I was reading the October 10 edition of The Rensselaer Polytechnic and noted that the Student Health Center had been critiqued on the editorial page. Specifically, the news editor who wrote the article “Sickly Students Suffer” presented two primary concerns: the Health Center not providing excuses for illnesses that have already passed (or all illnesses), and the Health Center scheduling patients by appointments rather than on a walk-in basis. The news editor offered some additional suggestions regarding improvements to the Student Health Center. I would like to use this space to respond to these concerns and suggestions.
The underlying principle of the Student Health Center’s medical excuse policy, which has long been available on our website (the author of the editorial had suggested it was not on our website), is to ensure that health care services are available to students who are in true need of medical care. It is an ineffective use of Student Health Center resources when medical appointments are used by students who are facing, or have experienced, a minor illness, that can be effectively managed with self-care, but they access care solely for the purpose of obtaining an excuse from a class, exam, or assignment. My belief that writing notes for all students who ask for a note would lead to our truly ill students being unable to access care is based on facts from another university where I worked. At this university, the number of visits when notes for only conditions that significantly impair daily functioning were given compared to when the policy was notes for any and all stated illnesses was 27,000 visits a year versus 41,000 visits a year respectively. This is a 51 percent increase in Health Center use just for notes.
We strongly believe we are here to serve the health care needs of the student body. We use our medical excuse policy to effectively focus on this goal. By limiting the issuance of excuses to very specific instances (e.g., medical necessity, isolation from the community) we prevent misuse of our services. As an acknowledgement that both academic expectations and access to health care services are important pieces of this equation for students, we offer students the ability to use discharge instruction sheets as verification of a visit to the health center. This compromise will communicate to faculty that despite the fact that a medical professional is not deeming their condition to warrant medical excuse from participating in academic activities, the student made an attempt to address their health care needs in a time of illness. This approach, which is consistent with the recommendations of the American College Health Association and major universities across the country, has been proven to minimize unnecessary visits and thus be an effective way to steward finite resources.
The article’s author offers a remedy to this limited resource problem: convince the administration to hire several more employees at the Student Health Center. In fact, the administration has supported the steady growth of Student Health Center services, facilities, and staff (medical, counseling and health promotion) under the Rensselaer Plan, and more recently the Clustered Learning Advocacy and Support for Students initiative, to meet the growing health needs of students. Through the careful stewardship of Student Health Fee dollars, in collaboration with input from the Student Health Advisory Committee, we have worked to meet student needs and keep costs down. To add 51 percent more staff to our medical services department as suggested by my experience at another university would add an approximately 30– 40 percent increase to the Student Health Fee. I am not sure I could convince current students or their parents that this was an effective use of their funds.
We believe we have addressed the availability of services through a managed appointment system rather than a walk-in system that improves access to care. When this Health Center utilized a walk-in only system many years ago, student satisfaction with the Student Health Center was about 70 percent. The low satisfaction rate was related to multiple students attempting to access services at the same time, particularly in the afternoon. This led to long wait times and great frustration among students. When we changed to an appointment-only system, our satisfaction ratings soared to over 90 percent. Last year the medical services section received a 91 percent satisfaction rating from students. Scheduling patients allows for a much more even and timely flow, thus leading to higher satisfaction. We plan on improving our appointment system further by adding online scheduling by the end of the year so that each student can choose their provider and the appointment time that fits their schedule the best online. Look for more on this in the near future.
We welcome and encourage feedback and suggestions from students. We solicit this information in formal ways such as our patient satisfaction surveys and SHAC meetings, and we invite individual students to bring their issues and concerns directly to staff at the Student Health Center. We have changed many of our procedures or policies in the past based on student suggestions. We would much rather hear concerns first hand through one of these channels rather than reading about them for the first time in a public forum. As such, we have reached out to the author of the October 1 article and shared the above with him prior to this publication. We continue our open door policy and look forward to working with him and all students on ways to improve Health Center services in the years to come.
For any of you who may be wondering exactly what the Student Health Center’s medical excuse policy is you can view it on our website at http://studenthealth.rpi.edu/, then hover over “Health Care Services” and then choose “Medical Excuse” from the list that pops up. Lastly, I would like to thank the Polytechnic staff for allowing me to respond in this edition.