Throughout the third year of medical school, I have rotated through several different hospitals, switching every few weeks. These hospitals vary in almost every way – from location, to patient population, to facilities, to culture. One of these sites is the Veterans Affairs (VA) hospital, where am currently rotating through. This site is unique place to rotate for several different reasons which I will touch upon.
Firstly, the patient population is obviously very distinctive. As the VA provides healthcare for patients who have served in the armed forces, the patient population almost exclusively consists of older men. There are few women and no children, which unfortunately means less diversity in clinical training. However, the patients who are at the VA are largely nice and respectful, often addressing healthcare workers with a “sir” or “ma’am.” An interesting thing to note is while the rest of medical world is moving towards, holistic, patient involved care, medicine at the VA seems more paternalistic. For example, when discussing a possible treatment plan with a patient one day, he asked me in a confused tone, “Why are you asking me? You’re the doctor, just tell me what to do.” This could possibly be a holdover from the military environment in which veterans are used to.
Another unique aspect of the VA is the common types of medical problems that are seen. Veterans often have a long list of co-morbidities when they enter the hospital – diabetes, hypertension, hyperlipidemia, coronary artery disease, and other conditions that stem from lack of health maintenance. Smoking and alcohol use is also incredibly common, and many patients are admitted for problems like pancreatitis, hepatitis, or COPD exacerbation as a result. Psychiatric issues are also very prevalent – given the circumstances of their service, PTSD and depression are common problems that veterans have to deal with. All of these combined make the VA a challenging place to work, but a good learning environment for these important issues.
Lastly, social issues are often very important and are commonly intertwined with the patient’s overall medical care. Many veterans that are treated in the VA are homeless or reside in VA sponsored nursing homes and rehabilitation centers. They also may have psychiatric or chronic medical problems as previously mentioned that require assistance after they leave. Therefore, a multidisciplinary team consisting of physicians, dietitians, physical therapists, and social workers often work with patients to make sure a discharge plan is ready for them by the time their hospital stay ends.