Readers of Tom Philpott’s Military Update column sound off.

Rx for Military Family Care: More Docs, Better Records

I am an active duty family physician based at Bassett Army Community Hospital, Fort Wainwright, Alaska, and nearing the end of a 15-month deployment in Iraq. I believe I have insights on solving problems mentioned in your article on military healthcare. Addressing three points, I believe, will have the greatest impact. I write primarily about the Army:

Number of physicians -- The Army alone is 100 to 200 physicians short of authorized levels. Most of the shortage is in primary care physicians, the ones who actually see patients, not supervisory positions which are almost always filled. The Army plays a lot of games with “programs” and “efficiency projects” to get more out of their physicians, but at the heart of it clinics and hospitals are very understaffed. Combine baseline shortages with PCS moves every two to three years and six- to 15-month deployments every two to three years, and you have the ultimate in inefficiency.

The Army needs more physicians to provide more stability for physicians and their patients.

Medical records -- The current military medical record system, while adequate for archiving information, is cumbersome and inefficient at point of care. It is most inefficient in places like Alaska where low bandwidth issues make retrieving old records difficult or impossible. There is a large learning curve for the medical record system, which means that new active duty physicians, reservist backfill physicians and new civilian hires have a prolonged period of inefficient work because they are learning the system. The military needs a simpler, more efficient medical record platform. I suggest something real easy, like Google documents.

Rising healthcare costs -- As healthcare nationwide becomes increasingly unaffordable, more persons on the margin of different systems gravitate towards the most affordable option, which if they are eligible is TRICARE and the VA health system.

If we have universal health care that includes military veterans and retirees, people will move towards physicians providing easier care access, thereby lifting the strain from TRICARE and military facilities.

Military physicians are committed, caring, diligent professionals. But we are overwhelmed by work demands, particularly administrative. Many of us are overwhelmed by the number of hours of work expected per week – an average of 80 at Bassett Army Community Hospital, for instance.

Attention to the above, while not easy, is likely to improve military medical care and access.

ERIC SCHNEIDER
Captain (P), Medical Corps, U.S. Army
Doctor of Osteopathy/Family Physician
Via e-mail

I have to agree with your recent column on military healthcare that more beneficiaries are going to private doctors because we are not getting the care that we and our loved ones deserve at military facilities.

In April 2007, my husband complained of tightness in his chest. A cardiologist at Brooke Army Medical Center in San Antonio ordered tests. Results of one showed he probably had a blockage in his arteries. However, no one from Brooke ever called with the results.

I happened to call my husband from my current station in Germany that weekend. He still complained of having chest pain. I told him to go to the emergency room if he didn’t feel well. Hours later I ran into a nurse at the clinic in Germany who asked how my husband was doing. I told her about the tests but that no one had called with results.

This nurse looked on the clinic’s computer and found results of the tests at BAMC. She could not give them to me but said my husband needed to be seen right away. He called this nurse in Germany to get the test results, and went to BAMC's emergency room. They immediately admitted him and activated the Red Cross to get me back. My husband had stents put in and spent several days in intensive care and on the telemetry floor.

A week later I went with him for a follow up visit to the cardiologist. My husband was still complaining of chest pain and was having a hard time walking because of shortness of breath. The military doctor basically said my husband would have to live with his chest pain.

I felt he should have a second opinion. This doctor said he could be seen at Wilford Hall Medical Center in three weeks. I felt something major was wrong and that my husband should be seen sooner. This doctor told me he would not authorize an appointment outside the two military hospitals, and TRICARE would not pay.

A family friend recommended a civilian cardiologist. This doctor realized right away that my husband was in congestive heart failure because he was retaining too much fluid. He prescribed lasix. Within 24 hours my husband was breathing easier. We paid for this cardiologist out of pocket.

Two months later my husband came back to Germany and now sees a civilian German doctor under TRICARE contract. I extended here primarily so my husband could continue seeing a private cardiologist. This doctor follows up on tests he orders. He has my husband come in twice a week if he is trying to regulate his medicine or doesn't think his pacemaker works right.

Military doctors should learn from civilian counterparts always to follow up on tests you order and that if something is puzzling you about a patient ask another doctor for an opinion, thus giving patients the best care possible.

NORA HERNANDEZ
Master Sergeant, U.S. Army
Via e-mail

My primary care is at the National Naval Medical Center, Bethesda, Md., and I could not be happier with my care.

I have cardiomyopathy. Dr. Mark Haigney is my primary cardiologist. I have his cell phone number and e-mail address. He and Erich Wedam spent hours on their day off working with my pacemaker and an echocardiogram machine, adjusting it for maximum output. They would do anything needed to keep my heart going.

I also had no trouble seeing Sarah Hatch as a physician's assistant and primary care provider when I need her. She is extremely efficient.

I always defend the military health system as the best system around, and I cannot thank these individuals enough for the care I receive.

ANNE GROVES
Arlington, Va.

Letters may be edited for clarity or length.  Write to Military Forum, P.O. Box 231111, Centreville, VA  20120-1111, send e-mail to militaryforum@aol.com or visit www.militaryupdate.com.