Fed UP! – More Detestable Bureaucratism from the VA.

I-CareI hate being lied to!  More than I hate being lied to, I detest, with every fiber in my being bureaucrats and the inanity they promulgate to excuse their stupidity and throw a wrench into the works.  Today I suffered through yet another call with my VA-appointed primary care provider (PCP).  Not an online conference, but a phone call.  Who was in the office with the provider and why?  How can I guarantee my HIPAA information during a phone call on an unsecured line?  How do I know who I am talking to?  These concerns and more arise when you receive a phone call to discuss important medical information, and my PCP does not care!  My PCP refuses to use the VA’s tools to conduct patient appointments and instead creates workarounds; what an ingenious method for telling lies and spreading falsehoods as bureaucratic inertia; I’m so thrilled!

The PCP continuously claimed all my imaging is “normal” and “unremarkable.”  The pain experienced cannot be related, and the sources are questionable.  In polite speak, the PCP is trying to tell me it’s all in my head; a previous provider from the VA already used this as an excuse for not performing their job.  For more than 10-years, I have been fighting the VAHCS for help in reducing pain and in getting to root causes for the problems experienced.  Yet, today’s call was just more of the same BS wrapped in feel-good words, platitudes, and bureaucratic non-answers.  Honestly, after the third time the doctor related, the imaging was normal and unremarkable; I lost my cherub-like demeanor!  I did not swear until I got off the phone, but I am not anywhere close to a happy patient.

Honest question, does the VAHCS troll medical school for the bottom of the barrel, those people who can barely pass a class, let alone qualify for medical privileges?  I need competence, and I get useless lumps.  I ask questions, and the snowflakes pop out of the woodwork like ticks on a deer or fleas on a dog.  I am thoroughly sick of being treated like a know-nothing inconvenience.  The most important person in the VA marketed PACT Team is the patient who will be active, engaged, and informed.  The second most important member of the VA Marketed PACT team is the Primary Care Provider.VA 3

Since 2002 I have had a problem in my gastro-intestinal system; since 2010, the pain has been debilitating, and four years ago, I was diagnosed with non-alcoholic fatty liver disease.  Today, 22 March 2022, the PCP reviewed the problems area on my electronic health record (EHR), which coincidentally resides at the top of the electronic health record and was mentioned four different times by myself, and noted that non-alcoholic fatty liver disease is not listed.  Tell me, how would that make you feel?  The PCP ordered today’s call before the recent imaging appointment on my abdomen and pelvis, but the provider, who called me almost 30-minutes late, did not even look up my record before calling.  Had not studied the imaging results and formulated a plan of action to move forward, yet as the second most important member of the PACT team, I am supposed to trust this bureaucrat; I think NOT!

Through the miracle of modern technology, I had read and researched the imaging results more than 24 hours before the scheduled appointment to discuss the results.  I came prepared, but the provider could not be bothered to prepare for a call they demanded, then had the sheer effrontery to keep repeating that the imaging is “normal” and “unremarkable.”  Then the provider has the gall to tell me, repeatedly, that I was yelling, when in fact, she only did not like being spoken to with emphasis and insistence that she do her job!  Yes, I called her a bureaucrat and a snowflake, whereupon she threatened to hang up the call, but I disconnected first.  I miss those old rotary phones you leased from AT&T, they had heft, and when slammed, they made you feel better about disconnecting a call.PACT_model

From research, it is abundantly clear that pain from hernias can show up or be felt in areas far removed from the hernia site.  Constipation is both an indicator and a symptom of hernias.  Muscle weakness in the legs, burning sensations, and much more are all indicators of a hernia.  Yet, when I asked about all the other pains and problems experienced in my abdomen, I was told the hernia could not be the root cause, and the imaging is “normal and unremarkable,” but the PCP could not answer why these other symptoms are unrelated when asked.  Where is the research, seeing as “Dr. Google,” is discouraged; Johns Hopkins and the Mayo Clinic, plus I have access to the medical libraries at the University of Phoenix and Grand Canyon University.  With less than five minutes of research, I can locate and read data from reputable sources to form the basis of questions to ask a PCP, which is encouraged of patients by the VA.  Yet, the doctor cannot be trusted to provide any intelligent data, do any preparation, or knowledgeably speak to a symptom list; when will the VA answer why their PCP cannot do their job?PACT 1

If only I were the only person experiencing these problems and issues with the VA.

Former VA cardiologist John Giacomini of Atherton, California, pleaded guilty to one count of felony abusive sexual contact.  In the fall of 2017, Giacomini repeatedly subjected a subordinate electrophysiologist to unwanted and unwelcome sexual contact, including hugging, kissing, and intimate touching while on VA premises.  On 10 November 2017, the victim explicitly told Giacomini she was not interested in a romantic or sexual relationship with him.  Nevertheless, Giacomini continued to subject his subordinate to unwanted sexual advances and touching, culminating on 20 December 2017, when Giacomini turned out the lights in an office, pulled the victim out of her chair, and fondled her until a janitor opened the office door and interrupted the encounter.  The victim later resigned from her position at the VA, citing Giacomini’s behavior as her principal reason for leaving.  Sentencing is scheduled for 12 July 2022.VA 3

Will the VA-OIG troll through this former provider’s employment history seek out the other victims, or will this be swept under the rug not to tarnish the VA?  Having been an employee of the VA, will anyone, EVER, look at how employment law is abused by the leaders in the VA and correct the problems?  This incident should never have occurred, nor should it have taken years of abuse to end this despicable behavior.  Yet, what does the VA do, shut both eyes and pretend it does not occur in consequence of the designed culture at the VA.

Why did the victim have to tell another adult that their behavior was unwanted, and quit their job, before the VA took action?  Will there be an inquiry from congress?  Will any lawyers stand up and demand the VA correct this detestable hole that allows this behavior to promulgate?  I am not holding my breath!

Speaking of electronic medical health records, the VA-OIG has issued three separate reports on this topic, and none of them paint the VA with anything that shows competence.  In the report titled:

Medication Management Deficiencies after the New Electronic Health Record Go-Live at the Mann-Grandstaff VAMC in Spokane, Washington.”  The following findings were related:

Deficiencies in medication data migration and management resulted in patients having inaccurate or incomplete medications in their records or made filling prescriptions accurately more difficult—all of which can affect patient care and safety.  Areas of concern included:

(1) Data migration
(2) Medication formulary availability
(3) Medication order processing
(4) Provider notification and alerts
(5) Controlled substance tracking
(6) Prescription drug monitoring program documentation
(7) Medication reconciliation
(8) Medication list accuracy.”VA 3

As previously stated, I am not as nice and never politically correct.  VA-OIG, please allow me to correct your assertion, “Deficiencies in medication data migration and management resulted in patients having inaccurate or incomplete medications in their records or made filling prescriptions accurately more difficultall of which DO negatively affect patient care and safety.”  Trust is the first casualty in war and in dealing with the VA in ANY form, manner, or method.  When you cannot trust your data to remain confidential, the entire electronic medical record system can only be rated as UNACCEPTABLE!  The upgrading of the electronic medical records system at the VA is a 10-year, multi-billion-dollar fiasco, and as a taxpayer, I am done paying for this system!

Not to be outdone by the medication side of veteran care experiencing failures, the following VA-OIG report was issued:

Care Coordination Deficiencies after the New Electronic Health Record Go-Live at the Mann-Grandstaff VA Medical Center in Spokane, Washington.”

The EHR rollout caused problems in coordinating veterans’ care, ranging from the flags for patients at high risk for suicide not transferring to veterans and their care providers having trouble accessing video appointments and patient portal messaging.  Tracking outcomes were sometimes lost, and disappearing laboratory orders also resulted.  Although the OIG did not identify associated patient deaths, future deployment of the new EHR without resolving identified deficiencies could increase risks to patient safety.”VA 3

Again, the VA-OIG is practicing political correctness instead of being specific, and upfront, the entire EHR is a disaster, the cost is prohibitive, and any fool should see it is time to pull the plug, cut the losses, and hold the leadership accountable!  Yet, what do we see; the EHR is progressing into infinity and beyond at a snail’s pace!

The final nail in the VA’s EHR coffin should be that nobody involved can communicate with the IT helpdesk for the EHR as the IT ticketing system is unreliable!  Form the VA-OIG, we find the following:

Ticket Process Concerns and Underlying Factors after the New Electronic Health Record Go-Live at the Mann-Grandstaff VA Medical Center in Spokane, Washington.”

The failure to process and respond to VHA staff ticketing requests for help or report concerns resulted in reporting, tracking, and resolving problems.  These deficiencies made it difficult for clinicians and administrative staff to serve patients and impeded EHR fixes that can affect future sites.  The inspection team also identified five factors contributing to the deficiencies identified in the two companion reports above: usability, training, interoperability, needed fixes, and problem resolution.”VA 3

Imagine for a moment, you are responsible for a multi-billion-dollar IT project, and one of the first issues discovered by the users is the inability to reach out for IT help; how long would you remain employed?  Would you ever expect to ever work again if any of these problems were your legacy for leading the IT improvement on a multi-billion-dollar project?  As a consultant, I know how fast you would be fired and taken to court for business losses.  Why are these leaders exempt?  Where are the blue-ribbon panels and committees demanding people be held accountable for this fiasco?EHR-VA-OIG

When the VA-OIG casually mentions that PCPs are untrustworthy and not using the current tools correctly, should the providers be issued new tools; NO!  Yet, this is the opposite of what common sense declares.  Are you, dear reader, as a taxpayer, fed UP yet?  My wife reminds me, “These problems happen in civilian hospitals.”  No, in fact, they do not.  If data migrated from one patient’s EHR to another patient’s HER, that hospital would be sued and shut down so fast by congress at the federal and state level, all before the media firestorm would have barely begun.  If a patient were jeopardized because their provider could not track medications, that patient would sue for malpractice and possibly a class-action lawsuit.  If an IT project was occurring in the civilian world, and the users could not contact the IT helpdesk, the project would be overhauled so fast, and people fired, new records would have been set.

Knowledge Check!It is time we end this charade and money pit call the Department of Veterans Affairs, and every other agency of the Federal government bloat!  The government should be leading, not lagging, where operational efficiency and fiscal sanity are concerned.  I repeat, only for emphasis, are you fed UP yet?

© Copyright 2022 – M. Dave Salisbury
The author holds no claims for the art used herein, the pictures were obtained in the public domain, and the intellectual property belongs to those who created the images.  Quoted materials remain the property of the original author.

Unconscious Bias – A Fallacy of the Oppressor!

Bobblehead DollA few years ago, I had the unfortunate privilege of having for a manager a homosexual person.  Let me emphasize; I do not care about your personal choices and lifestyle; keep it to yourself and out of the workspace.  Hetero- or homosexual, does not matter; it does not belong in the workplace!  Back to the manager, as he was openly homosexual, he embraced all the biases claptrap and accused me of being racist and homophobic.quote-mans-inhumanity

Of which, I am neither.  When informed that I am neither homophobic nor racist, sexist, genderist, etc., I was told he was observing my unconscious biases and claiming that I was not biased was actually declaring I was heavily biased.  He then went so far as to write me up for being biased.  At the time, I had not studied the research on biases and could not counter his charges.  This manager chose to stand inside personal space for the guys on his team, but not the females, which was sexual harassment, but the business refused to think this was sexual harassment.  That this manager continually rubbed himself against the guys on his team was also rejected as sexual harassment.quote-mans-inhumanity-2

I have learned much since this incident, and I want to help those in similar situations understand a few pieces of the language plasticity that goes into the bias arguments.  I will be clear that if a heterosexual male rubs against a female, which is considered sexual harassment, then the same is true for a homosexual, regardless of gender.  Being uncomfortable with being touched is not an indication of bias, simply an expression of a personal preference.

Unconscious Bias

3-direectional-balanceBog-standard bias is considered as attitudes, behaviors, and actions that are prejudiced in favor or opposition to a person, group, or thing.  But, here is the clincher, bias is judged by others as a projection of themselves when they encounter other people, places, or things.  If you think you have a handle on the language of biases, an unconscious bias is also called an implicit bias.  Implicit bias is described as bias that occurs automatically and unintentionally, that nevertheless affects judgments, decisions, and behaviors, however just to keep you in the dark, implicit biases are also stereotypes.  In social identity theory, an implicit bias or implicit stereotype is the pre-reflective attribution of particular qualities by an individual to a social out-group member. Implicit stereotypes are shaped by experience and learned associations between certain qualities and social categories, including race or gender.

Now, if you think you finally have a grasp on biases, stereotypes, and preferences, we add the final straw to the argument.  Biases and stereotypes are judged by an observer using their understanding, education, experience, and opinions as a projection upon you and your actions, behaviors, and attitudes as a lens to understand the world around them.  Thus, my not saying “Good Morning” to my manager was projecting his own biased thinking and homophobia, declaring my actions are homophobic slurs.  In reality, I am not a morning person and generally do not talk to anyone, spouse included, before 0800.  Walking in at 0400 to begin a shift in a call center meant my cherub-like demeanor had not woken up yet, and silence was the only policy.

Bias Self-AuditingWhy

In my email box, I have an email that includes a self-audit of bias for managers.  Before continuing, consider what you know about bias.  Bias is the thoughts, feelings, ideas, and visions of another person, project upon you and your actions, attitudes, and behaviors, so the person projecting can understand the world.  I cleaned up the obvious grammatical errors, not that this improved the material very much.

How and to whom do you delegate work?

            • By giving specific tasks to one team member, am I depriving another team member of a growth opportunity?
            • Am I giving the same level of detail, and therefore equally setting each team member up for success when I assign projects?

End goal: Ensuring that everyone has an equal chance to take on challenging and meaningful projects

How do you give feedback to different direct reports?

            • Am I delivering feedback casually to some team members and formally to others?
            • Do I soften critiques for some team members more than others?

End goal: Making sure you’re delivering feedback equitably.

Any generalizations you make about team members.

            • What kind of assumptions am I making about team members based on age, ethnic background, race, gender, sexual orientation, religion, appearance, or anything else?
            • Do my assumptions impact how I feel about their capability and competency?

End goal: Minimizing the perpetuation of stereotypes while practicing and displaying empathy.

Who do you praise publicly, and who do not praise publicly?

            • Is there a personal motivation behind team members I praise publicly and those for whom I withhold praise?
            • Do I limit the exposure of my compliments for some team members and show my appreciation more widely for others?

End goal: Ensuring that you’re sharing accolades fairly.

How and with whom do you exchange casual banter?

            • Do I have friendly conversations or share memes with some teammates more than others? How might that affect workplace alliances?
            • Do some teammates feel alienated or marginalized by witnessing my apparent affinity for other teammates?

End goal: Avoiding outsized allegiances with people based on your shared perspective to the detriment of developing relationships with others with different viewpoints.

Who do you go to for advice?

            • Do I go to the same people time and time again for mentorship? Do they look like me?
            • Are there people to whom I could go for advice and a more expansive perspective?

End goal: Avoid making decisions based only on the feedback shared in an echo chamber.

Consider these statements with me for a moment as part of a discussion on biases.  Feel free to leave your comments in the space provided below this article.  When I need advice, my manager is younger than I am, but has years of experience in the company.  His boss is older than I am by a little bit.  They both look like me.  Does this automatically mean that I must sacrifice talents, skills, abilities, and tenure because the information comes from someone who looks like I do?  No, logic screams.  But the emotional immaturity of those casting biased aspersion will claim yes.Anton Ego

When I first arrived on my ship USS Barry (DDG 52), my second-class petty officers were two white males, one black male, and one black female.  For competence, I went to the black female as she displayed the most leadership—the two white males were involved in their own relationships and were rarely available to answer questions.  The black male did not possess the maturity to answer questions.  The first-class petty officers were three white males, two of whom embodied immaturity, and our chief… well, let’s not speak ill of the dead.  If I acted as these bias audits claim, my Navy career would have been disastrous, for I would have rejected competency and maturity for race, gender, and incompetence.

Suggestions, Ideas, and Thoughts

Stop seeing race, gender, nationality, and other lines of separation.  These are distractions cast upon everyone by foul oppressors who see these lines of separation and project their inadequacies upon everyone else.  It is perfectly acceptable not to have biases and claim you have no preferences.  I do not care about your gender, race, color, creed, religion, handicap status, or anything else.  I care only about your competency, and if I can help you, or you can help me increase competency, let’s work together!cropped-rocks-in-a-stream-2.jpg

Believe that you are a good person!  I know those projecting their inadequacies and claiming you have biases are profoundly pernicious in their approaches.  But, when you have confidence that you are doing the best you can, you can rest easy when these pernicious oppressors begin to attempt to humiliate you.  In the movie “The Sound of Music,” there is a song called “I Have Confidence.”  When you need reminding of your goodness, play this song, and sing along at the top of your lungs!  I promise you will feel better!

When you treat everyone as you desire to be treated, without fear and with confidence, you will always have loyal people at your back to support you.  If you live by implicit bias and fear, the whole world will never trust you, and you will not have confidence in yourself.  Those who oppress want you miserable; deny them that opportunity!Knowledge Check!

Living without biases is possible, is easy, but is sometimes not very convenient.  But, as Mr. Miagi said in the original “Karate Kid,” “Man who walks in street, gets squished like grape.”  Dr. Seuss is right, “Be the best you, you can be.”  Stop allowing the oppressors into your mind; they are not worth your time.

© 2021 M. Dave Salisbury
All Rights Reserved
The images used herein were obtained in the public domain; this author holds no copyright to the images displayed.