Under the observant -- and often pink -- eye of the Dartmouth student body, Dick's House has managed to gain a less-than-desirable reputation despite a reputable staff, plentiful funding and adequate space.
Rumors of misdiagnoses, long waits and inept practitioners infect the perception of college health services -- yet students still overwhelmingly approve of Dick's House.
According to a health-service satisfaction survey conducted last summer by the College, 73 percent of responding students said that their overall experience at Dick's House ranged from good to excellent.
But the reason why the remaining 27 percent, proportionately the size of a class at Dartmouth, were not sufficiently satisfied with the care at Dick's House may lend some substance to the rumors.
"Students should get good care at Dick's House. If we don't give good care to students, it's our problem," Dr. John Turco said.
Bouts of fatigue and nausea compelled Courtney Chandler '05 to visit Dick's House early in Fall term. Clinicians then unexpectedly diagnosed her with depression.
"It's a little hard to be bubbly when you feel like you are going to die," Chandler said.
Even after maintaining that she was not depressed, the clinicians at Dick's House insisted she take anti-depressants. Her condition did not improve with this medication, and she left campus for an extended rest.
While at home, her family doctor said that she had contracted mononucleosis.
Chandler said that she was never seen by one of the four psychologists on staff at Dick's House.
Misdiagnoses, highlighted in part by the treatment of the conjunctivitis outbreak, pervade student perceptions of care at Dick's House. However, Turco believes that purported misdiagnoses are often an issue of semantics.
Schedule conflicts often result in students seeing various doctors while a single illness is being treated. Different clinicians may use different names for the same illness; i.e. an upper respiratory infection becomes bronchitis.
"We need to take into account the continuity of care," said Turco. "Very often, when patients come back, they are being seen at a different stage of the illness. It is very important for the clinician to educate the student that this is the same illness."
Rotating doctors also prevent patients from forming relationships with clinicians, which are particularly important in psychological treatment. Jessica Meed '01 said she was seen by a multitude of doctors during an extended illness that she felt was worsened by the medication Dick's House clinicians prescribed.
Meed said that these clinicians were unreceptive to complaints that she was feeling worse since she began treatment.
"They weren't responsive when I said that the side effects of the medicine were causing more problems than the initial complaint," Meed said.
Unsatisfied students like Meed often complain about clinicians' expertise at Dick's House.
"When the doctor leaves the room to re-examine an x-ray of your rib, and you hear from outside the room, 'yeah, but what is all of this, why is it like that ... ' and the radiologist responds, 'I think that's the rib,' your confidence in professional medicine is slightly shot," Carly Mensch '05 said.
Due to new federal guidelines, patients' requests for antibiotics to treat minor illnesses are more frequently refused, possibly prompting other complaints.
Nurse practitioners, or physician's assistants, attend patients for normal check-ups and appointments, which Turco said is common at most clinics. Some students, who may be accustomed to a family physician, request to see doctors instead of a nurse practitioner.
"For many, many issues, a nurse practitioner is just as equipped to see primary care cases as a doctor," Turco said.
Turco said that one source for many of the complaints against Dick's House stems from patients that do not return to Dick's House when an illness persists. Also, patients may not register complaints, preventing the staff from making progress in problem areas.
Compared to other universities, though, Dartmouth students have a limited range of options for registering complaints. Cornell University has improved its health care through a patient-advocacy program, according to Cornell's Associate Director of Community Relations Sharon Dittman.
At Cornell, students have four tiers of patient advocates to appeal to when a problem arises. All personnel are trained to be advocates, while 12 specially appointed health specialists, including nurse supervisors, doctors and counselors, are available to help patients further. If a patient is still dissatisfied, the patient can appeal to the director of health services or the general office of complaints at Cornell.
Currently, Dick's House is equipped with a suggestion box and a web site advertising an email address for student complaints.
Located within minutes of Dick's House, the Dartmouth-Hitchcock Medical Center provides care for patients requiring resources beyond Dick's House's capabilities. All blood tests and x-rays are also examined at the DHMC. Students under the Dartmouth Student Group Health Plan must pay extra for these services.
Four licensed doctors supervise all nurse practitioners and doctor's assistants. A few paid interns from the Dartmouth Medical School also work at Dick's House in specialized areas such as orthopedics and dermatology.
Counseling at Dick's House, located in the same building as primary care, saw approximately 3,800 visits from students last year. Students who need immediate care are seen the same day, and scheduled appointments have a 10-day waiting list, which is low compared to other colleges.
Dick's House also houses a licensed psychiatrist who can prescribe medication without having students seek outside medical assistance. Health services that lack a psychiatrist must refer students to local practitioners for prescriptions.
Meed commended the women's health doctors at Dick's House who "tended to be really good, and the most rational people I spoke with."
A quiet majority of students are satisfied with the level of care for basic treatments.
"I've had many positive experiences here," Laura Goodrich '05 said. "I've never really had any serious illnesses, but for everything else it has been fine, quick, and I got what I needed."
Dick's House offers a variety of services aside from medical care, including a dietician and a pharmacy that distributes prescription medicine at a comparably low price.
Allison Schumitsch '02's experience with the pharmacy, however, was less than ideal. After getting a prescription filled at the pharmacy, Schumitsch immediately noticed that the pills were a different color than normal.
After the pharmacists briefly "huddled," Schumitsch said that the deviant pills were exchanged for the correct pills without an apology.
Dick's House is certified by state of New Hampshire, the American College Health Association and the New England College Health Association.
Unlike Brown University's health services, Dick's House is not certified by the Joint Commission on Accreditation of Healthcare organizations, the organization that certifies most hospitals and health care centers across the country.
Barbara Fields of Brown's health services said that other accreditation agencies, such as ACHA, do not have as stringent requirements as the JCAHO. Fields added that only 22 universities and colleges are JCAHO certified.
Turco felt that acquiring this accreditation would not improve services at Dick's House.
