Damn. I missed the show. I need to find a taped copy. What do you mean by "untouchable" when you referred to residents?
My experience varied quite a bit from those of my friends who worked at various VA hospitals throughout the country. Most, if not all, VA hospitals are training hospitals so there are resident physicians there.
Where I trained, the facilities were excellent. The computer system was very modern, equipment was great and the doctors were the best in the state. These same doctors also rotated at the local med school hospital so they always kept up with the latest and greatest in medicine.
The resident physicians worked hard, too hard. There were always 1 or 2 bad apples amongst us but for the most part, these were good people. Unfortunately, we residents became very jaded. We used to kid around that our physician orders were only "recommendations" and that the nursing staff would only fill those orders if they felt like it. If we wanted to do anything right, we had to do it ourselves.
A couple things stood out. One night, I was on call and admitted a patient with significant ACTIVE gastrointestinal bleed. Because the ICU and step-down units were full, I had to admit him to the regular floor. I felt comfortable enough taking care of him there and checked in on him frequently throughout the night. At one point, I could smell the stench of digested blood the minute I walked by the room. I found him in the bathroom pooping out massive amount of blood. I checked his vitals and found him to be a little unstable. I immediately entered an order into the computer for him to receive a blood transfusion IMMEDIATELY. Just to make sure, I even told the nursing staff to transfuse the patient to avoid any delays.
Then I was paged to the ER to see some more patients. A few hours later, I had another resident check on the patient for me because I was still busy. The patient still had not been transfused. By this point, he was becoming very unstable. The other resident inquired the nurse if she had transfused the patient. She said no and that there were some mixups and she had informed me of it, which was a blatant lie. Once I learned of the mistake, I personally transferred the patient to the ICU and asked the ICU nursing staff to accomodate an extra patient. Luckily, the patient did ok.
I filed a complaint against the nurse but nothing was ever done about it, to my knowledge.
On another occasion, I was caring for this 80+ year old vet who had sustained a fractured hip. He was severely malnourished and too weak & depressed to feed himself. I asked the nursing staff and their assistants to assist the patient with his meals. Each time I walked in to check in on the patient, his food was sitting far from his reach and was left untouched. I voiced my complaints but to no avail. I ended up making the time each day to stand there and spoon-feed the patient. Bless his soul, he was such a nice man.
The main problem at this VA hospital was the sorely lacking INPATIENT ancillary services. Each nurse was taking care of 14-16 patients, twice the ratio of the local county hospital. The nursing assistants were a bunch of lazy dumbasses who really didn't give a rats ass about their patients. I don't blame the nurses at all, but the administration for overworking them and not providing them with the necessary support. Also, the social worker was lazy as hell and dragged her feet in trying to find placement for these patients at discharge.
The VA has a habit of hiring physician assistants to cut costs. Unfortunately, they seem to make a habit of hiring lazy people. Some of these bastards come into the hospital at 10AM and check out by 3PM, after rounding on 3-4 patients in the inpatient wards. We residents were pissed because these PAs were there to help us...instead, they didn't do squat.
The strong points of that VA hospital was relatively easy access to physicians. Appointments were easy to come by. Access to medications was also readily available. Procedures were promptly scheduled. Outpatient clinics were fully staffed.
I love my VA patients. Some of them may be crusty old men and many of them may have psychiatric and social issues. But for the most part, they were good patients, just as they were good soldiers, I presume. They were more motivated about their healthcare than the county patient population. And invariably, they treated me with dignity and respect as a person. It's really sad that the system that is caring for our veterans is so inefficient and flawed.
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