Tuesday, December 15, 2009

VA Seeing More Female Patients--Stand By!

I debated whether to post this here or at the Navy blog I guest on; I decided to do it here because it is primarily an entitlement and government spending thing, with some Navy/military thrown in.

Here's a story from the AP that tells us that the VA's patient load is growing younger and increasingly female. This is--in and of itself--uninteresting, as the opening of many military roles to women in the 7o's-90's is now resulting in a greater number of females eligible for treatment in the VA medical system.

No--what makes this interesting to me is the application of my N=1, anecdotal experience with females in the military medical system. The bottom line--they are voracious consumers of medical care, and I hope the VA is factoring into its future planning considerations an explosion in the cost of caring for an increasing number of them.

I was the Operations Officer on a ship that went "co-ed" in 1995. We basically swapped out 50 males for 50 females--and those 50 females comprised approximately 1/7 of the crew. If my memory serves me correctly--we calculated after a year of co-ed operations that the 1/7 of the crew that was female accounted for nearly 40% of all visits to shipboard medical.

More anecdotal evidence....as CO of a Destroyer, I conducted "check-in" interviews with every crewmember, working my way through the entire crew in a month after taking over, and then seeing each new crewmember within 24 hours of their reporting aboard thereafter. Often times, they would show up with their medical records in their hands, as I was just a stop on a dizzying array of check in activities they had. It never ceased to amaze me how thick the medical records of my female sailors were. I spent 21 years on active duty and accumulated enough wear and tear to have the VA bestow upon me a fat monthly check for my deterioration--but at the end of it all, my medical record--the accumulated paperwork of 21 years of medical care--was about an inch thick. The average female second class petty officer (say, 5-8 years of service) would show up with a medical record much thicker than that--some went into a second file altogether.

Well--some of you may be thinking (and I hope you are, because it is good and logical), "they (females) shouldn't be faulted for seeking medical care when they need it. Guys are just dumb for not going to see the Doc when something ails them. " And to that, I would respond--right you are. I'm not faulting them. I'm trying to provide you with evidence as to why I feel this is a tidal wave that has yet to hit the VA, and it is something they are just going to have to plan for.


"The Hammer" said...

Well women have more moving parts, they have Aunt Flo show up each month and they seem to not mind being poked and prodded (thank God!). They also have a "I'm to be taken care of" mentality. Most men could have a lump on their testicles the size of a walnut and they'd say the hell with it, it'll probably just go away. When I can't pis anymore I'll go to the doctor.
What really gets me though is why someone could spend one hitch in the service and then be entitled to VA medical benefits for the rest of their lives. How dumb is that?

Anonymous said...

"What really gets me though is why someone could spend one hitch in the service and then be entitled to VA medical benefits for the rest of their lives. How dumb is that?"

That is one of the 'benefits' of service. Did you think that your pay was your entire compensation?

Sally said...

I think your post is a little sexist. After 21 years, my medical record was thinner than Joe Biden's hair and that included maternity care. Because the females on your ship ran to the doctor for everything doesn't mean we all do.

And speaking of entitlement/government spending, at the risk of making you mad, was the Navy the cause of everything that the VA awards you a fat monthly check for?

brekiver said...


"The Hammer" said...

Just for the record I was a citizen soldier (well citizen Army guy, not much of a soldier, I just fixed radios). I was paid a wage and I was given food and shelter. I got to see the World a bit at Sam's expense. Plus I got a stipend for college which was only supposed to be for 48 months but they actually gave me 54 months (you know, the 5 year plan).
I have no service related disabilities so why would I or others similarly situated deserve free health care on the tax payers nickel?

Anonymous said...

"why would I or others similarly situated deserve free health care on the tax payers nickel?"

You are missing the point here 'Hammer'. When you enlisted, part of your promised compensation was access to VA care. Had you not been promised the care as part of your contract, then your argument would be right on. However, it is a tangible and hard fought for part of your benefits. I really think it is funny when servicemen blow off their benefits and then complain about how poorly they were paid. GI Bill benefit I think is the largest one fore fitted. How many of your fellow Soldiers never had the Army pay for their education or at least as much as the Army would. It is YOUR benefit, as is access to VA care. Those taxes that pay for that benefit are your taxes as well and it is simply a part of your compensation. Read your statement of allowances one day. That funny piece of paper they give you annually claiming that you make far more than you see in your paycheck. It puts a monetary figure on these intangibles or harder to quantify parts of your pay.

Anonymous said...

"I think your post is a little sexist."

But why was the post sexist? What part of the post was sexist or claimed that female Sailors were less capable?

Sally your post reminded me a little of those who claim racism every time one makes a comment referring to non white people. Is every occasion men and women are discussed or contrasted or observed, 'sexism?'

I don't know the answer to that question, but I hope that it is 'no.'

Sally said...

Anon, I did not suggest that CW inferred that female sailors were less capable. How did you come to that conclusion? His post claimed that women were voracious consumers of health care and one of the reasons he believed that to be so was the weighty medical records of the females in his command. I was merely pointing out that was not true of all female sailors and I don't believe that we should all be painted with the same broad brush. I believe that it is sexist to do so.

Anonymous said...

"Anon, I did not suggest that CW inferred that female sailors were less capable. How did you come to that conclusion?"

Because, Sally, that is what sexism is. Sexism is the belief or attitude that one gender or sex is inferior to, less competent, or less valuable than the other. You used the term 'sexist.' I did not. You are the one that jumped to the assumption that CW was making a claim on the competency of female sailors, which clearly he was not. I do not think that you meant to infer this, but you threw the term 'sexist' into the mix, much as some throw to the term 'racism' around.

Sally said...

No, Anon. Do you have a name, by the way? Sexism is an attitude toward a gender, and CW holds the the attitude, the belief, that female sailors avail themselves more frequently of medical care. I challenged that, and that alone.

Anonymous said...

"Sexism is an attitude toward a gender"

What? Where did you pick up that obtusely broad and easy to misuse definition? By that definition I suppose by the very act of being able to differentiate between genders, one is automatically sexist.

Most women have longer hair than men. Is that true 100%? No. Is it sexist? No. By your definition though it is. You are using a club (the term sexist) to attempt surgery. You need a finer definition or usage of the term sexist for it to have real meaning.

Again, the same thing happens daily with racism claims. Jesse would have you believe that anything he defines as racist is racist. Using the threat of racism as a club, similar to you now.

The Conservative Wahoo said...

Sally--a couple of things:

1. I don't think I was being sexist. I think I was predicting an increase in the use of VA medical services based on 1. a greater number of women in the military and 2) an extension of anecdotal evidence gathered in my experience. You called me sexist--and to refute me--offered your own anecdote. Unconvincing. That said, there's a fairly rich body of research that backs up my anecdotal assertion--here's the abstract for just one ( http://www.jstor.org/pss/1816827)

2. I'm not sure the Navy caused any of the ailments I receive compensation for. Though they are referred to as "service related", it doesn't appear that there is a much of an effort to affix a malady to a specific job skill or activity--rather, if the malady occurs while you're on active duty, it's considered service related. It is a broken and expensive entitlement system--no doubt.

Ghost of Halloween Past said...

I don't think CW's assertion is sexist in itself.

Based on CW's long experience measuring the size of his file against those of others, he warns that it's not the increased volume of women vets (mentioned in the article) that the VA may be blindsided by, but the voracious appetites of all those women -- for medical care. I think the research bears out an increased use of medical care by women in general (primarily due to those moving parts issues, including pregnancy and prescription-based contraception).

Your anecdote is somewhat offensive, though, not because that assertion is based on sexism, but because it is a bit intellectually lazy and has a loaded phrase or two (went "co-ed"?) that slyly say "Sure, I'm a sexist bastard ... but I dare you to find sexism in what I'm saying RIGHT NOW, sugar muffin."

Had you included the research upfront, you might have slipped the offense by us fragile womenfolk. They say size doesn't matter, but we get so dazzled by those big numbers, you know.

In all seriousness though, I'm curious about your calculations on medical use shipboard -- I think that's pretty important data and I'm glad you were considering it: what came of those numbers? Did you swap in a female medical staff, change up the routine care to address those voracious appetites? Stock a whole different set of prescriptions?

I think the question is not only how will the VA manage greater volume of women in terms of increased visits, but what will they do to adapt to very different medical needs.

I remember my only visit to medical staff at Quantico, having broken my finger (I'd like to have a great story about breaking it while jumping or even while hauling an M60 into position, but instead I caught it in the van door returning from a squadron outing to the movies). I screwed up my courage to ask about contraception while being splinted(in theory, what if, just in case at some future date ...), was tossed a generic package of pills with no instructions (no pretty pink color coded circle), and somewhat flustered by my question about use, the doc told me to use them, obviously, only if I thought I was going to be sexually active. Sounded great to me, figured that whole package ought to last me for years ... if I someday needed it.

From a woman's perspective, great job on the finger, but sub-optimal medical care for women's health issues. I'd have hoped there'd been a whole lot of improvement in the past 20 years, but after reading in this story of the vet whose VA doc ran blood tests to check her (non-existant) prostate, seems little has changed.

A Seaman said...

It's "Bush's fault".

The Conservative Wahoo said...

GHP--I love the use of the word "offensive"--as if you might have to take to your sedan chair with a case of the vapors, having read my discourse on the delicate sex. But because I know you were a near-Marine, I know you're much tougher than that.

I shall not claim offense at your cleverly veiled "size" allusions, as, well, they were just plain funny.

But I will claim "offense" at charges of intellectual laziness. Guilty as charged--which is why I cited anecdotal evidence and a low sample size. Yes--I wish now that I had cited the literature first--because that might have kept dear Sally from branding me a sexist--but because I cited it prior to your writing, I have to wonder why it didn't dissuade you.

As for your curiosity about the numbers--what I can tell you is that no one cared. No one asked us to track the numbers--it was simply something that was tracked in "8 O'Clock Reports" (numbers only, not cases/names to protect privacy). Statistical analysis was pretty easy.

That said "big Navy" saw it coming I think, as our integration of females included a senior female corpsman (who was not a swap--she was an add, raising our medical staff from 2 to 3). Additionally, prior to the arrival of our new crewmembers, the medical department had to order/obtain a number of new items for its AMAL (I don't remember what this means--it was 15 years ago--but it was the listing of items required to be on hand) and undergo a thorough Type Commander inspection to ensure it was ready to treat female. I remember much of this because--probably due to my sexism or at least my offensiveness--I was the designated "WISO" (Women in Ships Officer) for USS VELLA GULF (CG 72) when we integrated (didn't realize going "co-ed" was an offensive term--but who can know what will offend the fairer sex). It is likely that my role as WISO leads to my retention of the medical observations I've made in this string. I might not have these insights without having served in this position of great responsibility.

So let me get to exactly what it was that was offensive in my statements. You seem to understand the increased NUMBERS in absolute terms, of women in the system. You seem to grant that on the average, women use health care more than men. Where dear friend, is the offense to be found in my having raised these issues in light of a story about the VA? Yes, the article mentioned the increased volume of female patients--but it did not mention the likelihood that they will require proportionally more care--therein ADDITIONALLY raising the expense of the veterans care system.

I like to think that one of the things this blog does or should do, is to look at stories and think about "what else" might be at play.

But if you took offense, I am obligated as a gentleman to apologize, as propriety would dictate it is YOUR perception of offense that is important, and not the actual existence thereof.

Anonymous said...

GHP: You have got to love 'Devil Doc' medicine. I would hope that you got an outlier but the fact of the matter is that having gone to the ER, you may have received someone who at the time had relatively little experience with female patients having arrived from a less 'coed' area of the Marine Corps. Quantico is about as 'coed' as it gets, so there is no excuse there.

AMAL: Authorized Medical Allowance List

CW: Your blog entry was interesting and probably on point. Especially now with the combining of VA and DOD hospitals (Great Lakes will be the first). I think that an overarching question ought to be 'have the VA and DOD powers that be looked at how the mission of the new MTC's will adjust as both accept new demographics of patients?' That women use more medical services to an age is true. But I think that the opposite is true at some point as we age isn't it. Don't men in fact require more medical care during their late years? I am not sure if on a cost basis those come out nearly similar or not, but I am sure I read that someplace. I'll do the research. Maybe that is sexist though and I'll have to go seek counseling.

WISO: "Women in Ships Officer"??? Sounds like you were trying to steal the old aviation tag for the Radar Intercept Officers or Weapons Systems Officers from multi seat aircraft. Get your own Acronyms surface Navy. :-)

"The Hammer" said...

Look I know the law says I'm "entitled" to VA health benefits, I'm just saying it's a dumb law. Remember what the Beadle in Dickens said, "If that's the law, then the law is an arse".
We were in the service, as in service to our country. We weren't giving up our careers, we were there to do our thing and then to get on with it. If we left the service healthy and happy it's crazy to obligate our fellow citizens to pay for our health-care in perpetuity.

The Conservative Wahoo said...

I agree with the Hammer...I am owed nothing but my retirement check (which is legislatively termed "deferred compensation"). All the other bennies--including the fat VA compensation--are things for which I am grateful, but for which I feel no entitlement. Not that I'm going to send the money back--I'm no idiot. But if they decided to hack at it or take it away, I'd quietly assent.

Ghost of Halloween Past said...

"Where dear friend, is the offense to be found in my having raised these issues in light of a story about the VA?"

Such gallantry, why I'm positively paralyzed with pleasure. No offense in the issues, as I mentioned, I think studies and facts bear out increased use of medical services - as Anonymous mentioned, up to a certain age.

What gives me the vapors, though (and I really need to try to call in sick with the vapors one of these days)is the unexpected vacancy of data, valid source, or effort to go past your anecdote until prompted by Sally in comments. I'd have liked your personal experience as a supporting or just plain old interesting tidbit livening up the data. If there were data.

Now, as a minor aside, although I think legal scholars agree that the somewhat anachronistic term "co-ed" should always be followed by a phrase like "sex kitten" "or "in a clingy sweater," and to me it harkens back to Seven Sisters students chanting "Better dead than co-ed," I was joking about the use of the term being a possible flag for sexism.

I love the thought that you were the "WISO," although I have some suspicion that somewhat was playing an elaborate prank on you with that designation.

Repairing to the settee, now.

"The Hammer" said...

I disagree with CW. He made the service a career. It's all opportunity cost, what could he have been doing while he was serving his country (yes Tom, impregnating half the women on the East Coast excepted). Career military earned the benefit, others did not.
VA hospitals are full of losers who spent just enough time in the military to get the package, got out and reverted to the scumbags they are. Unlike an economy, this is a zero-sum game. Every dollar spend on some drunken loser is a dollar not spent on the war injured and retired folks. Simple as that.

Mudge said...

All this brings to (my occasionally unforgivable) mind a tee shirt I saw last year in DC: "I'm not a doctor but I'll take a look at it"

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