Abstract
The U.S. Department of Veterans Affairs (VA) operates the largest integrated health
care system within the United States. VA budgets continue to escalate in an environment
of heightened financial prudence and accountability. Despite having received many
awards in areas from patient satisfaction and safety to product innovations, like
any health care system, the VA is not immune to ethical conflict that requires exploration
and evaluation. Several VA dermatologists, including section chiefs, were interviewed,
and their responses to ethical complexities encountered or anticipated were analyzed
in fictional case scenarios. Five morally concerning issues were highlighted. These
include (1) providing care in a teaching setting with limited resources to a patient
population with few other health care alternatives; (2) stereotyping patients, altogether
an uncommon act, is possibly easier to do in the VA and has the potential to negatively
affect patient care; (3) service-related disability claim cases often include medical
opinion and findings documented in the medical record when judgments are made, thus
the VA physician can have a significant effect on the outcome of these claims; (4)
whether the VA provides a setting for apathetic physicians to thrive or instead allows
for a more meaningful work experience and then how to manage the subpar performer;
(5) except for the treatment of HIV lipodystrophy with injectables, primary cosmetic
procedures are prohibited at the VA and can lead to difficulties for the VA dermatologist
attempting to comply in a era where dermatology is being more closely associated with
cosmesis.
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Article info
Footnotes
☆This article expresses the opinion of the authors and in no way represents the Veterans Administration or the United States government.
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Published by Elsevier Inc.
