Editorial: On Dartmouth’s Medical Care and Practices

One of the many shared experiences of the prototypical Dartmouth undergraduate is viral infection with what has become commonly known as “crud” that spreads like wildfire across campus at least once each term. “Frat flu” is a related ailment that is often spoken of—or perhaps coughed—in the same breath. This is the customary self-diagnosis made of an illness that develops following an inordinate amount of time spent in frat basements.

While I think I may safely state that Dartmouth students typically try to persevere through the onset of illnesses as best as they can, ascribing their ailments to one of the aforementioned, a good many students invariably come to find that as time passes they get worse instead of better. Their conclusion: They either never had one of these two “common” Dartmouth sicknesses, or they had one, and it developed into something far nastier. Enter “Dick’s House,” founded in 1927 as the College’s infirmary, and at which appointments cannot be made online for anytime in the near future (you may try for the following week, though, if you would like). 

Dick’s House is open only on weekdays from 8:00am to 4:30pm. Hence, there are not enormous numbers of appointments available from the outset, and certainly not if the desired appointment day is near—as would be the case for most appointment-seeking, sick students. Moreover, experience (confirmed by the website) has shown that a clear majority of students are seen by providers who are not doctors. Some students are seen by nurses. Those sufficiently knowledgeable to call the appointment office to schedule their visit (once no more appointments are shown online) may be able to ensure that they will be seen by a “prescribing provider”—a doctor, perhaps, but far more likely a nurse practitioner (NP) or a physician’s assistant (PA).

These are not necessarily bad practices per se. If a doctor is not immediately available, it is right and proper that students be afforded the care that is available. However, it is utterly fantastic that Dick’s House—on the other side of the street from the Geisel School of Medicine, adjacent to the medical-school admissions office, and one mile from the Dartmouth-Hitchcock Medical Center—should be so bereft of MDs on its functional, daily staff. How about sending a few doctors a day around the corner and over to Dick’s House? 

Should this prove unworkable, how about Dartmouth’s administration make the decision to redirect funding from stacking its non-MD staff at Dick’s House to hiring practicing physicians? If this proves too difficult yet, perhaps among the abundance of retirees in the region can be found several doctors who wouldn’t mind being paid to come in one or two days a week to listen to some poor Dartmouth undergraduate’s wheezy chest.

Absent survey-taking capabilities, anecdotal evidence must be relied upon, and the fact of the matter is that all of the students with whom I have spoken on the matter feel that Dick’s House provides care substantially inferior to that which they receive at home. I agree with them. And of course, the majority of the care at Dick’s House comes from non-MDs.

Studies from the American Medical Association have historically conflicted on the validity of a distinction between the care provided by MDs and NPs/PAs. However, in recent years AMA-reported statistics have provided some demonstration of a distinction throughout the nation. For example, one study last year found that the quality of care afforded by nurse practitioners and physician’s assistants is less than that of doctors on nine out of 10 quality measures. 

Considering the amount of money our families are paying to give us the “best” undergraduate education, surely students should be getting the best medical care too. At present, few appointments are spread among few hours each day. There are no weekend appointments, leaving students to potentially suffer for at least two days, and no appointments can be made over the phone until Monday morning. There are few doctors, and I, many friends, and a substantial number of Dartmouth parents (per their Facebook page) have been left extremely dissatisfied with the non-MD “prescribing provider” staff. Even Dartmouth’s 24/7 on-call nurses have alerted students to the existence of an alternative—a clinic in West Lebanon. And most recently, chest x-rays are no longer offered at Dick’s House, as the relevant technician is on “medical leave.” Students who need chest x-rays need to be walk-ins at Dartmouth Hitchcock. 

Perhaps Dick’s House will be open during Green Key Weekend, as it was during last year’s Green Key, so as to provide care to students suffering from sickness induced by alcohol and from other illnesses too. While a step in the right direction, this will be only a temporary fix. Weekend hours need to be made permanent, more appointments need to be made available, and more physicians need to be hired.