During the College's reaccreditation process which the New England Association of Schools and Colleges conducted last November several students raised concerns about the quality of medical services offered at Dick's House. Students interviewed by The Dartmouth highlighted long wait times, a low quality of primary care and difficulties understanding the Dartmouth Student Group Health Plan as problems with treatment.
Dick's House is currently undergoing an external review of its services, Director of Health Services Jack Turco said. Nursing Director Charlene Bradley said the process, which will likely be completed by June 30, will hopefully improve the clinic's ability to serve the Dartmouth community.
EXTERNAL REVIEW
Dick's House is currently undergoing an external review process in order to evaluate how it can improve the services it provides students, Bradley said. The review is being conducted by Massachusetts Institute of Technology Medical Director William Kettyle '67, Harvard University Director of Athletics Sports Medicine Francis Wang '88 and Harvard Director of Behavioral Health and Academic Counseling Paul Barreira.
The three reviewers met with staff members and students in April and are currently preparing a report for the College, Bradley said.
Before his departure in August 2009, former Dean of the College Tom Crady encouraged the College to undergo an external review for Dick's House and various other aspects of the institution within the following two years, according to Turco. Turco encouraged acting Dean of the College Sylvia Spears to quickly begin the review for Dick's House to address the need for more space and more staff members, he said. After Spears consulted with College President Jim Yong Kim, Kim quickly supported the idea of the review, according to Turco.
Bradley said the review will likely be presented to the College before June 30, when Spears will vacate her position.
BUDGET CUTS
Wait time for appointments both for mental health services and primary care is one of the most common complaints about Dick's House, Bradley said. Many of these complaints may be the result of significant cuts to the Dick's House operating budget, Turco said. Bradley said he was unable to provide specific numbers for Dick's House's total annual operating budget.
In the wake of College-wide budget reductions, Dick's House laid off its staff psychiatrist, a staff psychologist, various medical records employees, two programming assistants from the Health Promotion department and a "unit tech" who did in-house cleaning, according to Bradley. The two pharmacists now work reduced work weeks and the two in-house information technology staff members have been replaced by one individual. Bradley is currently serving as the acting Administrative and Fiscal Officer while the College determines whether to eliminate the position, she said.
The ramifications of the budget cuts were not obvious when they were first implemented, Turco said. When the first-year dean position was eliminated, students who might have visited a dean for counseling were forced to seek mental health services at Dick's House, Bradley said. Simultaneous cuts to the Deans' Office and Dick's House severely inhibited the College's ability to offer mental health services, contributing to longer wait times for counseling, he said.
"We're starting to realize that cuts in the Dean's Office have an effect on the services we offer," Turco said.
Longer waits for mental health counseling have created a "domino effect," causing longer wait times for primary care appointments as well, Bradley said. Students who would have previously visited the staff psychiatrist, for instance, now "take up the time of the one of the primary care providers," she said.
"If we had the financial ability to hire on more staff, we certainly would do that," Bradley said
Wait times are traditionally longer toward the end of each term because students are more stressed and graduating students use Dick's House services in their final months to take advantage of the Dartmouth Student Group Health Plan, Bradley said.
Dick's House plans to implement an online appointment system next fall, which Bradley said will likely reduce student concerns.
Although students may experience long wait times at Dick's House, wait times for appointments are shorter than what a patient would face in "the outside world," Bradley said.
"We need to meet the needs of those acutely in need before students who want something like to begin birth control," Bradley said.
The small size of Dick's House's physical plant also constrains its ability to accommodate student needs, according Turco.
"It would be very helpful if I had two examining rooms," he said. "When we're busy we only have enough examining rooms for each provider."
Dartmouth currently ranks lowest in the Ivy League in terms of the number of counselors employed per student, after having once ranking near the middle, according to Turco.
PRIMARY CARE
Various students interviewed by The Dartmouth described the quality of primary care they receive from Dick's House as below average compared to the level of care they obtain at home or at Dartmouth-Hitchcock Medical Center.
Students praised the ease of scheduling prompt primary care appointments in cases of sickness and said they were seen promptly by a nurse after requesting a walk-in appointment at Dick's House. In non-urgent cases, it can be more difficult to schedule an appointment, students said. The majority of students, however, described their general comfort level while staying in the Dick's House infirmary as very high.
Other students described dissatisfaction with Dick's House's services, citing misdiagnosis as a major problem with the clinic.
A male member of the Class of 2013 who wished to remain anonymous was diagnosed with swine flu during the height of the swine flu epidemic when he really had a chronic disorder, he said.
"It seemed like they assumed everything was flu, which allowed my newly developed chronic disorder to slip through the cracks," he said. "I heard of other people who had difficulty during this time getting treated for things like pneumonia because they were told they had swine flu."
A female member of the Class of 2014 who has a history of tonsillitis said she explained her situation to Dick's House but was denied prescription medication after a strep throat test came back negative, she said.
Upon returning home, her doctor told her it was one of the worst sinus infections he had seen, she said.
MENTAL HEALTH
Although Dick's House offers mental health services, students often have trouble accessing them in a timely fashion, according to various students interviewed by The Dartmouth.
Many students are told there is a three-week long waiting list to see a Dick's House counselor, according to Katie Edkins '12, president of Active Minds. Although students can see a counselor off campus, this service is not covered by Dartmouth insurance, and the cost may be prohibitive for some students, she said.
Emergency counseling does exist but students aren't properly informed as to what constitutes an emergency, Edkins said.
Edkins said she has noticed an increase in the time needed to make an appointment, noting a corresponding increase in student frustration.
"I think a lot of people understand that it's budgetary, that hiring new people isn't something the College is doing a lot of right now," Edkins said. "I think that being able to address more student concerns more quickly would fix a lot of the other problems that people might have with Dick's House."
Zoe Friedland '12 said she sought counseling from Dick's House after one of her closest friends died in an apartment fire while studying abroad in Paris. Although Dick's House adequately advertises its services to students and provides sufficient medical care, the difficulty making appointments and the ambiguity surrounding emergency counseling visits pose problems for students, she said.
Upon calling Dick's House earlier this year, Friedland was told the wait for an appointment was four and a half weeks, she said, adding that she was never referred to a counselor in the Upper Valley.
"Their decision to make [mental health] seem like a priority, but then to make me wait four and a half weeks, is misleading," Friedland said.
Friedland said she emailed Kim about the issue, and he acknowledged that access to mental health is a problem and told her he was working to address it.
A female member of the Class of 2011 who wished to remain anonymous sought Dick's House counseling during winter 2009 after being raped the summer after her freshman year at Dartmouth, she said.
Although by the end of the term she decided she no longer wanted counseling, the time limit on the counseling she could receive at Dick's House seemed troubling, she said.
"It didn't seem like they gave us real backup," she said. "They said they would refer you to people off campus but that wasn't an option for me financially even if I did want to continue counseling.
A female member of the Class of 2014 who also wished to remain anonymous said she had a positive experience with Dick's House emergency counseling. Upon learning that the wait time for a regular counseling appointment was four to six weeks, she requested an emergency counselor who was "great and a good listener," she said.
Turco said he hopes Dick's House's external review process will remedy the long wait times.
"We want to work in a situation where students have to wait no longer than a week to 10 days [for mental health counseling]," he said.
Turco said he wants to ensure that students have access to more timely "triage" appointments in which they can arrange a meeting with a counselor who gathers a general overview of their issues and refers them to an in-house counselor specializing in those problems.
INSURANCE
Many students have little knowledge regarding how health insurance applies to their own medical situation, according to students interviewed by The Dartmouth.
Elisabeth Ericson '11 was referred to DHMC by Dick's House for allergy testing after experiencing recurring respiratory and sinus infections. When the allergy test came back negative, the doctor suggested an MRI. Ericson who is on the Dartmouth Student Group Insurance Plan was never informed about the cost of the MRI until she received a $1,000 bill in the mail, she said.
"I was 19 and had never been a patient at a hospital," Ericson said. "I assumed that because I had insurance, it would be covered."
Ericson's situation highlights students' lack of access to information regarding health insurance, a reality driven by students' parents handling their health care needs before college, she said.
Ericson suggested that Dick's House provide information to students that outlines health insurance coverage under a variety of circumstances, especially that explains that a significant co-pay could be required of a student on the Dartmouth Student Group Insurance Plan. Although Dick's House currently provides a booklet to students on the College's insurance plan, that information does little to adequately explain the role of insurance in different scenarios, she said.
A female member of the Class of 2011 diagnosed with ADHD this term was referred by Dick's House to an off-campus counselor for treatment following a long wait time for counseling. The Dartmouth Student Group Insurance Plan offers no coverage for ADHD, even though it covers a significant percentage of the costs associated with counseling for other psychological conditions, according to the student. The student's counselor has to describe her condition as "anxiety" on billing forms to the insurance company so that she can receive financial assistance, she said.
Last year, Jennifer McGrew '13 visited Dick's House to obtain vaccinations for her Language Study Abroad in Brazil the following summer. Although she had to pay part of the cost "out of pocket" because not all the vaccinations were covered under her insurance plan, she was never informed about such costs prior to the treatment, she said.
