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November 5, 2013

Student Health Series Part II: The Services

This is the second installment of a quarter-long series on student health care, the first of which can be read here and the third of which will be published November 19. Where only first names appear, names have been changed to protect the privacy of the sources. 

Last March saw the launch of an anonymous student blog entitled Student Health Horror Stories, the self-proclaimed home of “terrifying tales of abysmal service with UChicago Health and Counseling.”

One submission on the blog was a four-line poem: “Went in knowing I had pink eye and the flu./Told them I had pink eye and the flu./They said I had pink eye and the flu./They prescribed me cough drops.”

Issues that come up repeatedly in the blog include being unable to get an appointment at a desired time, being misdiagnosed, and being treated unkindly by the Student Health Services (SHS) staff.

According to The American Journal of Medicine, 15 percent of all medical cases in the developed world are misdiagnosed, and the National Institute of Medicine estimates that $750 billion is lost each year due to misdiagnoses, excessive administrative spending, and inflated prices. Amid the national conversation about the efficacy of health care, where does the University’s Student Health Services stand?

The state of the SHS

Services at the SHS include medical care visits with any SHS providers, routine physicals, basic lab tests, some STD testing, and some physical therapy testing. They are covered by the Student Life Fee, which is $354 per quarter for College students and $331 per quarter for graduate students.

SHS does not cover most laboratory tests, emergency room care, consultation or treatment by specialists or providers outside SHS, medical supplies, and hospitalization, among other services.

This fall, SHS announced several changes to its operations. An additional physician was hired, bringing the total clinical staff to six physicians and four nurse practitioners who serve between 80 and 130 patients a day, according to Assistant Vice President of Student Health and Counseling Services Alex Lickerman (A.B. '88, M.D. '92).

“Walk-in” hours are now available Monday through Friday for students who call first and cannot make the appointment time offered to them, and Saturday hours are available from 9 a.m. to 1 p.m., which resulted directly from student demand.

Both sides of the spectrum

At the end of winter quarter last year, third-year Ruchi Mahadeshwar developed what seemed like an innocuous cough. After a few days of cough medicines, home remedies, and rest, her cough became bloody, and she started running a fever.

Mahadeshwar made an appointment at SHS, where a nurse practitioner diagnosed her with whooping cough, a highly contagious bacterial disease that commonly affects infants. The nurse practitioner prescribed her antibiotics, and Mahadeshwar trekked to CVS to pick up the prescription. But the CVS pharmacist questioned the diagnosis.

“She was like, ‘Your cough sounds pretty bad; it doesn’t sound like a common virus, but I don’t think it’s whooping cough. I haven’t prescribed this in years. We rarely prescribe this. Do you happen to know another doctor you could go to?’” Mahadeshwar recounted.

Mahadeshwar learned through her own research that whooping cough was highly contagious but remembered that the SHS nurse had made no mention of this. “That’s kind of one of the things that set me off thinking, ‘I don’t think this woman knows what she’s talking [about],’” Mahadeshwar said.

A Chicago native, Mahadeshwar went home to her general physician, who diagnosed her with bronchitis and prescribed her antibiotics. Mahadeshwar recovered within the next two weeks.

In an opposite situation of underdiagnosis, Mary, a third-year, visited SHS last summer with a temperature of 101 degrees and a sore throat and was told that she had a common sore throat. She returned the next day with a 103-degree temperature and had some tests run on her. That weekend, Mary returned to her home in St. Louis to see her pediatrician, who diagnosed her with mononucleosis.

When Mary called on Monday to receive her test results, she was told that the nurse practitioner had left for vacation and that she had not authorized anyone else to release the results.

“I would have had to wait two weeks to find that I actually had mono,” she said. “Then it turns out that my test results from [the University] test showed that I had liver complications that the University didn’t even bother to call and let me know [about].”

When Mary returned to Hyde Park, she established herself as a patient at the University of Chicago Medical Center.

“When I finally became a patient of my physician, she said, ‘Student health is O.K. at handling a cold or stomach virus, but they’re not to be messed with for major health complications,’” Mary said.

Mary also found scheduling at SHS to be difficult. “You have to call as soon as you wake up, 8 a.m. if you want to get in on the actual day of. You shouldn’t have to call at a specific time if you want to be seen by a doctor.”

Lickerman agreed that the best time to call for an appointment is “first thing in the morning before slots start to fill up,” though he claimed that SHS offers students an appointment within 24 hours of their phone call 100 percent of the time.

Not all students have had negative experiences with SHS. For second-year Mosum Shah, SHS has been effective, efficient, and convenient on two occasions. After calling at 8 a.m., Shah said she booked appointments a few hours later with minimal waiting time on both occasions.

“They took the samples that they needed, and they told me exactly what was wrong with me, prescribed me the appropriate medicine, and it was done,” she said. “In all honesty, it felt like I was going to a doctor back home.”

A changing institution

Overall, student opinion of SHS has been varied. According to Lickerman, the results of the latest patient satisfaction survey indicate that 95 percent of students or more are “satisfied” or “very satisfied” with most aspects of SHS. Spanning from July to September, the survey focuses primarily on interactions with personnel, waiting times, and the location and appearance of the clinic. The survey did not ask about diagnostic accuracy.

Recognizing the varied student experiences, Student Health and Counseling Services (SHCS) is expanding the Student Health Advisory Board (SHAB) from six students to 20. SG Vice President for Student Affairs and second-year Jane Huber said she and SG president and fourth-year Michael McCown spoke extensively with administrators at SHCS and wanted to attract more student input.

“The thing is that [SHCS] is so all over the place in terms of students’ experiences and reactions and stuff like that, so I think the idea of institutionalizing a way in which students can get all of their perspectives and experiences heard is really exciting,” Huber said.

There were over 40 applications for SHAB, which is higher than normal for a student committee, according to Huber. Nonetheless, she does not believe SHAB will have all the answers.

“I think it’s going to be a long-term process. I do think it has great powers to make some positive things happen, but I don’t think SHAB is going to be the only solution,” she said.

The Maroon is committed to understanding all aspects of student health care. If you or someone you know has experiences relating to health care on campus, please contact harinijaganathan@uchicago.edu. 

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