FOCUS: Just what the doctor ordered?

Student Health ServicesStudent Health Servicesreceives mixed feedbackStudent Health Servicesreceives mixed feedbackfrom its patients Cassidy, who said she used Student Health last semester when she was diagnosed with mono, recalled that she almost didn't visit the office. "I was afraid to go because of all the horror stories I'd heard from my friends," she said. But Cassidy was luckier than her peers. She said she had a fairly good experience with Student Health. "I ended up with a really good doctor, so I got that up close and personal feeling that made me feel comfortable," she explained. Most students' experiences at Student Health fall under this category of "fairly good" experiences, according to Engineering senior Vivek Rao, former chairperson of the Student Health Advisory Board. "In general, Student Health has a pretty good reputation," Rao said. "Most of the time, the complaints we get aren't very severe." There is, of course, the occasional exception to the rule. Judging from the buzz among the University community, no matter what Rao said, most students feel the negatives outnumber the positives. Wharton freshman Neysan Rassekh said he began to feel extremely drowsy and ill during his first week at the University. Student Health doctors told him to take Tylenol and get some rest. When that didn't help, he went back again, only to receive the same advice. While out of town, Rassekh became violently ill, ending up in the Georgetown University Medical Center, where he underwent surgery for a rare infection. Physicians at Georgetown told him, that had he been properly diagnosed from the start, surgery would not have been necessary. Cases like these seem to pop up more often than not when the words "Student Health" are mentioned to a group of students. Administrators at Student Health and SHAB members argue that their satisfaction rates are quite high among students, particularly those who have visited the office repeatedly. According to Rao, most of the rumors floating around about Student Health are just that -- rumors. "When something bad happens, that's when you hear about it," he said. "People tell their friends and then the friends tell friends. Before you know it, it's circulating all over campus and every version of the story is different." Rao added that most people who warn others about the service have not actually had a negative experience. "But they do know people who had an awful time there," he added. Rao speculated that the main problems between Student Health and its patients arise from "different expectations of what a student health service should do." Collins said that many students come to college having never had an experience with any doctor other than their family physician. "A lot of problems arise when they expect the same individualized attention and relationship they had with their doctor at home," she said. Collins added that most students' loyalties lay with their family physician until their ties with home have been loosened. In The Beginning? Student Health was founded sometime in the early 1950s, according to Student Health Director Marjeanne Collins. Medical School graduate Paul Schrode was the first director of Student Health, serving for nearly 30 years before retiring in 1976. Since its inception, the service has been a fundamental part of the University health system, providing care to thousands of students and faculty members, Collins said. All Student Health physicians have an appointment in the School of Medicine and hold credentials recognized by the Hospital of the University of Pennsylvania, according to Collins. This double accreditation leaves little room for finding fault with Student Health doctors' credentials, she added. Collins explained that doctors must not only meet Student Health standards -- they must also live up to the expectations of the Medical School and HUP. In addition to licensed physicians, Student Health also employs a number of nurse practitioners who handle less serious cases. Student Health offers clinical services in primary care, sexual health care, psychiatry, women's health, orthopedics, sports medicine, dermatology and podiatry, in addition to its emergency services. In addition, Student Health offers preventive services including allergy shots, weight control, cholesterol and blood pressure screening and various other measures to ensure the physical well being of its patients. Student Health works jointly with HUP to provide lab services to students free of charge. Checkups, testing for sexually transmitted diseases and other primary care appointments are also free to Penn students. "All they are charged for is medication or any in-depth testing they might have to undergo," Collins said. Although Collins said she encourages students to make appointments before coming in, walk-in patients are also welcomed. Student Health attempts to see 50 percent of walk-ins within a half hour of their arrival. However, as many infuriated students will vouch, the wait can end up being anywhere from 15 minutes to more than two hours. College freshman Anton Metlitsky said he walked into Student Health with a cough and signed the patient roster. He was told there were two people in front of him. Two and a half hours later, he was still waiting. When he went to ask about the delay, receptionists told him there was still one person scheduled ahead of him. Student Health officials claim it is operating within appropriate boundaries. In fact, according to Collins, the service actually has higher rates of timeliness than the standards. She also said students who are the sickest take priority within a group of walk-ins. Measures of Improvement The Student Health Advisory Board was formed to handle all complaints filed against Student Health. According to Rao, the majority of the complaints aren't "concrete." "They deal with things like long waits, rude receptionists, physicians who don't devote their full attention to the patient -- things like that," he said. Associate Vice Provost for University Life Larry Moneta noted that receptionists received the lowest ratings out of all Student Health employees. SHAB, which is made up of students who apply to the board, has the jurisdiction to "get rid of nurses or physicians who aren't living up to Student Health standards," according to Rao. The board administers random surveys to gauge students reactions to their Student Health experiences. In the most recent survey, Student Health scored extremely high in the area of "empathy of health care providers" and fairly well in the area of "timeliness of care." In the reception category, however, scores were significantly lower. In response to this obvious displeasure expressed by students, Student Health underwent a complete receptionist staff change over the last two years. It also requires all employees to undergo a quality improvement program which stresses attitudes towards patients, courtesy and eye contact. In addition to SHAB, Student Health is reviewed by its Medical Advisory Board. Also, Student Health implemented a community advisory board made up of students, faculty and staff this year. Student Health Associate Director for Clinical Medicine Evelyn Weiner is in charge of the Quality Assurance Program, one of the systems which continually monitors Student Health's reliability. "[QAP] looks at how we provide care and whether we are meeting the requirements for our service," she said. Weiner added that QAP also monitors medication prescription, watching to make sure medicine is doled out appropriately. The Question of Antibiotics Although telling Rassekh to take Tylenol and get some rest turned out not to be the best advice, many other students hear the similar responses from Student Health. And, as a result, they complain too. A good number of the complaints dealing with medication that Student Health receives read something like, "I went in feeling ill and they didn't give me any medicine," according to Collins. However, according to Brian Strom, who chairs the Medical School's Department of Biostatistics and Epidemiology, this advice is by far the best to give. "Antibiotics tend to be grossly overprescribed," said Strom, who is also the director of the Center for Biostatistics and Epidemiology. According to Strom, viral infections like the "common cold" are not treatable by antibiotics. Penicillin and similar medications are only effective on bacterial infections like strep throat, sinusitis and bronchitis. He said he feels the overprescription of drugs stems from the extreme pressure doctors feel from people who complain that their doctors don't give them medication when they're sick. "They feel like if they don't prescribe the medication, they are going to lose their patients," he explained. Strom added that there are two major downsides to overprescription besides the high prices of the medication. "The first is the extreme risk of adverse effects such as nausea and skin rashes," he said. "Antibiotics are the leading cause of adverse reactions." He added that adverse reactions are very likely to show up in college-age students. The second downfall to overprescription of antibiotics is "the question of changing the natural flora of bacteria," according to Strom. He explained that a new wave of bacteria -- that seems to be unaffected by any sort of antibiotics -- has made itself known in the recent past. "These cases aren't just few and far between anymore," he said. "They're becoming a major problem." Strom added that organisms once vulnerable to drugs such as penicillin are now immune. Collins said Student Health is following the new prevailing trend of not prescribing antibiotics for everyday ailments. "We save those medications for really serious illnesses, those which must have this sort of treatment to get better," she said. Collins added that although Student Health does not have a list of drugs they regularly prescribe, there are approximately 25 drugs that are commonly accepted as being standard treatments. "We keep these items in stock at all times, since we use them a lot," she said. "Most of the students have basic needs we can treat with these drugs." What About Misdiagnosis? Student Health generally has a good reputation for making the correct diagnoses in the majority of cases the office sees, according to Moneta. However, there are occasional mishaps, like Rassekh's case. "I feel these incidents, which are isolated, are probably a simple lack of realization that minor symptoms can progress to major illnesses if not treated," Collins said. Moneta added that misdiagnoses happen once in a while in every health care facility that treats as many patients as Student Health does. "The bottom line is, problems happen, but they happen everywhere," he added. "The number of minuses pale in comparison to the number of people who have had great experiences at [Student Health]."

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