Friday, June 20, 2014

The VA & PTSD TX: So what's it to be today?

Anyone who knows anything about organization, and I'm talking everything from closets to corporations here, knows that you need to have a plan, be consistent and check on your follow-through. Right? So, doesn't it make sense that when you are a major US Government arm charged with treating military personnel for one of the most pervasive and disabling of injuries, Post Traumatic Stress Disorder (PTSD), you should be hyper-organized? I am, of course, referring to both the Veterans' Administration and the Department of Defense.

Excuse me, but who's in charge at the VA and DoD and what DO THEY DO to insure efficient daily functioning with measurable outcomes? Does anyone know how to input data into their computers, run a decent algorithm and come up with something that actually increases their odds of doing it right? No?

Reading that the VA actually may function much like a rag tag group of corporate robots in uniform is disheartening, indeed. Our military, whether active or retired, deserve better and they have a right to be screaming at the top of their lungs about this travesty of medical incoherence called the VA medical system. And while we're at it, let's not forget the role played by the Department of Defense (remember when they called it the War Department?). Don't they oversee, in some way, the incredible expense ($3.3 billion annually) of these purported therapies that dole out tens of thousands of medications (with little regard for side effects and interactions, it seems) and therapies?

We are now being told that these two entities function as though they are semi-friendly neighbors who don't exactly share family recipes or peeks into the checkbook.  Aren't they supposed to integrate their services and maintain active communication to insure the best quality bang for these big bucks? Apparently not.

Forgive me if I compare it to something I've seen in my own professional career. How about working at huge psychiatric hospitals where each unit uses whatever type of psychotherapy the psychologist in charges wishes? Ah, so on one day you get a hefty dose of analytic therapy, and a "friendly visitor" (aka unregistered analyst student), another unit you are transferred to is totally rigidly behavioral (the psychologist was rigid as well), another is more CBT (cognitive behavioral) and the third is out to lunch in terms of what should be used so she just used whatever struck her as fun at the time. She just had them dragged, literally, into group on any given day.

Want to give your patients with schizophrenia a beer once in awhile? Okay with that psychologist. Another thought a bit of reality would be good, so she took patients home to clean her house and they thought she was wonderful.  Where was the person in charge of either this department or the hospital in all of this? Well, he just wanted the halls to be clean and, if they were, he was completely satisfied or out playing basketball for promotions. Yes, that happened, too. Great way to run a hospital.

How does anyone use a therapy without knowing whether or not it's working or even causing more damage to the patient? Wouldn't you think there's something missing here in terms of management? How can anyone sit in Congress and not have a staff member charged with watching how inefficient things were over at the VA?

After having treated thousands of patients with PTSD, what does the VA believe is the best treatment for the large majority of them? Do they have any idea? Any data? A good algorithm? Where are the programmers needed for this? Sure you need medical staff, but if you turn them loose without a good manual for treatment and training, how good can they be? How accountable are the chiefs? Is this still being swept under the carpet? How was this permitted to go on for so long and who bears the ultimate responsibility here? Don't just throw someone under the bus; find out how to fix it.

How bad is this rampant infection we call VA health care for PTSD?  How do you do anything without measuring its outcome? Simply cleaning the rug in your home has an outcome you can measure and that sure beats treating someone for PTSD. I love the language they are now using. They are using "quality metrics" (nice term, don't you think?) and they have a "series of clinical outcome measures" (which ones?).  Who developed your quality metrics and outcome measures? I sure hope it wasn't someone at either the VA or the Department of Defense. Their skills and dedication, at the moment, are seen as being on shaky ground when viewed through the perspective of prior performance.

Keep tuned to the antics and let's see what really happens. And let's hope veterans groups keep the pressure on because lord knows our military need their support in this.