Open wound: privatizing the Veterans Health Administration (VHA)

After spending more than 30 years researching health care delivery and nursing in the American private, profit-driven health care marketplace, I decided to explore how the Veterans Health Administration (VHA) delivers healthcare to 9 million of the nation’s veterans. Although neither I, nor anyone in my family is a veteran, I knew that the VHA had made impressive strides in implementing healthcare teamwork and improving patient safety. I knew the system was more accountable than the settings in which I –a non-veteran– get my healthcare. I had, however, no idea how impressive the system really is.

Nearly five years observing and interviewing veterans, their families, and their caregivers, showed me how the VHA delivers excellent care –at far lower cost than is available in the private sector– to the nation’s most complex patients.

In Wounds of War, I introduce you to the veterans who receive this care and the dedicated employees who deliver it. I take you into exam rooms, hospital wards, therapy groups, homeless and legal programs, and even cooking classes where the VHA caregivers are interacting with their patients.

And you’ll find that while our broader healthcare system delivers fragmented healthcare services, the VHA is grounded in an integrated model.

It has perhaps the only functioning mental and behavioral health system in the United States and delivers high quality geriatric and end of life care, all while simultaneously addressing patients’ housing, employment, and legal problems.

True, we should all have this kind of integrated care; but it is critical to veterans. After all, military training and service places them at high risk for mental health and substance abuse problems, suicide, chronic pain, homelessness, and legal issues, to name a few.

The VHA has done something really rare in American medicine. Today, many hospitals may advertise team-based care, but will not spend their resources to teach people to work together. The VHA has devoted enormous time and energy to train employees to work on teams. You’d be surprised to find out that a veteran’s primary care provider will actually consult with his or her mental health therapist or orthopedist, social worker, dietician, or physical therapist in a face-to-face conversation –not only through notes entered into a shared electronic medical record–, in order to determine the best plan of care.

Over and over again, I am reminded how lacking this kind of integrated care is outside the VHA.

The other day, a friend who’d been suffering for years from back pain, consulted with a high- priced orthopedic specialist. The specialist peered at his X-rays and declared that he wasn’t a candidate for surgery. Maybe, the physician told my friend, PT would work, or chiropractic, or acupuncture, or even yoga.  Check it out, he advised, as he rushed on to his next appointment. My friend was on his own.

If my friend was a veteran, he would have been scheduled for a visit with an integrative pain team. He would have been helped to enroll in the kind of pain classes that significantly reduce patients’ perceptions of pain and enhance daily function. He would have been scheduled for physical therapy and even signed up for classes of yoga and mindfulness meditation. And all of this would have been coordinated by caregivers, not left in the hands of a vulnerable patient.

Plus, it wouldn’t cost the veteran one dime.

Today, President Donald J. Trump and Congressional Republicans are attacking and trying to privatize the entire system, rather than to improve and strengthen it. They are following the game plan of ultra right wing-libertarian billionaires like the Koch brothers, who have carefully crafted a narrative of a broken government-run healthcare system. Aided and abetted by some Democrats who fail to understand the promise and problems of the VHA, they have passed legislation like VA MISSION and VA Accountability Acts. These laws will outsource more VHA care to the private sector, starve the system of resources, close facilities, vilify VHA employees and shift billionaires of tax payer dollars into the hands of private sector hospitals, doctors, mental health practitioners, medical equipment companies, and even real estate developers.

That’s why I hope you will not only read Wounds of War but also join me and the veterans, healthcare reform groups, and unions that are fighting for the VHA. We owe it to the veterans who have sacrificed for their country to maintain and improve a healthcare system designed to serve their specific needs. And it would also be an important step towards promoting the kind of successful models of care that should ultimately be available to all of us, not just veterans.


For more information on Wounds of War and the VHA, listen to our latest #1869podcast:

 

About the author of this blog post: Suzanne Gordon is an award winning journalist and author who writes about healthcare delivery, health care systems and patient safety. Her last book, The Battle for Veterans’ Healthcare: Dispatches from the Front Lines of Policy Making and Patient Care was published by Cornell University Press in May of 2017.  She received the Disabled American Veterans (DAV) Special Recognition Award for her work covering veterans’ healthcare. Ms. Gordon is the Senior Policy Fellow at the Veterans’ Healthcare Policy Institute.

Open wound: privatizing the Veterans Health Administration (VHA)

“Celebrate life” with our #CCAM Cancer Crossings giveaway!

September is Childhood Cancer Awareness Month (#CCAM), and both politicians and healthcare professionals are calling for a “Cancer Moonshot.” Thanks to exciting work in checkpoint inhibitors, anti-cancer vaccines and immunotherapy, we’re making major inroads against a disease that impacts 14 million people across the globe every year.

Yet to have real progress, we need to remember the lessons of a small team of doctors who reached the pinnacle of cancer research a half-century ago. Nicknamed the “Cancer Cowboys,” this extraordinary group of doctors took acute lymphoblastic leukemia from a 100 percent death sentence to the 90 percent survival rate it has today.

Not that long ago few in the medical community dared to take on cancer. In the 1960s, pediatric handbooks had little to offer about possible care and treatments. The Cancer Cowboys decided this was unacceptable.

Even though they were sometimes ostracized by their peers, these doctors developed modern-day chemotherapy practices and invented the blood centrifuge machine, helping thousands of children live longer lives. And despite being at hospitals scattered across the country – Buffalo, Memphis, Houston and Washington, D.C. – these doctors gathered every few months, often after-hours at each other’s homes, to discuss their latest clinical trials and findings.

“Of course, this was before cellphones and video conferencing,” says Dr. Donald Pinkel, who founded St. Jude Children’s Research Hospital in Memphis. “So, it wasn’t easy. But we made sure we always knew where we stood with each other.”

The patients and their families benefited greatly from such efforts. My younger brother, Eric, was diagnosed with leukemia in 1966. Soon after he was admitted to Roswell Park in Buffalo, New York, my mother was told she was now part of his medical team. That this team extended from the doctors to the nurses to the families themselves. “I appreciated that we were all in it together,” she says. “That we needed to be to make any real progress.”

Throughout my career, I’ve been fortunate to write about many successful teams and organizations, including the 1980 U.S. Olympic hockey squad, the 1968 St. Louis Cardinals and Detroit Tigers. But none was as impressive as the Cancer Cowboys.

Today, many more hospitals and healthcare systems have joined the efforts to stand up to cancer in all its forms. Yet in touring the country in support of Cancer Crossings -my book that’s part family memoir, part medical narrative-, I wonder if today’s health-care community can be as united, as determined, and as accessible as the Cancer Cowboys once were. In the end, our hopes for another Cancer Moonshot may well depend upon it.

Click here to start reading Cancer Crossings FOR FREE, with our “Celebrate life” on #CCAM GIVEAWAY, and for the month of September only!

 

Celebrate Life

 

 


 

Also of interest: Check out author Tim Wendel’s interview on our #1869podcast for more information on Cancer Crossings: A Brother, His Doctors, and the Quest for a Cure to Childhood Leukemia, and the story behind this wonderful book:

 


 

About the author of this blog post: Tim Wendel is the author of “Cancer Crossings: A Brother, His Doctors and the Quest to Cure Childhood Leukemia.” Part family memoir, part medical narrative, his latest work is a valuable voice in Cancer Awareness Month.

 

“Celebrate life” with our #CCAM Cancer Crossings giveaway!

Be an Informed Patient this flu season

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Hopefully, you’re not dealing with the flu, but if you are, authors Sara L. Merwin, MPH, and Karen A. Friedman, MD, have some handy tips in their patient-centric book The Informed Patient: A Complete Guide to a Hospital Stay.

As we’re all seeing and hearing on the news at the moment, we’re smack dab in the middle of the worst flu season for some time. Bear in mind that the late fall and winter months usually have the longest wait times for a bed.  Continue reading “Be an Informed Patient this flu season”

Be an Informed Patient this flu season

Doctors at War – A Modern Nonfiction Update to M*A*S*H

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Cambridge Professor Embedded in Afghanistan Military Hospital
Explores the Courage, Compassion, and Comic Tragedy of Modern War

“There is a massive propaganda industry, embraced by all institutions from schools to the press and churches, that seeks to deny the stark facts de Rond chronicles. This is why the British Ministry of Defense did not want the book published. De Rond shines a light on a reality we are not supposed to see. It is a reality, especially in an age of endless techno war, we must confront if we are to recover the human.”
—Chris Hedges, author of War Is a Force That Gives Us Meaning

We weren’t supposed to read Mark de Rond’s new book Doctors at War.

A high-ranking medical officer in the British Ministry of Defense insisted de Rond write this book, and do so without fear of censorship. However, upon its completion, the ministry told de Rond it would oppose the book due to his exceptionally candid and true-to-life account of a trauma surgical team at work in the “world’s bloodiest” field hospital, Camp Bastion, in Afghanistan. Despite such pressure, Mark de Rond has chosen to publish the book.

Doctors at War tells of the highs and lows of surgical life in hard-hitting detail, bringing to life a morally ambiguous world in which good people face impossible choices, and in which routines designed to normalize experience have the unintended effect of highlighting war’s absurdity. Mark de Rond, a professor of organizational ethnography at Cambridge University, lifts the cover on a world rarely ever seen, let alone written about, and helps rebalance popular and overly heroic, adrenaline packed tales of what it is like to go to war. Here the crude and visceral coexist with the tender and affectionate, as do pleasure and guilt, kindness and cruelty, courage and cowardice, and the profound and pointless. In sum, it provides a unique insight into the lived experience of war from the point of view of good people forced to make difficult choices in an absurd environment.

Purchase Doctors at War today on our website and receive a special 30% discount. Use promo code 09CAU6.

For more information please contact Jonathan Hall: jlh98@cornell.edu

Interview with Mark de Rond:
Continue reading “Doctors at War – A Modern Nonfiction Update to M*A*S*H”

Doctors at War – A Modern Nonfiction Update to M*A*S*H