A while back, I used to do outpatient clinic at the VA and our clinic receptionist was possibly the worst receptionist I’ve ever seen ever.
I've done a lot of clinics in the last few years and dealt with a lot of nurses and receptionists... and for the most part, they have been pretty good. I mean, some have been great, some have been okay, and some have been not so great. But this woman, let's call her Hilda, was amazingly bad.
I don't know what her job entailed exactly because every time anyone asked her to do something, she replied, “That’s not my job.” Basically, every time I came to her desk, she was either chatting with patients or more likely chatting with a friend on the phone. When a patient arrived, we (the doctors) would call the patient out of the waiting room ourselves and bring them to the examining room. I guess she scheduled patients for regular visits, but she wasn't even allowed to schedule any of the EMGs, Botox, epidural steroid injections, or anything else because she was constantly accidentally overbooking patients. So we (the residents) had to do much of the scheduling.
She definitely didn't clean the examining rooms. When I walked into the examining rooms in the morning, they looked like a hurricane hit. There were dirty gowns strewn around the room, dirty tissue paper on the tables, dirty pillows on the examining tables. When I was 40 weeks pregnant, I had to change dirty pillow cases and put new sheets on the examining table for every patient I saw, because Hilda said “that wasn’t [her] job.” One of the rooms ran out of tissue paper to put on the examining tables and I asked her if she knew where more was, and she didn't. She'd been working there for YEARS and she didn't even know where the paper was for the tables?? I had to ask my attending to change the paper on the table.
Another resident told me a story about Hilda: he was doing consults in another part of the hospital, so he asked Hilda to page him if one of the clinic patients showed up. (We had a high no-show rate.) A patient showed up and Hilda just let the patient sit there for over an hour and didn't bother to page the resident or any doctor to let anyone know the patient was there. She said she “forgot.”
I remember there was one week when Hilda called in sick to clinic, and me and the other resident did the receptionist work. We basically just put a sign-in sheet near her desk and grabbed the charts ourselves. It wasn't any extra work whatsoever.
I have honestly never been in any other situation where the residents had to schedule their own patients, room their own patients, and clean their own rooms after every patient. But I guess it’s the culture of the VA that useless, lazy, or incompetent people can’t get fired. An attending at the VA once said to me that the only way to get fired from a VA job is that you’d have to make babies with a dead patient three times. The first two times you made babies with the dead patient, you’d just get a warning.
When sharing this observation, did he actually use the phrase "make babies"?ReplyDelete
I can't decide whether to be impressed or disappointed at that.Delete
Did conception actually have to have taken place, or was intent enough for a write up?Delete
In my training the best nurses and stuff were in VA outpatient clinic. When I started my job I often thought of those great people nostalgically. When I changed my job I still thought of these people nostalgically. VA culture is changing and improving. I know a doctor who was fired from VA for not doing her paperwork.ReplyDelete
I would have to say that my VA experience is the same as yours was, Fizzy. So many things that weren't their jobs to do. In clinics, they don't even do the vitals. Apparently it's a favor if they do vitals for you. Not that I think that doctors should rank above nurses, but it's very clear that there was a totem pole at the VA and we were at the bottom.ReplyDelete
Definitely at a large metro VA where the nurses do nothing. (I am so not a nurse-basher. Had a nurse catch an error of mine the other day - at another hospital - and I highlighted it, rather than hide it … I believe in partnerships). Part of that partnership should include nurses getting vitals on patients, say, over the course of maybe a shift or something … and then charting those vitals, not on the back of a piece of paper they then throw out and fetch out of the trash when you come and ask, for example.ReplyDelete
I do want to add … I'd rather take a step back and blame the system, not the individuals. our healthcare system has so many perverse incentives. Doctors do more tests when they make money off those than if they are salaried - this is proven. So many ways we have established doctors have incentives to line their own pockets. It's unfortunate but true (as a whole, not always individually and certainly not always consciously). Similarly the VA has some messed up incentives. I also saw some great nursing at the same VA. Not every individual is part of the problem and often these problems have systemic causes and it is on all of us to fix those and not just blame the individuals. (For example, lets figure out how to reward a good job and demote someone doing a bad one …) So anyway, was just feeling pretty negative about what I said because it's a system problem.ReplyDelete
Did we train together?! I trained at two VA outpatient clinics -- one receptionist was AMAZING and the other was Hilda to a T! Residents did the vast majority of scheduling and all the non-custodial room cleanup. I never even considered that she straighten a room since she did so little else.ReplyDelete
Sounds like little has changed in 30+ years..... your tax dollars at work, don't it make you proud?ReplyDelete
It's a weird dichotomy. Logistically, it seems to give better care than most places. EMR (and a robust one) before any other hospital, great continuity of care, a minimal amount of "we will care for you despite our inability to care for you" (for example, we would not start cases that would send patients to the ICU if there were no beds for them). On the other hand, the stereotype of VA nurses doing nothing but reading Cosmo at the nursing station was so prevalent that our Fuck You Brother, I've Got My Internship sketches had it prominently placed. Despite all the dysfunction, I would have (and many of my co-med students) killed to have landed a job there.ReplyDelete
The executive assistance for our CMO/VP of Medical Affairs is totally useless. She is always on the internet and doesn't help with any of the directors work, and most of them are doing her work for him since she is so incompetent. Hope she gets let go when he retires or is forced to move on.ReplyDelete
There is absolutely no way that Hilda has not been promoted to senior management by now.ReplyDelete
Never worked in a VA, but did work in a military hospital. I was the secretary/receptionist, which meant that it was my job to sign patients in, schedule patients, and do the administrative work the clinic had. I was neither trained nor credentialed to take vitals, and it wasn't my job to clean exam rooms (the techs did that). While painting the best face on it and calling it a misunderstanding as to what her job actually entailed, did anyone ever look at her job description? Her job may have been like mine - administrative, and that was it. On the other hand, she does sound lazy, and working with someone like that would have driven me up the wall.ReplyDelete