UHS: Clean Bill of Health?

M. Allison Arwady '98 rarely gets sick. Actually, up until the fall of her sophomore year, the last illness Arwady remembers is her sixth-grade bout with pneumonia.

"I knew something was definitely wrong when I started to feel sick," Arwady says. "The symptoms were familiar with the pneumonia I remembered having, but the doctor I saw at UHS sent me home with a decongestant."

Three days later, Arwady, too weak to walk, returned to UHS in a police car.

Arwady was inspected by another doctor, who diagnosed her with pneumonia and sent her to Stillman Infirmary, where Arwady spent the next week.

"With a week in the infirmary and the time I spent recovering, I ended up falling behind in a lot of classes," Arwady says. "I wish they had diagnosed me earlier."

On the surface, Arwady's experience seems like the stuff students' complaints about University Health Services (UHS) are made of.

But Arwady, who is a Crimson editor, goes beyond the usual gripes about the health services and quickly points out that she doesn't blame UHS for the misdiagnosis.

"I don't know enough about medicine to know if the doctors could have actually detected it any earlier since both doctors said the pneumonia was hard to hear," she says. "Once I was admitted to the infirmary, the care was wonderful."

Other students' experiences seem to agree with Arwady's.

Emily R. Sadigh '99 says that most of the problems she has had with UHS involve access to doctors.

"Just last weekend, I called and wanted an appointment with a doctor, dentist and optometrist," Sadigh said. "The earliest they could offer me, besides spring break, was in April. I ended up getting an earlier appointment by seeing a nurse practitioner."

Sadigh says that this isn't the first problem she has had with UHS. Last fall, she called UHS describing flulike symptoms, only to be told "not to worry."

"It ended up getting a lot worse, and a week later when I did see a doctor, he diagnosed it as bronchitis," Sadigh said.

Like Arwady, Sadigh has no complaints about the care she finally received.

"Everything worked out after that, and that has usually been the case at UHS," Sadigh said. "You just need to get in to see the doctor."

With that kind of assessment, it seems as if Harvard students are on target with what the real problems are at UHS.

Records obtained by The Crimson from the State Board of Registration in Medicine show that UHS doctors have had no complaints filed against them and have faced no disciplinary action in the past 10 years.

The same records show that none of the doctors have made a malpractice payment in the past 10 years. State court records show only two malpractice suits since 1990. Of the two, one was dismissed in 1994 while the trial of the other is still pending.

"When a complaint is filed by a hospital institution, a professional organization, a government agency, or fellow doctors, and we investigate such a report but don't send it to a hearing, then such information is kept confidential," says Charles Moore, public information officer with the board.

"On the other hand, complaints, even dismissed complaints filed by patients, are public information," Moore adds.

Such complaints are absent from the records of the UHS doctors.

The Problems

While the doctors' records may be spotless, some students say problems with UHS still exist.

"The problem isn't the doctors--it's that I've never been able to reach a doctor," says Kerlen Chee '98. "There have been times when they try to diagnose me over the phone."

"It's understandable since they have a lot of people to see, but they shouldn't blow people off when they call," Chee says. "There's a reason why they call. It couldn't hurt to just squeeze someone in for a few minutes."

Other students expressed concerns specifically about UHS's mental health services.

"A lot of it has to do with the attitude of the receptionists and all of the bureaucracy," says one Quincy House sophomore who has used UHS's mental health services over 10 times during her Harvard career.

"The receptionists at the mental health services just don't have any idea what the patients are going through," she says.

"When I call for help, I expect the person on the other end to talk me through it," says another sophomore, whose close friend has used UHS's mental health services in the past. "I'm only an undergrad; I'm not trained in mental health services."

"My friend needs help and in the middle of the night, there doesn't seem to be anyone to turn to," the sophomore adds. "There seems to be no structure to help out, but we're in a very stressful college environment where it's not a surprise if students need the help."

Avenues for Reform

Dr. David S. Rosenthal '59, director of UHS, admits that working with the support staff is one thing UHS has to learn.

"We are continually training our support staff, but as new people come on, there needs to be additional training," Rosenthal says. "The most important thing is to not erect barriers between students and the medical care because many times you don't know if the situation is serious or not."

Rosenthal says he encourages students to voice their concerns by contacting him over the phone or through e-mail.

"If they don't call, then problems will fester, and I won't be able to take care of them," Rosenthal says. "I want to be made aware."

But students still seem unwilling to contact Rosenthal or Kathleen Dias, UHS patient advocate, to file a complaint.

"I don't think my complaints are valid since they are mostly about long waits," Chee says.

"It's usually not enough of a big deal," says Travis D. Wheatley '99. "My main problems have always been the receptionists who seem to jerk me around. Those seem more like minor annoyances."

Dias refused to release the nature and number of complaints she receives annually, explaining that it was confidential information. But in 1992, Dias was quoted in a Crimson article saying that students had filed less than 10 complaints with her department in the last year.

Dias now claims that she never released such information and declined to comment on the nature of the complaints that she generally receives.

Kevin C. Chien '98, a member of the Student Health Advisory Council (SHAC), said students often may not file a complaint because they want it to remain confidential.

"Perhaps they are concerned about the confidentiality issue, or they feel like their complaint won't be taken seriously," Chien says. "We talk to the student and see if we can identify the person they are concerned with, whether it's a doctor or part of the support staff."

SHAC co-chair, Tara L. Adamovich '97, explains that SHAC, a student-run advocacy group, was formed to voice student concerns about health services.

The seven-person board meets weekly with Dias, Adamovich says, and accepts both complaints and suggestions.

Adamovich estimated that of the seven to 10 responses the group gets each week, about 50 percent are complaints concerning the care they received. Chien said that most students have had problems with the availability of doctors and the ability to get appointments.

Rosenthal says that compared to the number of visits UHS receives, the number of complaints is quite small.

"We get suggestions all the time about services, compliments about specific physicians, and the quality of care. Complaints are rare," Rosenthal says. "Nobody tries to hide anything. We're obviously concerned."

Rosenthal also stresses the confidentiality of the procedure.

"Any issue raised about any physician is first seen by the patient advocate and then seen by me," he says. "It's kept entirely confidential, but the response would go back to the student."

Adamovich says that SHAC follows a similar procedure.

"When we receive a complaint, we discuss [it] confidentially within the group and assign one member of the council to deal with the specific situation," Adamovich says. "We're here for those students who want to turn to their peers."

SHAC plans to compile the responses the group has received this past year and present a report on student concerns and commendations to Dias and Rosenthal.

Satisfied Customers

Despite UHS's negative reputation, many students have equally positive experiences that support the state records.

Claudio A. Sauer '00 headed to UHS in mid-October after injuring his knee in a game of intramural soccer.

"The doctors were very attentive while I was there. They checked up on me pretty often," says Sauer, who ended up staying at UHS overnight after doctors expressed concern that his knee might continue to swell and stop circulation.

Given a brace and a referral to a UHS orthopedic surgeon, Sauer was told he had a bruised ligament. His injury was not correctly diagnosed until Christmas break when persistent pains prompted him to visit his physician at home. An MRI showed that Sauer had actually torn his ligament.

But Sauer says that despite the initial misdiagnosis, he was satisfied overall.

"Their primary concern was my immediate well-being," Sauer explains. "The X-ray they did when I first went in didn't show a break, so at that point there was no need for an MRI. It just wasn't a major ligament."

Adamovich says she thinks such experiences are not as uncommon as some students think.

"In many cases, we've found no truth in many of the rumors that students start about UHS. A lot of the students are satisfied with the services they're getting," says Adamovich.

"Often the complaints are the result of misunderstandings in interactions with the doctors and interactions with the receptionists," Adamovich adds.

Some students say they agree with Adamovich.

"I've never had a problem with them," says Xiaomeng Tong '98. "I think a lot of people are exaggerating. It's only natural for people to hate an institution like UHS, and it's only natural when people say they hate UHS that others would agree."

Rosenthal suggests students would be much more satisfied with the care they receive from UHS if they selected a primary care physician.

UHS encourages students to select this physician using the information they provide which lists the physicians' educational backgrounds and hospital affiliations.

"I don't know if that's a good basis for making a decision," Sauer says. "Having credentials just isn't enough. I'm sure they're all well-qualified, but there's a lot more to it."