Coming into health

Perceptions are slow to change. Just ask the people who run Pickens Health Clinic.

For as long as most can remember, students have complained about the on-campus student health services. Horror stories abound, from misdiagnoses to reports of languishing in the waiting area for more than an hour. And despite a concerted effort to address students' infamous frustrations, the negative opinions about Pickens Health Center linger.

Pickens underwent a series of changes last year to ensure quicker and better quality of health care for students. The changes separated both physically and administratively the family and student clinic aspects that the center provides. Students now check in at their own counter, and patients visiting the family clinic are seen by a separate set of health care professionals in a different wing of the building.

"The students that have come in this year do seem to be pleased," said Jean Hanson, assistant director of student health, noting that the number of complaints this year has decreased. She added, however, that "there's still a lot of folks out there who haven't experienced the new [arrangements]."

The student health clinic is designed to

provide primary care functions similar to a family doctor. Just as a family practitioner diagnoses and refers patients to specialists, the student health clinic moves students through the appropriate medical channels.

Traditionally, students have complained most vehemently about misdiagnoses, lengthy waiting times and the clinic's inconvenient location.

But the possibility of misdiagnoses, for starters, is a problem that experts said has always plagued the medical community.

"In short," he wrote in a positing to the duke.general newsgroup, "there are a few good people [at Pickens], but there aren't enough."

Relating to Greenberg's concern is another that is frequently cited by students: that they are not seen by fully trained physicians.

Employing medical students to examine patients, however, is a standard procedure at many student clinics, said Dr. Sam Parrish, director of the student health and wellness center at Johns Hopkins University. In fact, he said, patients seen by medical students may even have a slight advantage because "there are two sets of hands" working on the patient.

Unbeknownst to patients, Christmas explained, medical students fill out a report after conducting their examination and then report their findings and their diagnosis to a doctor. The doctor then evaluates the diagnosis and determines the next course of action.

Moreover, the Pickens' restructuring has enabled the health care professionals that treat students to focus solely on that specific population instead of participating in the family health clinic's general rounds.

"A lot of the misdiagnoses came from people who didn't have a lot of experience dealing with students," said Trinity senior Randy Kenna, student liaison to the Medical Center Board of Trustees and former head of the Student Health Advisory Committee. "By separating the two [clinics], you're getting people who are experts in [student care]."

Students also often claim they have been misdiagnosed when they do not receive what they deem the necessary antibiotics to treat their illness. Christmas said the student health clinic tries to limit the use of antibiotics on viruses because such treatment is simply not effective. Nevertheless, he said, "we're getting second-guessed by students who aren't very medically sophisticated."

Parrish said he has had similar problems at Johns Hopkins. "We spend a good amount of time educating people that antibiotics don't work for viruses," he said.

Complaints are also frequently logged about what many consider excessive waiting times to see a doctor.

Although Christmas said he does not have survey data to document a decrease in waiting time, he noted that anecdotal evidence suggests things are improving. The average student waiting time, he said, is now about 17 minutes. The center has also begun factoring emergencies into its daily schedule and, as a result, a student that must be immediately seen does not disrupt the entire schedule.

Experts outside of the University said the estimated wait is not too bad.

"Many practices agree that they owe people some explanation of a delay more than 20 minutes," said Dr. Harvey Estes, the director of the Kate B. Reynolds Community Practitioner Program of the North Carolina Medical Society Foundation.

Another measures that keeps student health running smoothly has also drawn some complaints from students: If you arrive late for an appointment, the clinic might make you reschedule.

"If you're 15 minutes late and then you're put in our schedule, it really backs up," Christmas said. "We do it primarily because it's not fair to other patients." Students are scheduled every 15 minutes, he explained, meaning that those who arrive late have missed their time slots.

The decreased waiting times and the more specialized care have helped, some students said, but the Pickens' location-a bus ride away for most students-remains an issue.

"The biggest problem with student health services is... the location of where the clinic is," Kenna said.

From a medical vantage point, Christmas said, Pickens' easy access to Hospital North makes it an ideal location, but he agreed that it is in a difficult location for pedestrians. Regardless, he continued, Pickens is not as busy as it should be-in part because of its location.

"We should be seeing more students than we do," he said. "[Additionally,] one of the things we've recognized in the past year or two is that Pickens is far too busy for its size."

To alleviate location and space problems, Christmas said he has suggested to his supervisors that the student health clinic change locations. He emphasized, that it would take at least three to five years before a newly located student clinic would be ready for use.

"It would be nice to have [the clinic] right next to the Chapel," he said, "but I don't think it would ever happen."