From: fulk@cs.rochester.edu (Mark Fulk)
Subject: Re: "Incompetent doctors"
Organization: Computer Science Department University of Rochester
Date: Wed, 9 Sep 1992 15:02:38 GMT

Aha, I see the old discussion of student health/military doctors is back!
Rather than expose my prejudices right away, I'll cite my impressions in
a number of institutions:

1. Student health, UNC-Chapel Hill.  Doctors seemed very good, if a bit
brusque.  I was a kid then, so not much of a judge; however, I'd note
that the SHS was located right next to the med school, and seemed to
be staffed with residents.

2. Student health, Rockefeller University, was the outpatient department
of the New York Hospital - Cornell Medical Center.  If you had the bad
luck to get cancer, Sloan-Kettering was across the street.

3. Student health, SUNY/Buffalo.  Probably the worst I've seen, despite
being located next to the med school.  Examples:  Gynecologist giving
STD diagnoses and Pap smear results to patients in a loud voice with
his office door open.  Several patients emerged in tears while we waited.
Another prescribing birth control pills by tossing a handful of different
packs over: ``see any you like?''  A third claiming that cervical biopsies
don't hurt, screaming at me for staying in the examining room to hold my
girlfriend's hand, and leaving off the statement of complications and
risks until after he was done, and we were leaving.  Dermatologists
would refer student patients to their outside practices, assuring that
insurance would cover it; it didn't, and a few friends of mine got stuck
with medical bills in the thousands.  At a state university, the students
aren't usually rich enough to pay these.  I actually picked up Blue Cross
on my own, so we could go to private doctors, after that.  It cost me
about $250/month (in 1982-3) to cover us (we'd gotten married in the
meanwhile).  I could afford this because my mother had just died, and
I'd inherited some money.

4. Student health, University of Rochester.  Pretty bad, from what I hear.
The front office staff and primary care doctors seem to be the problem.
If you get past them, the next line is made of Strong Memorial house
staff, and they are excellent.  The people who complain most bitterly
about UHS are graduate students with families.

I am also aware of an infectious disease case in our college; in this case,
a straightforward one of a disease that is regrettably becoming common once
again, UHS mischaracterized the case, undertreated it, and failed to carry
out its public health responsibilities.  As a result, more people became
infected, possibly with serious health repercussions in one case.  It took
the state and county health departments to get any sort of reasonable
response out of UHS, and even that response was anemic.

5. Public health service doctors, and Coast Guard medics, Governor's
Island CG base, New York.  First a note: Governor's Island is the
CG's largest base, with something like 8,000 personnel on board; that
is about 20% of the CG.  It is the headquarters of the Atlantic Area,
whose commander is the third-ranking officer in the CG.  (The Commandant
and Vice-Commandant are in Washington.)

Medical care was from doctors in the Public Health Service.  Some of these
were young people who were working off their obligations; generally these
folks were reasonable and competent, as far as I could tell.  I was lucky
not to have to deal with them very much.  Also some private physicians
(and a private optometrist) did a bit of work on the base, typically
on a weekly or monthly basis.

However, there were at least three PHS doctors who were clearly refugees
from the real world.  At least two were obviously alcoholics; they had
become fixtures at the O club.  The third disappeared periodically; the
last straw came when he was on duty, but didn't show for a patient having
a heart attack.  The medics did a good job for the patient, whom I saw a
few weeks later doing fine; and the fellow's wife was rumored to have been
relieved that the old so-and-so had the sense to disappear and not kill
her husband.  These three stick in my mind; I am sure there were more cases.
In particular, there was a rumor about a shrink that got hauled away in
a straight jacket; this is such an urban legend, though, that I doubt that
it really happened.

The CG medics were terrific, by the way.

6. Buffalo, NY VA.  I didn't know the main medical staff, but I knew the
people in rehabilitation through my wife, who was a speech pathology
extern there in 1982-3.  I was very, very impressed by these people.
My wife worked with stroke patients (mainly), and has since decided
that she prefers that work above all other in speech.  (Her thesis
was on cleft palate patients.)  When we can work it out, she will
very likely go on for a Ph.D. in neuropsychology.

I did know one VA resident (in internal) who mistreated his wife's cat
bite (I was supposed to be watching the cat when it bit her on the hand).
They were just leaving for Boston (for her surgical residency); on the
way, she became very ill.  The veins on her arm blackened; as a result
she needed surgery and had to delay the start of her residency for
several weeks.  The resident admitted later that he'd given her the
wrong antibiotic.

Evidently (please correct me if I've got this wrong, Ken) the usual
organism transmitted in domestic cat bites is Pasteurella.  The usual
antibiotics don't work with this organism; perhaps (I don't know)
it is gram-positive and the resident gave his wife penicillin.

(Actually, km, please do fill in the likely details.  I only got a sketchy
story at the time, and would love to know more.  I am pretty sure about
the Pasteurella, though.)

Obviously, this story has little to do with the care at the VA.

Mark
-- 
Mark A. Fulk			University of Rochester
Computer Science Department	fulk@cs.rochester.edu
Newsgroups: sci.med