UHS Care Sound, Despite Fears

Early on a Tuesday morning last December, Richard Lee '96 had a very rude awakening.

Fast asleep in his third-floor room at 29 Garden St., Lee rolled off his bed and broke his jaw on a roommate's chair.

"My proctor called up UHS and they told me to sleep it off," Lee says. "But my proctor looked at me and I was in shock, so they brought me in anyway."

Lee says a doctor in the University Health Services' (UHS) urgent care clinic told him they couldn't handle the situation. So he was transferred to the Massachusetts General Hospital, where his jaw was set. Later in the day, Lee went back to UHS, where he spent the night.

On Wednesday, while still on morphine, Lee was discharged from UHS. But despite the morphine, his pain persisted and the left side of his head throbbed. He returned to UHS on Thursday, only to be told he had an ear infection that had nothing to do with his broken jaw.

But as Saturday approached, Lee realized the pain might be too severe for him to fly home for winter break. On Saturday morning, he went to UHS again where he received an injection of Demerol, a potent narcotic painkiller. He was given more morphine and was handed a Valium pill to take on the plane.

The triumvirate of drugs nearly knocked Lee out, but he made it home to his doctor--who said his jaw had been set poorly and was putting pressure on his ear.

"The doctor back home said [the Mass. General doctors] set my jaw wrong," says Lee. "He had to redo it. I spent the week in pain because [UHS] couldn't recognize this problem."

Lee, who spent the next 47 days with his mouth wired shut, is now known by many first-years for his ordeal. Many undergraduates say stories like Lee's have shaped their perceptions of UHS in a negative light, often breeding widespread distrust of the service.

Students and doctors agree that care at UHS is generally adequate, but once in a while, as with most any large health care provider, mistakes do occur. Those stories circulate around campus, often escalating into horrific accounts that hurt UHS' credibility among students. UHS' lack of communication with the students makes it harder to restore that credibility.

An overwhelming majority of 80 students interviewed last month say friends' accounts of misdiagnoses--not their personal experiences--make them fearful of using the health service.

But in a Crimson poll of 317 undergraduates conducted last week, 70 percent of students rated the quality of care as "fair" or higher, with only 14 percent answering that the care is "poor." Eighty-one percent of those polled say they have been to UHS at least once. The poll has a five percent margin of error.

Almost all of the 15 UHS doctors who were interviewed say student concerns with the quality of care at UHS are mostly a matter of perception.

"When I was an undergraduate here the stories were exactly the same," says Dr. Peter J. Zuromskis '66, director of the urgent care clinic. "Usually it's second or third hand information. The students say, 'I've never been to UHS, but...'"

The Crimson investigation also found that student claims of incompetent doctors at UHS are unfounded. Most of the 10 full time and 13 part-time physicians are experts in their fields, as they have graduated from top medical schools and practice in other area hospitals.

In addition, because UHS serves faculty and staff in addition to students, it can afford to employ specialists in more than 15 different fields, from allergy to rheumatology.

Zuromskis says the system of group care at UHS, which may create problems of access and attitude, does ensure higher standards of care.

"Our quality control here is better because of group practice, where lots of people are in the care system and can pick up a chart to see if a mistake was made," Zuromskis says. "It may not be as intimate as a single practice, but there are more people participating which improves quality."

An extensive search of the records of the State Board of Registration in Medicine and the Division of Health Care Quality of the State Public Health Department yielded only a handful of complaints, none since 1989. State court records showed fewer than five malpractice suits since 1989.

Kathleen Diaz, the patient advocate at UHS, says students filed less than 10 complaints with her department last year.

In fact, UHS administrators at times seem complacent about the quality of care they feel they provide to the Harvard community. In his opening statement to the 1988-1989 annual report, former UHS Director Dr. Warren E.C. Wacker wrote that the health service was "not qualitatively better than it was in 1971, but more comprehensive in what we have to offer the community."

Objective evaluators also find little wrong with the care at UHS. Every two years, UHS is evaluated by a visiting committee of doctors and health care administrators from outside organizations. Peggy Stevens, associate executive director of Humana-Michael Reese, a health maintenance organization (HMO) in Chicago, and a member of the committee, says Harvard students should have little to complain about.

"The quality of care indicators are excellent," Stevens says. "They have a very select group of physicians at UHS and very good quality control."

The Chicago-based Joint Commission on the Accreditation of Healthcare Organizations, a private, not-for-profit organization, accredited UHS in 1992. The health service received generally high ratings in the accreditation report, although commission spokesperson Stephen L. Davidow says the report also identified "one or more areas" in which UHS care was sub-standard.

And officials at area hospitals, who often see patients UHS is not equipped to handle, agree with objective evaluators.

"UHS is providing good care," says Christine Simonian, emergency room practice manager at Brigham and Womens' Hospital. "Whenever students are sent here for care, we never see any problems with the way they have been treated. Their care is good."

A significant minority of the 80 undergraduates interviewed praise the quality of care at UHS, citing access and friendliness as their main gripes.

"I went in there for a pinched nerve once, and they found that I had lyme disease," says Fred J. Leidner '95. "They caught the disease in time."

Katherine A. DeLellis '96 says the nurses treated her with extra special care when she checked in with a fever.

"There was a long line upstairs, but the nurse took one look at me and said, 'You look like you need help,'" DeLellis says. "I saw a doctor within five minutes."

Particularly strong, according to almost all doctors interviewed, is the mental health service. Students almost unanimously say they especially appreciate the treatment they receive there.

"I use them," says one senior, who has chronic fatigue and immune dysfunction syndrome. "I very often can't get out of my room. I go to someone in mental health. They are confidential when they call my room and leave a message."

Disparities

Still, there must be a reason for the widespread lack of confidence among students, as evidenced by the 80 interviews. There appears to be a canyon of difference between what doctors see as excellent care and what many students perceive as inadequate and careless treatment. Many of those treated well say they were either surprised or just lucky.

DeLellis, who was treated promptly for her fever, says the care is somewhat random because her twin sister, Susan, went to UHS the next day with similar symptoms and was told nothing was wrong with her.

"I trust UHS," Katherine says, "My sister doesn't."

And no matter how much doctors stress the high quality of care at UHS, an overwhelming majority of the 80 students either knew someone who had been misdiagnosed or had been mistreated themselves.

Some students, particularly those who are originally from the Boston area, say they use other doctors. Many students say they return to UHS only because it is convenient.

From a missed case of gastrointeritis, to a wrongly set broken thumb, to an unnecessary cast on their leg, students are replete with horror stories.

Jason S. Martin '94 was lifting something when he pinched a nerve in his back and collapsed to the floor. Three friends carried him to UHS.

"The doctor asked me if I was allergic to anything," says Martin. "I said aspirin and penicillin. But he gave me a shot of Demerol which causes a reaction in people allergic to aspirin and penicillin. I went into a spasm."

Martin says he had a severe reaction, collapsed to the floor and couldn't open his eyes. A day and a half later he was able to go home where he says he slept for three days.

"I thought of taking action, but my mom dissuaded me because everything worked out all right in the end," Martin says.

And some female students interviewed say they are displeased with UHS's women's health care.

A first-year student, who spoke on condition of anonymity, says when she went to UHS after spending the night vomiting, the first thing her nurse practitioner did was administer a pregnancy test.

"It was embarrassing and inappropriate but I didn't have the strength to protest," says the first-year. "That kind of thing really embarrasses you. You don't want to go back."

The student says the nurse practitioner changed her birth control prescription on that occasion and after a later visit. The change, she says, made her sick and moody.

"She put me on pills that made me sick and sometimes made me cry," says the first year. "When I went home, my doctor said she couldn't believe they changed my prescription. She said what they had done was wrong."

Dr. David S. Rosenthal '59, director of UHS since 1989, says some of the stories students tell are quite valid. "But the stories students tell are quite valid. "But the stories never get to where they should be until weeks later," he says. "Then we can't do anything about it."

While he acknowledged that doctors sometimes make mistakes, Rosenthal also says that student expectations of UHS are too high.

"College health service is misunderstood by students and their parents," he says. "If they have a headache, they think they need a catscan."

Both Rosenthal and Zuromskis see matching students with personal primary care physicians as the solution to the problem of perceived and actual inefficient care.

"Set yourself up with a primary care physician," Rosenthal says. "In the long run it will reduce health care costs and improve quality."

But UHS has very little success convincing students to choose their own personal physician. Although Rosenthal says that 90 percent of faculty and staff have a primary care physician, the Crimson poll showed that only 37 percent of students have their own personal doctor at UHS.

Although in the past Rosenthal experimented with assigning primary care physicians to students, UHS officials are only instructed to suggest this option when students come to the building seeking care.

Many officials favor a system in which primary care physicians are assigned before students enroll. At MIT, students receive a biography, picture, and business card of their doctor in the mail the summer before their first year.

"I favor the assignment of a doctor before-hand," says Mark Goldstein, chief of pediatrics and student health services at MIT. "One girl said she called in because she had a letter and a card. That saved her one step. Just having the card is an incentive to call."

And some officials at UHS question why primary care physicians are not assigned to students, like they are at MIT.

"It does sound like a good idea to me," says Kristen Heller, a registered nurse. "I belong to an HMO and as soon as I signed up they made me choose a doctor [for my primary care]. It makes a lot of sense."

But UHS's main problem seems to be communicating with the student body. Not only has this lack of contact prevented undergraduates from understanding the value of a personal doctor, but it also prevents UHS from dispelling its image as an inefficient source of health care.

"I don't know how to get rid of the rumors," Heller says, "I wish I did."

Rosenthal says there are eight student health groups that help close the communication gap between UHS and the students. But most of these groups provide health or counseling services, and none serve as a voice for student complaints to UHS.

Rosenthal says the Student Health Advisory Committee (SHAC) serves as the basis of the liason between students and UHS.

"They do more outreach than UHS does," he says.

"There's a lapse in communication. That's part of our role," says Sahil Parikh '95, chair of the committee.

Members are now working on a video to introduce first-years to the health service.

But while SHAC was originally conceived of as a "sounding board between students and UHS, it evolved into a health awareness organization," Parikh says.

The council, in fact, has had less and less influence in recent years, though members continue to help interview candidates for positions as doctors. Students sign up for the council at registration, and more than half of the current members are first-year students.

Even if perception is the only problem with UHS care, the health service and its doctors still have a lot of work to do. Efforts at increasing the number of students with primary care doctors have been relatively unsuccessful, and in an interview this month, a clearly frustrated Rosenthal asked reporters if they had any suggestions for getting students and doctors together.

Rosenthal knows that unless he finds a more effective method of improving UHS's image, students will continue to feel that quality care is the exception and not the norm. And doctors know too well that if a sick student doesn't get proper treatment, it can mean lots of pain, 47 days with your mouth wired shut, or even worse.

"I got good care when I went to UHS," says Ranjit M. Layagari '96. "I must have just gotten lucky."

A majority of undergraduates say they fear using undergraduate Health Services, having heard numerous accounts of their peers' misdiagnoses. Unless UHS finds a way to improve students' perception of its care, students will continue to believe that quality care at UHS is...

Do you have a primary health care physician at UHS?* 79%  * 59%Total  83%What is your view of the quality of care at UHS?Very Good  7%Good  27Fair  36Poor  14Don't Know  16Of those who have primary health care physicians:What is your view of the quality of care at UHS?Very Good  12%Good  24Fair  39Poor  12Don't Know  2Source: Crimson poll of 317 respondents taken on April 14 and 15, 1993.Margin of error at 15

"The doctor back home said [the Mass. General doctors] set my jaw wrong," says Lee. "He had to redo it. I spent the week in pain because [UHS] couldn't recognize this problem."

Lee, who spent the next 47 days with his mouth wired shut, is now known by many first-years for his ordeal. Many undergraduates say stories like Lee's have shaped their perceptions of UHS in a negative light, often breeding widespread distrust of the service.

Students and doctors agree that care at UHS is generally adequate, but once in a while, as with most any large health care provider, mistakes do occur. Those stories circulate around campus, often escalating into horrific accounts that hurt UHS' credibility among students. UHS' lack of communication with the students makes it harder to restore that credibility.

An overwhelming majority of 80 students interviewed last month say friends' accounts of misdiagnoses--not their personal experiences--make them fearful of using the health service.

But in a Crimson poll of 317 undergraduates conducted last week, 70 percent of students rated the quality of care as "fair" or higher, with only 14 percent answering that the care is "poor." Eighty-one percent of those polled say they have been to UHS at least once. The poll has a five percent margin of error.

Almost all of the 15 UHS doctors who were interviewed say student concerns with the quality of care at UHS are mostly a matter of perception.

"When I was an undergraduate here the stories were exactly the same," says Dr. Peter J. Zuromskis '66, director of the urgent care clinic. "Usually it's second or third hand information. The students say, 'I've never been to UHS, but...'"

The Crimson investigation also found that student claims of incompetent doctors at UHS are unfounded. Most of the 10 full time and 13 part-time physicians are experts in their fields, as they have graduated from top medical schools and practice in other area hospitals.

In addition, because UHS serves faculty and staff in addition to students, it can afford to employ specialists in more than 15 different fields, from allergy to rheumatology.

Zuromskis says the system of group care at UHS, which may create problems of access and attitude, does ensure higher standards of care.

"Our quality control here is better because of group practice, where lots of people are in the care system and can pick up a chart to see if a mistake was made," Zuromskis says. "It may not be as intimate as a single practice, but there are more people participating which improves quality."

An extensive search of the records of the State Board of Registration in Medicine and the Division of Health Care Quality of the State Public Health Department yielded only a handful of complaints, none since 1989. State court records showed fewer than five malpractice suits since 1989.

Kathleen Diaz, the patient advocate at UHS, says students filed less than 10 complaints with her department last year.

In fact, UHS administrators at times seem complacent about the quality of care they feel they provide to the Harvard community. In his opening statement to the 1988-1989 annual report, former UHS Director Dr. Warren E.C. Wacker wrote that the health service was "not qualitatively better than it was in 1971, but more comprehensive in what we have to offer the community."

Objective evaluators also find little wrong with the care at UHS. Every two years, UHS is evaluated by a visiting committee of doctors and health care administrators from outside organizations. Peggy Stevens, associate executive director of Humana-Michael Reese, a health maintenance organization (HMO) in Chicago, and a member of the committee, says Harvard students should have little to complain about.

"The quality of care indicators are excellent," Stevens says. "They have a very select group of physicians at UHS and very good quality control."

The Chicago-based Joint Commission on the Accreditation of Healthcare Organizations, a private, not-for-profit organization, accredited UHS in 1992. The health service received generally high ratings in the accreditation report, although commission spokesperson Stephen L. Davidow says the report also identified "one or more areas" in which UHS care was sub-standard.

And officials at area hospitals, who often see patients UHS is not equipped to handle, agree with objective evaluators.

"UHS is providing good care," says Christine Simonian, emergency room practice manager at Brigham and Womens' Hospital. "Whenever students are sent here for care, we never see any problems with the way they have been treated. Their care is good."

A significant minority of the 80 undergraduates interviewed praise the quality of care at UHS, citing access and friendliness as their main gripes.

"I went in there for a pinched nerve once, and they found that I had lyme disease," says Fred J. Leidner '95. "They caught the disease in time."

Katherine A. DeLellis '96 says the nurses treated her with extra special care when she checked in with a fever.

"There was a long line upstairs, but the nurse took one look at me and said, 'You look like you need help,'" DeLellis says. "I saw a doctor within five minutes."

Particularly strong, according to almost all doctors interviewed, is the mental health service. Students almost unanimously say they especially appreciate the treatment they receive there.

"I use them," says one senior, who has chronic fatigue and immune dysfunction syndrome. "I very often can't get out of my room. I go to someone in mental health. They are confidential when they call my room and leave a message."

Disparities

Still, there must be a reason for the widespread lack of confidence among students, as evidenced by the 80 interviews. There appears to be a canyon of difference between what doctors see as excellent care and what many students perceive as inadequate and careless treatment. Many of those treated well say they were either surprised or just lucky.

DeLellis, who was treated promptly for her fever, says the care is somewhat random because her twin sister, Susan, went to UHS the next day with similar symptoms and was told nothing was wrong with her.

"I trust UHS," Katherine says, "My sister doesn't."

And no matter how much doctors stress the high quality of care at UHS, an overwhelming majority of the 80 students either knew someone who had been misdiagnosed or had been mistreated themselves.

Some students, particularly those who are originally from the Boston area, say they use other doctors. Many students say they return to UHS only because it is convenient.

From a missed case of gastrointeritis, to a wrongly set broken thumb, to an unnecessary cast on their leg, students are replete with horror stories.

Jason S. Martin '94 was lifting something when he pinched a nerve in his back and collapsed to the floor. Three friends carried him to UHS.

"The doctor asked me if I was allergic to anything," says Martin. "I said aspirin and penicillin. But he gave me a shot of Demerol which causes a reaction in people allergic to aspirin and penicillin. I went into a spasm."

Martin says he had a severe reaction, collapsed to the floor and couldn't open his eyes. A day and a half later he was able to go home where he says he slept for three days.

"I thought of taking action, but my mom dissuaded me because everything worked out all right in the end," Martin says.

And some female students interviewed say they are displeased with UHS's women's health care.

A first-year student, who spoke on condition of anonymity, says when she went to UHS after spending the night vomiting, the first thing her nurse practitioner did was administer a pregnancy test.

"It was embarrassing and inappropriate but I didn't have the strength to protest," says the first-year. "That kind of thing really embarrasses you. You don't want to go back."

The student says the nurse practitioner changed her birth control prescription on that occasion and after a later visit. The change, she says, made her sick and moody.

"She put me on pills that made me sick and sometimes made me cry," says the first year. "When I went home, my doctor said she couldn't believe they changed my prescription. She said what they had done was wrong."

Dr. David S. Rosenthal '59, director of UHS since 1989, says some of the stories students tell are quite valid. "But the stories students tell are quite valid. "But the stories never get to where they should be until weeks later," he says. "Then we can't do anything about it."

While he acknowledged that doctors sometimes make mistakes, Rosenthal also says that student expectations of UHS are too high.

"College health service is misunderstood by students and their parents," he says. "If they have a headache, they think they need a catscan."

Both Rosenthal and Zuromskis see matching students with personal primary care physicians as the solution to the problem of perceived and actual inefficient care.

"Set yourself up with a primary care physician," Rosenthal says. "In the long run it will reduce health care costs and improve quality."

But UHS has very little success convincing students to choose their own personal physician. Although Rosenthal says that 90 percent of faculty and staff have a primary care physician, the Crimson poll showed that only 37 percent of students have their own personal doctor at UHS.

Although in the past Rosenthal experimented with assigning primary care physicians to students, UHS officials are only instructed to suggest this option when students come to the building seeking care.

Many officials favor a system in which primary care physicians are assigned before students enroll. At MIT, students receive a biography, picture, and business card of their doctor in the mail the summer before their first year.

"I favor the assignment of a doctor before-hand," says Mark Goldstein, chief of pediatrics and student health services at MIT. "One girl said she called in because she had a letter and a card. That saved her one step. Just having the card is an incentive to call."

And some officials at UHS question why primary care physicians are not assigned to students, like they are at MIT.

"It does sound like a good idea to me," says Kristen Heller, a registered nurse. "I belong to an HMO and as soon as I signed up they made me choose a doctor [for my primary care]. It makes a lot of sense."

But UHS's main problem seems to be communicating with the student body. Not only has this lack of contact prevented undergraduates from understanding the value of a personal doctor, but it also prevents UHS from dispelling its image as an inefficient source of health care.

"I don't know how to get rid of the rumors," Heller says, "I wish I did."

Rosenthal says there are eight student health groups that help close the communication gap between UHS and the students. But most of these groups provide health or counseling services, and none serve as a voice for student complaints to UHS.

Rosenthal says the Student Health Advisory Committee (SHAC) serves as the basis of the liason between students and UHS.

"They do more outreach than UHS does," he says.

"There's a lapse in communication. That's part of our role," says Sahil Parikh '95, chair of the committee.

Members are now working on a video to introduce first-years to the health service.

But while SHAC was originally conceived of as a "sounding board between students and UHS, it evolved into a health awareness organization," Parikh says.

The council, in fact, has had less and less influence in recent years, though members continue to help interview candidates for positions as doctors. Students sign up for the council at registration, and more than half of the current members are first-year students.

Even if perception is the only problem with UHS care, the health service and its doctors still have a lot of work to do. Efforts at increasing the number of students with primary care doctors have been relatively unsuccessful, and in an interview this month, a clearly frustrated Rosenthal asked reporters if they had any suggestions for getting students and doctors together.

Rosenthal knows that unless he finds a more effective method of improving UHS's image, students will continue to feel that quality care is the exception and not the norm. And doctors know too well that if a sick student doesn't get proper treatment, it can mean lots of pain, 47 days with your mouth wired shut, or even worse.

"I got good care when I went to UHS," says Ranjit M. Layagari '96. "I must have just gotten lucky."

A majority of undergraduates say they fear using undergraduate Health Services, having heard numerous accounts of their peers' misdiagnoses. Unless UHS finds a way to improve students' perception of its care, students will continue to believe that quality care at UHS is...

Do you have a primary health care physician at UHS?* 79%  * 59%Total  83%What is your view of the quality of care at UHS?Very Good  7%Good  27Fair  36Poor  14Don't Know  16Of those who have primary health care physicians:What is your view of the quality of care at UHS?Very Good  12%Good  24Fair  39Poor  12Don't Know  2Source: Crimson poll of 317 respondents taken on April 14 and 15, 1993.Margin of error at 15