It’s all about the money

The Department of Veterans Affairs is apologizing to a veteran who received a voicemail from a facility in El Paso Texas, in which VA employees can be heard speculating that the veteran was seeking to retain his 100% disability rating, when one of them says, “It’s all about the money.” – Task and Purpose, 10/29/2024. https://taskandpurpose.com/news/va-voicemail-investigation-el-paso-texas/

Where to begin about the Veterans Affairs physician caught on tape saying of a patient, “Yeah, it’s all about the money. Trust me, I know this… and again, he probably wants travel pay, too.” This anti-patient, anti-veteran sentiment is troubling, to say the least. It’s the opposite of a therapeutic alliance; the opposite of a patient-physician relationship built on trust. But is it rare? Is it an outlier? That’s a difficult question to answer.

Some of the best physicians in America work at the VA. I’ve trained under them and would gladly have them treat my family members. The same applies to active-duty physicians. The physicians I trust the most would be appalled by this tape.

I can hear you saying, “Hey Hardman, you’re not answering the question. Is this rare or not?”

Truthfully, conversations like these are far too common. They may not occur every day or in every department, but sadly, they do take place. It’s hard to pinpoint the root cause. It involves stress, burnout, and “blowing off steam.” These conversations often stem from witnessing cases where some veterans seem to take advantage of a system designed to give them the benefit of the doubt. That’s the generous explanation.

The less generous reality is that healthcare culture sometimes allows or even encourages an adversarial dynamic between patient and physician. I’ve heard a lot of disturbing commentary over the years, ranging from complaints about “Dr. Google” to false accusations of “drug-seeking behavior” and dismissive phrases like “supratentorial” (a dismissive way of saying that a patient’s complaints are all in his head). And I’ve heard my share of complaints about veterans and final physicals, with physicians complaining that veterans are “trying to pad their records.” This reality is far from confidence inspiring.

But going back to this physician and his caught-on-tape moment. The VA did the right thing by swiftly rejecting his comments. It also did the right thing by announcing its plans to investigate the matter and take appropriate action. But the VA—and all of medicine—needs to go further. We need to take a hard look in the mirror and ask ourselves, “Why did I go into medicine? Why am I in medicine today?” And, most importantly, “Am I treating patients with the respect I would want for my son or daughter, brother or sister, father or mother?”