When Stephen Barlow '08 limped out of Health Services after an injury playing intramural soccer his freshman year, he fully believed the providers' diagnosis that he had a sprained ankle. When his ankle failed to improve, his second trip to Health Services led to a referral to an orthopedist, where X-rays proved his alleged sprain to be a full-blown break.
"The orthopedist took an X-ray and looked at it for a bit, and told me it was broken," Barlow, a Herald cartoonist, said. "She said it should have been pretty obvious from an X-ray."
Barlow, who later returned to Health Services for other reasons, said he thinks for the most part Health Services accurately diagnoses and treats common problems, but they should have known earlier to refer him elsewhere for his injury. Next time he gets a sports injury, Barlow said he will probably go elsewhere.
Health Services, which is comprised of four physicians and seven nurse practitioners and physician assistants recruited mostly from the New England area, only provides primary care service. For more complicated cases, the Health Services providers make a "medical decision" to send students to outside sources if they believe a more specialized opinion is needed, said Director of Health Services Edward Wheeler.
"Our emphasis is on primary care, sort of the routine problems and concerns of that particular age group," Wheeler said. "For problems that need a higher level of expertise, we have a rich referral list."
Though most students interviewed by The Herald were pleased with Health Services' quality of care, Barlow is not the only student who felt the providers failed to accurately diagnose his problem. One sophomore, who spoke to The Herald on condition of anonymity, had far less trust in Health Services after multiple visits with four different providers failed to diagnose and treat her mononucleosis. Her sickness ultimately resulted in an emergency trip to the hospital.
"I felt like I had to prove to them that I was sick. I felt like they didn't take me seriously," the sophomore said.
A physician in the ER recommended she visit a Providence general practitioner instead of Health Services so she would receive faster treatment from only one physician. The student said driving the extra distance to the general practitioner is worth avoiding the complications of Health Services on campus.
Like Barlow, Deidrya Jackson '10 visited Health Services after hours for an emergency - but she was satisfied with the result. Jackson felt that the nurse on duty acted appropriately to find the cause of her abdominal pain, which the nurse believed might have been food poisoning or allergies.
"I felt bad because I didn't feel sick anymore by the time I got there," Jackson said. "But the follow-up was excellent. I think I'd be okay about going to them for a more serious problem."
Monica Kunkel, infirmary coordinator of Health Services, urges students to only use after hours care in emergency cases such as Jackson's. Kunkel said students might not be able to receive full treatment after hours, when most services are shut down, and that too many students visiting for minor problems detracts attention from the real emergency cases.
Wheeler said what a student often considers urgent does not fall under the same definition a clinician would use. Wheeler advises students to call, not walk in, after hours.
Katie Lamb '10 visited Health Services after hours last year after hitting her head in the middle of the night and finding herself unable to read a book properly afterwards. They redirected her to the Miriam Hospital for treatment.
"I think given the circumstances of them existing on campus, they do a really good job," Lamb said. "They are very aware of where their boundaries lie and of the services they can't provide."
Health Services tends to refer patients to doctors and specialists with whom they are familiar and have a history of getting patients in quickly. For emergency room situations, providers typically refer students to the Miriam Hospital and Rhode Island Hospital because both are affiliated with the University and the Alpert Medical School, Wheeler said.
Wheeler said many of Health Services' physician referrals are affiliated in some way with the med school. For problems that require more than basic care, patients are often referred to specialists.
"Our focus is primary care. If we think that someone needs care that is beyond the level of services that we provide, such as a typical family practice, we refer them elsewhere," Wheeler said. "It's when we feel that we need a more expert opinion than ours and when we need more help with diagnosis."
For a typical concern, patients will usually be scheduled with a nurse practitioner or a physician's assistant, though a physician is available during daytime hours for consultation, Wheeler said. Many students, like Lisa Gomi '10, are pleased with the care they receive from both nurse practitioners and doctors. Gomi said the providers have been attentive and clear in addressing her concerns.
"The treatment was about what I expected," Gomi said. "It was a little time-consuming, but it was worth it."
Health Services' Kunkel said she realizes that before coming to college, few students have ever been responsible for their own health treatment. Many students come in for similar problems related to respiratory illness, lack of sleep and poor dietary habits, she said.
"It's a bridge time between being an adolescent and an adult. I think that part of what we're able to do here is teach students how to access the healthcare services," Kunkel said.
Working with patients to bridge the gap between adolescence and adulthood draws many of the providers, like Staff Physician Marsha Miller, to Health Services.
"I have many patients that I've followed through maybe eight years, followed very regularly. One of the things I like is establishing relationships, otherwise I'd work in an emergency room," Miller said.
Health Services' size also drew Miller to Brown. Compared to other universities' enormous health care centers, she said Brown's is very manageable, and even intimate.
Despite the smaller size, the University has several services most other colleges cannot provide due to budgetary constraints, said Margaret Klawunn, associate vice president for campus life and dean of student life.
"The fact that we offer the infirmary and the EMS are two features that most schools don't have in terms of their health services," Klawunn said.
The student health fee that all students pay as part of tuition almost entirely funds Health Services, Wheeler said. Because of this fee, the University can afford services such as EMS, the infirmary, health education, nutritionist staffing and psychological services. A very small portion of Health Services' funding comes directly from the University, Wheeler said.
"If you come to Brown you pay the health fee and you can come as much as you want without thinking of paying a co-pay or insurance," he said.
That fee is $306 per semester for the 2007-08 academic year, according to Health Services' Web site.
A number of schools, including many in the Ivy League, require a health services fee. One of the few exceptions is Cornell University and their health service provider, Gannett. University allocation funds roughly 60 percent of Gannett's costs, and charges for visits, which are subsidized by Cornell, cover the rest. A typical visit to Gannett costs a flat fee of $10.
Konstantin Kashin '10, a transfer from Cornell University, was used to the "bureaucracy" of Gannett that meant long waiting times and going through a series of nurses before seeing a provider.
For a cough, Kashin had to go through two nurses at Gannett before seeing a nurse practitioner. Though he was given a same-day appointment, the visit took between four and five hours.
On the other side of the spectrum from Gannett is Middlebury's health services, Parton Health Center. In agreement with the size of the school itself, Parton is staffed by one physician, fourteen registered nurses, and two nurse practitioners, said Terry Jenny, the associate director of the health services. Middlebury lacks an EMS, but has a two-bed infirmary for student use.
Kaitlin Fitzpatrick '10, a transfer from Middlebury, was frustrated by how many times providers at Parton sent her home rather than treating her illnesses directly. Fitzpatrick said she once visited Parton four times for the same illness and never saw the staff physician in her seven to eight total visits to Parton last year.
"If you want to see a real doctor - because there was only one - you had to wait two weeks for an appointment with him," Fitzpatrick said.
Fitzpatrick also noted the difference between the ease of filling prescriptions at Brown compared to Middlebury. At the University, the in-house pharmacy can fill most prescriptions or have them delivered within a day. At Middlebury, Fitzpatrick had to walk more than 15 minutes to the nearest pharmacy in order to have her prescription filled.
"Health Services here is more likely to address the problem sooner and help you... as opposed to Middlebury - they sent you home until you were on your death bed," Fitzpatrick said.
Health Services is externally reviewed every three years by the Joint Commission accrediting organization, said Russell Carey, interim vice president for campus life and student services. The review helps the center stay updated on issues that need to be resolved within the department.
"We are constantly looking at everything that we are doing," Carey said. "Students are not aware of how much work goes into what we do, but we make a very positive impact on students lives and are trying to constantly improve that."
