I've had several surgeries in the military and VA systems, including
nose job, impacted (horizontal) wisdom teeth, two hernias, inner ear
removal (tricky stuff deep into bone just short of the brain cavity),
and removal of prostate and half my large intestine. Each was planned
well in advance with a consistent surgeon, and I had a choice among
surgeons. I made sure the more serious surgeries (cranial, prostate,
colon) were done by university teaching hospital surgeons -- generally
the most highly recommended medical providers available -- who worked in
conjunction with the VA (in Albuquerque and Seattle). The surgeons and I
worked together for many weeks -- and I could have changed surgeons at
any time; I was specifically offered that option, including the oncology
department head. I'm sure you should have similar options in the D.C. area.

I've used the VA health system for almost 20 years now, and have been
well impressed with everything but their recovery wards, which seem to
be midieval torture chambers. I've also used several large urban
hospital systems for comparison, and don't see any difference. In fact
many of my VA procedures are farmed out to civilian hospital systems,
and many of the docs I use in VA hospitals are university teaching
hospital staff.

How does your friend find out? He asks. He IS in the VA system, I
presume? He will use it the same way he gets treated for any other
medical problem: make an appointment, talk to the doc, get a workup,
elect a treatment, and pursue it.

I discovered my PC outside the VA system. When my biggest local hospital
balked at dual PC/colon cancer surgery, I Googled the Seattle VA system
220 miles away, discovered it is a major oncology and prostate cancer
center, then phoned their oncology section directly. "I've been
diagnosed with Gleason 8 PC; can you fix me up?" I got an appointment
with a urinary oncologist very quickly, talked to a few surgeons, picked
one, had my local uro check out his reputation, and was roto-rooted
within a month.

If your friend isn't using the VA system for most of his care, he should
check it out. It's SO simple once one is in their system; you call, make
an appointment (or walk in if it's an emergency), get fixed, and walk
away. No paperwork, no money, no hassles UNLESS SOME CLERK SCREWS UP.
Heck, they even pay me to drive there if it's more than about 50 miles
away.

ONE PROBLEM: There are some clucks in their system. I use a very small
local VA clinic for routine stuff like lab tests and prescriptions for
known problems, and the docs there are idiots. I use real civilian/ VA/
military hospitals and specialists for stuff I can't second-guess them on.

I.P.