Jon Stewart and the VA

Yesterday, Jon, in his program The Daily Show, had as a guest the former Chief Technology officer of the United States.  Those who watch The Daily Show will know that Jon has been deeply concerned about the handling of veterans' medical issues by the VA.

I share that concern and I heard Mr. Chopra put forward some useful ideas.  It seems reasonable that having the various uniformed branches generate patient medical information in some standard format that the VA's systems could then read would go a long way toward streamlining the process of moving responsibility for the care of injured vets from military to civilian responsibility.

I think the problem goes even deeper, though.  The real problems lie in the definitions of things.  For example, everyone believes we (the US) share a common language with Great Britain.  In fact we do communicate pretty well and there are very few words that don't cross the boundary.  Sometimes though a word seems to be understood and it isn't until later that we realize there has been a breakdown.

"Let's have a look under the bonnet" (or in "the boot") for example, often cause confusion.  The need to climb a flight of stairs to get to a "flat" on the first floor might or might not be important.  These examples illustrate the flighty nature of words.  Sometimes they mean one thing and then they mean something else.

In health care, even within the civilian area in the US, the goal is always precision.  When one doctor reads a clinical note about a patient written by another physician, any confusion at all causes delay which can be life-threatening.  At a minimum, confusion causes additional expense when diagnostic work needs to be re-done.

You'll have to trust me when I say that I could start an argument in any group practice by asking for a definition of "patient."  When a physician is presented with a gaping wound or a missing limb there is no doubt who the patient is.  Farther downstream in the process, though, once insurers, administrators, lawyers, legislators, and "family" have become involved, there can be a lot of doubt as to who the patient is.

The VA is simply the one left standing when the music stops.  They haven't created the problem and they will not be able to solve the problem.  I doubt there is anyone in Congress willing or able to envision and create a solution.  After all, there aren't enough veterans to dictate the outcome of that many elections--are there?