In Firm Health: Diagnosing UHS

The University Health Services (UHS) is in a peculiar situation.

UHS offers one of the most comprehensive medical programs available to students in the United States. Among its services, UHS offers a 34 bed infirmary, health care in gynecology, obstetrics and urology, and other services which are not available usually to university students.

UHS also has a very qualified staff, with many of its physicians gleaned from acclaimed medical schools or hospitals. The UHS staff includes several graduates from the Harvard Medical School, as well as teachers at the school. One UHS physician is a surgeon at Brigham and Women's Hospital in Boston, while another is a physician at Peter Bent Brigham, a highly respected hospital in Boston.

Seemingly, this should make students feel that UHS is a very qualified, safe place to go for health care. And some students are very satisfied with UHS. Some claim that they receive as good care there as they do from their own doctor at home.

However, there is also a significant portion of the population that thinks UHS is slow, impersonal and does not offer good medical treatment. For all its credentials, some think UHS is not a first-rate health service.

"It isn't established enough," says Pamela L. Nava, a student in the Graduate School of Education.

"It seems like they have mediocre people there," says Michael J. Conboy III '87.

Some students say they wouldn't trust UHS to treat them if they had a complicated disease. "If I were drastically ill, there is no way I would go there," says Leslie J. Messineo, a first-year student at the Law School.

And finally, UHS is the occasional the butt of student jokes. "The story here is that no matter what cold you have, you are going to receive one of two things from UHS: two aspirin or a cane, if you're lucky." says Shannon B. McNulty '87.

UHS officials assert that their health care is among the best in the country and that most student complaints are only directed towards one of the services which UHS offers.

Problems with the Walk-In Clinic

That service is the walk-in clinic.

In the walk-in clinic, UHS patients can come in whenever they like and see a doctor sometime that day. No appointment is necessary, and patients rarely see the same doctor twice even if they go in several times.

Since the walk-in clinic sees approximately 40,000 patients a year, and approximately 170 every day, some patients have to wait a long time to see a doctor. And when they do see a doctor, they are not always going to get the most intimate treatment. This is why UHS hears complaints about impersonal service, and long waiting times, say UHS officials.

In a 1983 study of waiting times, UHS found that the average waiting time in the walk-in clinic was 27 minutes. But some students complain of having to wait much longer.

"I resent having to wait an hour and a half every time I have to go to get a small check up," says Lisa M. Ginet '86.

In another UHS poll done in 1983, service at the walk-in clinic scored a much lower satisfaction rating than service in other UHS departments.

UHS officials claim that they have never encouraged use of the walk-in service, if a patient can get a personal physician instead.

"The walk-in clinic is not the best place to get health care--especially if a person has a long time illness," says Director of UHS, Warren E.C. Wacker.

"We have always said, on page one of the UHS information guide: Get yourself a personal physician instead of going to the walk-in clinic all the time," says Dr. Sholem Postel, deputy director of UHS.

Doctor's Office Hours

Postel says that UHS is now developing a system which will encourage patients to get their own personal physicians instead of just using the walk-in clinic for their health care needs.

The plan is called the Reserve Time System and, under it, doctors have to reserve some part of their working days for patients who call up and want an appointment as soon as possible.

At its best, patients should be able to see the doctor 48 hours after the call. After seeing a doctor once in his office rather than the clinic, UHS officials think the patient will be more likely to return to the same doctor the next time he feels sick.

The final product should be better patient care at UHS, officials say. "The person who has a doctor here is apt to find very satisfactory medical care, as opposed to the person who just uses the walk-in clinic," says Postel.

Postel says that, since UHS started using the Reserve Time System last June, attendance at the walk-in clinic has declined 20 percent. This coincides with a decline in the number of complaints UHS has received about waits in the walk-in clinic.

The program hasn't been fully implemented yet, so officials hope to see a greater drop in walk-in visits. Postel also expects that, as the numbers of patients in the walk-in clinic declines, the reputation of UHS will rise.

"I think a lot of people who are dissatisfied with UHS go through the walk-in clinic only and only have an impression of it, whereas UHS has much more to offer," Postel says.

Money for Service

What UHS has on top of the walk-in clinic is a huge facility servicing about 175,000 patients a year, not all of them students. Many Harvard staff and faculty use UHS.

Students pay a flat fee in September to use UHS for the whole year. The fee was $325 this year and will rise to $350 by next year, according to Helena E. Hart, financial officer to UHS.

A student who pays the fee can use UHS whenever he wants, and he is covered for most health services for the whole year. He will only have to pay for some medical work done at UHS. He will have to pay for dental work, and for some optometry services.

A student can decline to pay the fee and opt for medical care at some other health service or at a private practice if he wishes.

In 1984, the student fees brought in over $2 million to UHS while the fees paid by the faculty and staff at Harvard, which are matched partially by Harvard University, came out to nearly $5 million.

This large amount of money enables UHS to offer a lot of the services which are generally missing at other university health systems. "Most other university health services just have a walk-in clinic, and that's it," says Wacker.

UHS, on the other hand, offers dental service, mental health service and orthopedics service, among other things. And it is this wide range of services which Postel thinks people will appreciate when they discover that UHS is more than just a walk-in clinic.

A Bad Experience?

However, there are still some students who complain that the delays and the impersonal service at UHS are not their main concern. They say the problem is the health care the doctors provide.

Some students either have heard bad stories about UHS or have had bad experiences there which have convinced them the place does not serve sound medical care.

"I have heard bad rumors about the place. I trust them for minor illnesses, but for more serious stuff, I don't think I'd go," says Betty Knapp '86.

"My roommate last year went into UHS complaining that he had chicken pox. The doctor told him that the last thing he could possibly have was chicken pox. And then he contracted the worst case of chicken pox that UHS saw all last year," says Richard F.F. Nichols II '86.

"Freshman year, I broke my ankle," says a Harvard student who asked not to be named. "They took an X-ray, and they said I had no fracture. I could see the fracture in the picture, and they told me there was no fracture. So I took the X-ray to another doctor, and he put me in a cast for six weeks."

Accounts like these have an affect on the people who hear them and cause distrust of UHS's services.

"We serve a closed community here at Harvard," says Patient Educator Kathleen M. Kniepmann, "and when someone has a bad experience, word spreads about very fast. If a person hears a bad story, he may very well decide, 'Well, I'm not going to go to UHS for my health care.'"

In response to some of these "horror stories," director Wacker says that UHS receives some of its best compliments for the care it provides for its patients who have more serious illnesses than those usually treated in the walk-in clinic. He refers specifically to the Stillman Infirmary as a UHS service which receives very good compliments.

"If the walk-in clinic is our worst foot, then Stillman is our best," says Wacker.

Wacker also says that some people get disappointed with UHS because they expect a doctor to tell them exactly what their illness is, when a doctor often cannot be sure what disease a person has.

Catching Mono

He refers specifically to mononucleosis as a disease which takes a long time to positively identify, even though it may make a student feel a little sick at the outset.

"A million times I've heard the story about kids who visit UHS before Christmas and complain they have mono. The doctor at UHS does not find it. They go home for Christmas break; the disease has had time to develop, and their doctor at home finds it. Then they come back here and say 'UHS missed my mono,' when that just isn't the case."

Wacker also says that doctors occasionally do not see fractures on X-rays if the fractures are very slight, but that as the break heals, calcium forms over the break and reveals the fracture more plainly. This explains why one doctor might miss a fracture, whereas another doctor, who sees a patient a while later, may tell the patient that he has been walking around with a broken limb for a while.

In addition, Wacker says that thought many students say they won't go to UHS if they have a serious illness, they wind up going there anyway and are often pleased with the service they receive.

Wacker also notes that UHS was one of the first health services to offer a patient advocate--an administrator whose duty is to receive, investigate and report on patient complaints.

Postel says that he and Lisa Chertkov '85, the patient advocate, review all the complaints that UHS has received every week. Postel says that in the last six months, the worst complaint UHS has received has concerned two prescription errors which were corrected and in which the patients involved were not injured.

Finally, Wacker notes that UHS has invested a lot of money to make UHS a good health service. "I think we have one of the best health services in the country. You know, after all, it is Harvard," says Wacker.