UHS CONCERNS

Some students believe University Health Services (UHS) suffers from an image problem.

It is sometimes mocked by campus humor magazines and occasionally belittled by the students it strives to serve.

"The perception on campus among students is that UHS does not promise them the best in health care," David J. Malan '99 said. "I am less comfortable at UHS by far than I am with [my] doctors at home."

Students interviewed recently cited all sorts of problems with UHS, including excessive and insufficient medication and lack of responsiveness from UHS doctors.

Johnisha Matthews '99 says that her UHS doctors constantly over- or under-estimate her health problems. Matthews, who suffers from sinus problems, goes into UHS every two weeks to get allergy shots. She says that such routine appointments are "no big deal."

However, "when my allergies get really bad, it can build up into a sinus" problem, Matthews says. "It's usually around when the weather changes."

When this happens, Matthews says she has to seek more comprehensive medical treatment. Sometimes, she says, UHS doctors are overassiduous and prescribe too much medication, but at other times, Matthews says, they hesitate to prescribe any drugs at all.

"One time they wouldn't give me drugs, and I had to get my mom to send my antibiotics because they were really adamant that it was probably a cold, and I would get over it without any help," she says.

Stuart D. Shapley '98 says he experienced a similar problem last year. Shapley walked into UHS complaining of a sore throat and a cold and walked out with Azmacort, an asthma inhaler usually prescribed for chronic asthma sufferers.

Jennifer E. Hoffman '99 says she also received treatment above and beyond what she felt was necessary for her condition. Hoffman says she once went into UHS with the stomach flu and ended up being hooked up to an intravenous tube for dehydration.

"I just had a stomach flu, and all I wanted was an excuse to get out of my final because I had a 102 [degree] fever and kept throwing up," she says. "It was just one of those 48-hour bugs that come and go. I would have recovered just as quickly without the IV."

Jonathan A. Hahn '99 said he experienced the opposite problem with a doctor who refused to take his illness seriously.

One day during his first year, Hahn says, he felt dizzy because of the flu as he did his homework, so he decided "to take a shower to lower his temperature and to clear his head."

He blacked out in the shower but managed to make it to UHS with the help of his roommates, where he waited two hours before he saw a doctor. The doctor tested him for mononucleosis and then sent him home.

"What I thought was basically an emergency situation, they just said, 'Let's test to see if you have mono,' Hahn says. "They just told me I didn't have mono and that was it."

Matthews says that while some doctors undermedicate their patients, she also had a primary-care physician who "gave me whatever I needed."

"I guess they feel bad that we're students, and we have all this stress [and they want to give you] whatever you need to feel better," she says.

Matthews says she believes over- or under-medication occurs because doctors are not familiar with their patients' medical histories and have not worked with them for a long enough period.

But UHS Director Dr. David S. Rosenthal '59 said in an interview on Wednesday that Harvard students might feel under-medicated because they are used to being on medication and their bodies have thus built up a tolerance to certain drugs.

"A lot of people come on drugs to Harvard," Rosenthal says. "They have a fever, they have antibiotics. They develop resistance to antibiotics."

Matthews says that she feels her UHS doctors "always go to extremes."

"Unless you build up a history with a patient, it's hard to know them well enough so you can make distinctions, and I think that's the big problem with UHS," she says. "Students don't go there on a regular basis, and when they go there, they might not get the doctor they've seen before, so I guess it's impossible to really get to know the patient."

Rosenthal says that a wide range of UHS services are available to students; often students just don't take advantage of them.

This year, UHS assigned a primary-care physician to each first-year and sent every first-year a letter informing him or her of this special patient-doctor partnership.

However, Carie Ullman Michael, assistant director of clinical operations administration for UHS, says that only a few students have responded to the mailing thus far.

Rosenthal also says that few students have made an effort to voice their complaints at open houses, sponsored by UHS, which solicit student feedback.

"In September, there was an open house for students to come to UHS to talk about any issues they might have," Rosenthal wrote in an e-mail message. "Last week, SHAC [Student Health Advisory Committee] sponsored an open meeting in Ticknor Lounge. I was present at both, and despite excellent publicity, a handful of students attended.

"I think there's a perception that we don't care and we're not listening," Rosenthal said in the interview. "But we do care."

Shara R. Kay '01 says that even when a doctor has a patient's medical history in front of him or her, that doesn't necessarily make the physician more responsive to the patient's needs.

Kay, who suffers from sinus problems, says that when she first went into UHS for treatment, the doctor prescribed cough medicine with codeine.

"Cough medicines obviously didn't cure sinuses, so I went back," Kay says.

The next doctor prescribed an antibiotic as well as Tylenol with codeine, she says.

"I went to get the prescription filled, but he didn't specify the quantity," she says.

When she finally got the filled prescription and took it home, Kay says she noticed that it contained Ceclor, an antibiotic related to the penicillin family of drugs, which she is allergic to.

Although it was stated in her medical record and she had repeatedly told both her doctor and the UHS pharmacist of her allergic reaction to Ceclor, Kay says none of the UHS officials had bothered to take notice.

"UHS pharmacy said we realized we gave you the wrong thing [but] we didn't have your number," Kay says. "I could have been choking to death and then they lie and say they tried to call. I'm never going back."

Grace K. L. Kataburuki '99 experienced a similar encouter with an absentminded doctor.

"Basically, my prescription for painkillers following the removal of my wisdom teeth wasn't working," Kataburuki says. "I went in for a new prescription. My chart says I'm allergic to Tylenol. Early in the appointment, I told the guy I was allergic to Tylenol. When he gave me a prescription, I asked if he was sure this wouldn't be complicated by my allergy to Tylenol. He said no."

But 20 minutes after Kataburuki took the Tylenol prescription with her lunch, she says, "welts started coming up on my face like they do when I'm having a Tylenol reaction."

"I called UHS thinking I'd discovered a new drug I was allergic to because of course they would never have prescribed Tylenol," she says. "The guy finally checks his desk reference only to discover he prescribed the generic equivalent of Tylenol 3."

Kataburuki says she drank gallons of water to get rid of the welts and became sick to her stomach.

"I got the patient advocate to get the prescription taken off of my term bill, but I never did get a real apology, and...some people have much more serious reactions than mine," she says.

Malan says that he has never had much confidence in UHS personnel. "Personally, I have felt that the physicians and nurses I have seen there are not the best in the field," he says.

However, Rosenthal notes, "the staff here is very qualified." He adds that UHS handles more than 45,000 primary-care visits each year.

Michael, who was a graduate student at the Harvard School of Public Health before she began working at UHS, says that she had only positive experiences with UHS while she was a student.

"I only saw nurse practitioners, and I thought that was fine," she says.

Matthews adds: "Sometimes, they seem to know as much as the doctors."

Halfway Heaven, a recent book by Melanie R. Thernstorm '87 about the 1995 murder-suicide in Dunster House, criticizes UHS's Mental Health Service for not recognizing suicidal or homicidal tendencies in Sinedu Tadesse '96, who killed her roommate, Trang P. Ho '96, and then herself.

Thernstrom writes that Tadesse had been seeing a UHS counselor since her first year but he had never prescribed medication for her and only saw her on "a limited basis."

Thernstrom adds that the counselor possessed only a doctorate of education from the Harvard Graduate School of Education rather than a medical degree.

"Suicide is a tough subject," Rosenthal says. "Even people in hospitals commit suicide. People can be in care and still commit suicide. People come [to Harvard] with a lot of stresses, and it can be aggravated in a college environment."

However, Rosenthal, Michael and UHS Patient Advocate Kathleen K. Dias point out that this month is National Depression Screening Month and that UHS has been publicizing it assiduously.

Despite anecdotal complaints, there are students who report complete satisfaction with UHS and with the professionalism of its health providers.

Peter S. Manasantivongs '99, who was treated for hives right before he took his Graduate Record Exam last week, says he has nothing but praise for UHS.

"My only experience with UHS was a positive one," he says. "I have nothing but good things to say."

--Baratunde R. Thurston contributed to the reporting of this article.