Wednesday, April 21, 2010

Home Sweet Medical Home

I love the VA. I love the fact that I get off exactly at 4:30 pm and that I don't ever work any weekends or night shifts anymore. I am really digging the fact that the VA is about to make my life a whole lot easier.

The VA, as you can imagine, has fully embraced the concept of the medical home (cue angelic holy music). Granted, as one of the few working Americans left, I'm paying for most of this medical care anyway, but it doesn't mean that I'm bringing all my patients home with me. It means that thousands of dollars have gone to creating self-important planning committees and taking hundreds of VA employees to spend a week at the Venetian Hotel in Las Vegas (that's your federal tax-dollar at work!) Apparently I'm part of a "teamlet", which involves a medical provider, RN, LPN, and a clerk. Theoretically this means that the patient gets better care. In reality, it means that the patient is going to have even LESS access to his/her doctor. It means that we're going to have more nurses and non-medical trained clerks providing a "medical home" for the patient.

Isn't that sweet? I just want to know if I can also get an interior decorator on my team...

It means that instead of actually seeing your doctor in clinic, you'll now have the opportunity to have your checkup by telephone. IF you're lucky. More often than not, a nurse will be the one calling you with your labs and telling you not to even bother coming to clinic. Got a problem? Talk to the clerk. All of a sudden, I'm like the freakin' Wizard of Oz, which means that you're going to get a whole lot of "fluff and buff" and not much actual medical care by me. Good luck with that.

In the meantime, I'm thinking of hiring a shirtless pool-boy for my medical home as I sip on my organic acai berry cosmopolitan from my recycled earth-friendly martini glass.


  1. 4:30pm?????????
    your gettin screwed, all the VA docs I know are gear up by 3pm Max...

  2. welcome back Quix,

    but let me get this strait... his oneness (praise his name) comes out last year and tells people to stay away from Vegas... and you AND your staff get flown out there to stay at THE VENETIAN on the taxpayer dime (as opposed to something with a roach or two but a few hundred dollars a night cheaper) all to figure out how to implement a "patient care initiative" that puts NO RESPONSIBILTY on the patient and will allow for the hiring of more GS workers who don't work and can't be fired? good, that sounds great... i'm down.

  3. The first law of bureaucracy is to have enough people associated with any decision so that no one is responsible for a bad outcome.

    The beauty of a the "teamlet" approach is that standardized, computerized, money saving, medical policy will be administred by those layers of nurses and clerks. Any real medical problem will get to the doctor a bit too late to blame him. The nurses and clerks can't be blamed, because they don't know enough to be responsible for a bad decision. ("They did their best" excuse.) The only blame goes to "the System", which will be continually refined and improved by Panels in Washington D.C.

    There will always be a "supervising" doctor, to make this a Medical System, rather than the indifferent, rationing mechanism that is the real intent.

    Am I too cynical? I'm not a doctor, so what do I know.

    Easy Opinions

  4. nice take andrew,
    i was thinking about this Vegas boondoggle of the VAs and wondered if it would be possible to find out who was responsible. no, it would not be possible. i didn't think, however, that they would extend this courtesy to their doctors... wonder how it impacts on tort claims... oh wait, can't sue the government... hooray medical home!

  5. A colleague attended this... she said there were thousands of people.
    Can't decide whether this will result in more inappropriate consults to cardiology or less. Time will tell.

  6. I am one of those nurses in a teamlet already.
    We have the best primary care in the country, this medical home just makes it even better.
    At the VA, it is not that big of a change, at least not in my clinic.
    As far a Las Vegas goes (I did not attend)
    I think it was a great idea to help this get off to a good start. They probably negotiated the price down, and got a really good deal.
    The people who went worked their butts off and saw very little after the conferences. They should be thanked and commended for going!

  7. dear anonymous,
    don't break your arm patting yourself on the back. you are a shill.

  8. No one is prompting me to buy into the medical home. I can honestly say that the care I give in a VA primary care as a RN case/care manager is better than the care received by myself or other family members in non VA facilities.

  9. anonymous,
    i have no idea how to respond to that except that right about now satan himself is ice skating.

  10. Anon VA Nurse;

    Glad that your VA is working so well. I will tell you that everyone I knew who went to the Vegas boondoggle acknowledged that it was a complete waste of time and that they came away from it without any more knowledge than when they went. They should be commended for going to the conference?!? For what? Wasting taxpayers money on a conference that was worthless? If that conference was all-so-important and sooooo needed, then why did the VA decide to put ME on the only beta teamlet since I didn't even get invited to the "conference"?? (and I do use that term loosely). That's just classic government for ya. Invite some administrative types who don't actually SEE patients and then leave the actual work of trying to get the damn thing to work to someone who actually works for a living. And now we have "huddles" and meetings to talk about things that haven't been changed in the last 4 weeks. When one teamlet was asked to talk about their "progress" the quote was, no shit, "We're waiting for something from somewhere." Nice! That sums up the medical home. I'm waiting for something from somewhere to materialize and its like trying to find a secret map for a secret buried treasure that doesn't exist. Dr. Quixxote, medical home interior decorator