half my day was filled with seeing WWII vets. These days I am lucky if I see one per day.
These are the men and women of my father's generation. Well, mostly men, but I actually do have a couple female WWII vets. I even have two married couples from that era. Well, I used to. Unfortunately, I've recently lost the husbands. This happens when your pushing 90.
I have the greatest respect for these fellows. They changed our world, you know. They made our modern America and our modern world what it is today. Sure, it is all changing again, but this foundation from which things are changing is thanks to the WWII vet.
I've heard so many stories from these guys, stories that are a part of history, stories that could make movies. I've had survivors of the Battle of the Bulge, survivors of the Normandy invasion. I have patients that helped free Jews from Nazi concentration camps.
I have one fellow that tells me the story of how he was stationed in Hawaii when the attack on Pearl Harbor happened. He was on a different Island at the time. He saw wave after wave of Japanese planes flying over head, and he had this sudden dread, he knew exactly what was going to happen. He didn’t have any communications available, and he could do a thing about it.
Can you imagine how horrible that must have been? I can't get my head inside that. To see these planes over head, to know they are about to bomb your countrymen. To know that this will certainly pull you into a war. To not be able to do a dammed thing about it.
I have one patient who was a survivor of the wreck of the Indianapolis. The ship was bombed by the Japanese after the treaty was signed. The attacking vessel didn’t know that the war was over. Most of the people on the Indianapolis were killed, but there were several survivors who drifted on debris, waiting for rescue.
My patient tells me about another fellow near him who slowly went nuts over the ensuing hours and days. The other fellow starting hallucinating, seeing bottles of clean water under the ocean. My patient kept trying to talk sense into the fellow, but he just couldn’t do it. The other fellow would repeatedly work himself up into a fervor about the hallucinated water bottles, and dive down to try to retrieve them. This continued with increasing intensity until one time the fellow never returned from his dive.
I feel privileged to hear these stories from these old guys. These are stories that shaped our world. These are stories that are rapidly fading from live memory.
I am honored to hear what they have been through.
The Motivation of the VA Doctor
Memorial day seems like a perfectly appropriate day to begin this blog
I have to say that working for the VA, practicing medicine for the VA, is the most rewarding career I have had. I spent two years in private practice, and two for an HMO. I've been with the VA for four years now. The personal rewards for practicing for the VA far outweigh the other venues.
I feel better about what I do, here. I am not driven by outside sources to make money. Because when you work for the private sector, even in private practice, this is what drives your day; making money. At the VA, front-line doctors like myself are driven by quality outcomes. How well controlled are our diabetics, our hypertensive? Are our CAD patients on the right meds? These are the things that are measured in our practice, and these are the things our bosses come down on us for if we miss important measures.
No one cares if I make any money, because quite frankly, I don’t. It's government funded. I can't pad my salary.
Personally, I think the consumer gets a better deal this way. Quality of care is the number one driving force in my daily work, not profit.
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