Thursday, March 19, 2020

My Experience with Military Health Care

This morning, I want to describe some of my experiences with the military health care system.  While these may sound pretty negative, I want to emphasize that I was almost always very happy with the care provided once I got in to see the right specialist.  All of the people were nice, helpful (as much as the system allowed), and appeared very professional.

I'm a retired Lt Col in the Air Force.  I was an engineer, so all my experience was with stateside clinics or hospitals.  I've used TriCare Prime since retiring.  That means I'm assigned a local military hospital or clinic and must get all of my care (other than emergencies while traveling) from that facility.

First of all, you have to see a primary care 'physician' to start addressing any medical problem.  Most of those visits are now with a nurse practitioner that is not a physician.  The primary care person will refer you to a specialty clinic if they think you need it.  The referral goes into the system, and you are supposed to be called within 72 hours to schedule an appointment.  I'm told the rules say the appointment must be within 30 days of that call.  My own experience is that is more like 5+ weeks now.  If you need an MRI, CAT scan, or x-ray, you generally have to make another appointment for those.  Labs and pharmacy are usually walk in, once a provider has entered the request into the system.

While I was active duty, I didn't use the medical system a lot.  I think I had molars and one or two minor issues.

But I do remember one situation.  This was after the country was saying we were over-prescribing antibiotics and we needed to cut back.  Apparently, the military told their providers to minimize use of antibiotics.  I went in to the military clinic at their morning sick call after two weeks with a serious cough.  I was coughing up green nodules of mucus about 2/3 of an inch in diameter.  I kept one to show the doctor.  But I didn't have a significant fever.  He claimed that meant no bacterial infection and thus no antibiotics.  He gave me a prescription for cough medicine.

Well, it got worse for about a week and a half and then I went into the emergency room.  They gave me antibiotics and it went away in a couple of days.  I've never again gone into primary care for any kind of cold or flu.  Maybe I got a loser, but I suspect not.

After retirement, I found out through a routine PSA check that I had cancer.  I took the surgical route and have been cancer free since.  There were some side effects of the surgery that they had to take care of.  While the system was a bit slow, I was very happy with that care.

Now I'll get to a recent (year and a half ago) bout with vertigo.  I was on a camping trip, luckily only about 3 miles from the car.  The world spun and I could hardly walk for a day and a half before we came out early.

By the time I got to the emergency room, half a day later due to distance.  I was just unsteady.  They were able to reintroduce the world spinning with some head movements, and tried a maneuver.  They sent me home with advice to get to primary care within 72 hours.  Well, primary care had an opening about 7 days later.  They listened to me, did some checks for a stroke (every doctor during this period did checks for a stroke) that showed nothing, and put in a referral for an ENT visit.  That one was relatively fast at only about a three week wait.  So a month after the bad episode, I got to see someone who knew about vertigo.  During that month, I had some minor bouts, but was slowing improving in steadiness.

At ENT, they did the stroke tests, then some head maneuvers to see my reaction.  Of course, it didn't spin that time.  So they put in a request for an MRI of the inner-ear canal system.  That delay was only about 3 weeks, but then another 3-4 weeks after before I could get back into ENT.

They told me the that the MRI was negative.  Did some more stroke tests and head maneuvers.  I told them about the balance issues I was still having and some very mild spinning episodes.  They sent me home with some instructions on how to resolve vertigo with home head maneuvers.

I did some research on my own and found out there was a series of tests that could be run.  So I called in and asked if I could have them done.  The doctors so far had said they didn't know what caused my vertigo.  They set up the tests about two weeks out.  Then another month to get back in to ENT to discuss the results.

Basically, they told me the tests showed one side of my head had a 30% degradation in its balance capability.  And they referred me to a neurosurgeon.  They also referred me to physical therapy.

That took another month, and a bunch of calls to TriCare, as he was off-base.  He saw me and put in a referral for another, more extensive MRI of the neck and brain.  That took more weeks to get and to get back into the surgeon's office.  He showed me the results and said nothing appeared to be wrong.  He recommended another visit in a year.

So 9-10 months after the event, and 3-4 months of unsteadiness with the occasional spinning world, my vertigo experience was over.  I had found out that on one side I had a slight balance issue. Note I have never fallen other than a couple of times on the trail in slippery stuff.  And other than this period, I've never had balance issues.

My take away is that in most cases, doctors don't have a clue.  They are well trained, knowledgeable, and professional.  If you have a standard problem with obvious symptoms, you are good.  But the system cannot move fast enough to get you to a specialist while episodic symptoms are still severe.  Cancer, of course is different, as it doesn't usually go away.

I had 10 months of waiting for appointments that never determined what caused the episode and never provided any relief from slowly disappearing symptoms.  I do think the physical therapy helped as it stressed my balance system and allowed me to regain my confidence.

My wife has had a different kind of experience.  She has asthma, allergies, and gets periodic infections as a result.  She seems to have about a 50/50 opinion about her doctors.  Some she says are idiots and some she likes.  She seems to have to go to the ER to get antibiotics as she cannot get seen soon enough at her primary care when she gets an infection.  She's had a strong cough now for quite some time, and they cannot fix it.  I won't go any further, but she too doesn't think much of the military health care system.

The reason I went through all of this is to point out the drawbacks of a Medicare for All or single-payer government run system.  Care is rationed, no matter what you think.  And you won't be happy waiting for over a month or several months when you have a serious problem.  And you also won't be happy that doctors are forced to follow government guidance (on medicines and tests) on how they treat your problem, whether they agree or not.

Please take my advice.  Don't vote for anyone advocating government run health care.

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