More Modern Facilities Brought UHS Problems Of A More Subtle Mode

WHEN Dr. Dana L. Farnsworth was appointed director of University Health Services in 1954, Harvard was not a safe place to get sick. The medical facilities were centered in the decrepit Hygiene Building on Holyoke St., a structure which had been acquired from the Spee Club in 1931 which had partially burned down.

A patient who arrived on a busy afternoon found only standing room available, and the standing overflow blocked the passage of nurses carrying supplies. The whole thing looked like Durgin Park on Saturday night.

Doctors and nurses sent messages from one floor to another on an antiquated dumbwaiter. Laboratory technicians had to huddle in the center of the lab because the inadequate lighting cast shadows in the corners. Offices and consulting rooms were not much bigger than closets, and flights of twisting stairs separated the registration desk, the offices, and the surgical ward. In surgery, instruments were sterilized in an old "potboiler" that resembled dining hall washing machines.

Today, Harvard's Health Services are generally recognized as the best in the nation, and--if the number of speech invitations is a reliable index--Dr. Farnsworth is the nation's leading college health administrator.

Dr. Farnsworth has built up a medical complex which serves as family doctor, hospital, Board of Health, dentist, and friend on a lonely night to over 12,000 students a year--including Law, Business, and Medical students. Beginning with a staff of 20 in 1954, he now has 144 doctors and dentists, 33 nurses, 87 full-time staff and 21 part-time employees.

In addition to the obvious chores of treating mononucleosis, broken limbs, and exam-period nervousness, UHS involves itself in research, fire prevention, radiation control, psychiatry, and vocational guidance. It has worked out a comprehensive insurance plan which protects undergraduates every day of the year, and is one of only two schools in the country--the other is M.I.T.--to extend its medical facilities to University faculty and employees.

Winding stairs have been replaced by Holyoke Center elevators. The laboratory is modern and well-lit, and instead of antiquated apparatus for emergency care there is equipment which even some big city hospitals don't have--such as the Pacemaker acquired in 1965.

Standing and Waiting

But UHS is not free of problems. The standing and waiting of 13 years ago has been replaced by sitting and waiting at the walk-in clinic today. The overcrowding is especially serious in psychiatry, where students complain they have to wait months for an appointment.

The most vehement and colorful complaints are aimed at emergency care and diagnosis. One student says he went to UHS with an infection in his inner ear which had destroyed his sense of balance. He was dizzy and could not walk straight, but the doctor said nothing was wrong and sent the boy home. But the student refused to leave, primarily because he physically could not manage it. He was finally treated.

A scared freshman entered UHS early last year, slowed by fatigue. The doctor he saw told him nothing was wrong and added that he ought to stay out of Stillman Infirmary if possible or he would find himself far behind in his work. The freshman complied, and spent a vigorous day in classes and Lamont. The following morning, he lay in the Infirmary with a collapsed lung.

Despite the accumulated lore, UHS has only been sued once in the last 15 years. A medical school student sued the University because he lost his eyesight when doctors were trying to save his life from a serious infection. The case was settled out of court.

UHS's legal responsibility to students is exactly the same as the responsibility of any doctor or hospital to its patients. The $95 medical fee--paid by all undergraduates as part of tuition--is purely a financial responsibility, like a private insurance policy, which protects the student in case of injury or illness whether or not he is at school when it occurs.

Dr. Farnsworth recognizes the overcrowding problem but there is not much he can do about it. It is the dilemma of the administrator who does not control unlimited funds. But, Dr. Farnsworth quickly points out, no patient ever has to wait to see a psychiatrist if he is deemed an emergency case--that is, if he has become psychotic.

No Other Walk-In Clinic

The UHS director admits that students do sometimes wait a long time in the walk-in clinic. But, he adds, almost no other health service has a walk-in clinic, which means you must go to the desk and register for the next available appointment slot. "Waiting in our clinic is certainly an improvement over that," he concludes.

Even as UHS adds personnel, overcrowding seems inevitable because more people use the various services more often each year. In 1965-66, there were 47,068 visits to the Medical Services, an increase of 3333 over 1964-65. The number of visits to Stillman Infirmary increased very little, but the Emergency Service handled 5850 cases--about 700 more than the year before. There were 1200 more surgical visits, and a 20 per cent increase in the total number of psychiatry patients. Coping with this growth is more difficult than it seems, because the rate of growth is highly erratic. In the Medical Services, for example, the increase was 3333 visits this past year, but only 647 the year before.

WHILE more students are using UHS, more are also using outside hospitals--the number was up 36 per cent last year, most of whom were surgical patients. Of course, the Health Services is not equipped to handle all medical cases and these will naturally be treated in other Boston hospitals. Furthermore, UHS does not offer to its students a great variety of specialists. There is a regular staff in dermatology, since skin problems are so prevalent among college-age people, but for most special treatment a student must go elsewhere.

Although students "expect everything from UHS," as Dr. Farnsworth says, it simply is not economically feasible to offer much specialization in the Services. UHS, nonetheless, tries to employ at least a few doctors with knowledge of each major area of specialization.

Economic unfeasability is also the reason why UHS has dropped the obligatory medical examination upon entrance to the College. According to UHS's report to the President which will be released in April, requiring the examination only of athletes and students who will be working does not seem to be having any harmful effects. Illness gets diagnosed, either by voluntary visits to UHS or by examinations elsewhere.

As UHS has grown from what Dr. Farnsworth called an "abominable" setup in 1954 to what he now says is "the most imitated and studied College Health Services in the country," its problems have naturally changed in character. Instead of the adventures and dangers of starting a new health network, Dr. Farnsworth now faces the more sophisticated, if less dramatic, problems of maintaining a going concern.

"As our diagnostic facilities grow increasingly complex," Dr. Farnsworth explains, "it becomes more difficult to maintain the warm, friendly relationship between student and doctor."

"We're determined to keep it personal," he emphasizes. Dr. Farnsworth is the creator of the giant complex of men, machines, and buildings which is the University Health Services. But he is also a psychiatrist, author of many books on student problems, and a genuine interested-but-not-pushy father figure, who prefers talking about young people to talking about the headaches of administration. And he wants to keep his baby from turning into a Frankenstein.