Commander Rappold's article

[texdrake]

Commander Rappold presented some good criticism and some good suggestions. I would like to see more of the same. I have been doing some research into military medicine the last month or so and would like to generate some criticisms and suggestions. Those who have the time, could you please post them here and I will attempt to generate a synopsis from it...

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[aatrek]

texdrake..
good for you.. we need more input into this whole system.
some suggestions:
need to be more specific on what your evaluating. for example: reviewing mil med is like reviewing the US education system! (highschool system sucks, while undergrad is Ok... ).. same with mil med. Note for example on personal utilization: the AF has a much better utilization policy and rotation of personal (esp in the medical fields anyway). As you know,not only are the branches very different.. but also the different sections in military are different.
Take for example, one of the biggest waste of time and money is forcing the "war mentality" on hospital systems in "peaceful areas". Meaning, it would be much more effcient (personal and cost wise) to run hospitals in non-war zones (most of our hospitals) in a civilian fashion and not have to superimpose this whole "we are the military, we have to do it like we do it in the field".. after all, at the end of the day, its nothing but a waste of paper and money and persons. Trust me when I say, it does not perpare anyone for depolyement either..

Best of luck and you I completly agree the CDR R. article was supperb. He just got deployed to Iraq last month I heard! again.
A.

 

[Galo]

The negative aspects of military medicine have been posted alot here already by myself and other physicians based on their experiences. Look at the con thread, and avoid military medicine threads.

Where is the report you are talking about??

Also in reading the above mentioned threads you may see a great dichotomy between people who have experienced the system fully, and people who are either in training, or been in the military a long time, repeatedly attempt to detract from our experience based on their limited or present good experiencel. You just have to read what the printed media says including the goverment itself to get a clear picture that military medicine is not of the same quality it once was. It is a decrepid declining system that is dying a slow death and taking the vast majority of physicians through an experience they just want to get out of.

G

 

[aatrek]

Galo,
I just wanted to clarify that any reservation I have about mil med (same goes for the article I mentioned), and contrary with all the threads in this forum, are with regards to how mil med has failed its patients. NOT how it’s failed its physicians.
As stated many many times prior, we are all adults, and we choose this, so we should just stop crying about it. I can think of a million worst situations, both civilian and global.
What threads in this forum lack, and what the article picks up on, wisely, is how the medical and financial logic of mil med is weak at best, and suicidal at worst.

I hope this clarifies some.
Thanks for your input.
A.

 

[Galo]

Galo,
I just wanted to clarify that any reservation I have about mil med (same goes for the article I mentioned), and contrary with all the threads in this forum, are with regards to how mil med has failed its patients. NOT how it’s failed its physicians.
As stated many many times prior, we are all adults, and we choose this, so we should just stop crying about it. I can think of a million worst situations, both civilian and global.
What threads in this forum lack, and what the article picks up on, wisely, is how the medical and financial logic of mil med is weak at best, and suicidal at worst.

I hope this clarifies some.
Thanks for your input.
A.

Agreed,

However, I think USAFDoc has made it abundantly clear how the failure has led directly to patient harm. I had to work infinitely harder to make sure those things did not happen to my patients, but also saw how physicians who were mediocre in their best day and incompetent most of the time, did directly harm patients.

I do not think the problem will end until the logic that the military uses, is erased from the medical corps.

G

 

[militarymd]

By failing the physicians, mil med is failing its patients.

 

[aatrek]

it seems we all agree here.
I can tell you, that I am currently dealing with putting one of my collegues (in our department) on a remediation program, where he has to run EVERYTHING by either myself or another physician.
You can not imagine the resistance I got from our DSS and XO, even though this mean a lot of work for only two people (myself and my other partner). I honestly told them that I can not in good faith have him treat any patients after all the mistakes he did in the last two months. Sadly, there is no system for this. In fact, the system is such that it acually protects these idiots. The sadest part is that most of these phsyicians have a "judgement" or "personality" issue, thus not easily corrected. Its not like they can just look things up. It more of they just don't know that they are clueless, and thus very very dangerous. They lack the judgement to take care of pts, but even worst, they lack the judgment to know when to ask for help.
Thus the strict program that he has to run even a simple hernia by one of us.

good luck everyone. I guess its a good thing there are people like you guys out there. At least someone care.lol

best of luck to all.
A.

ps. mil md, good to hear from you my friend. how are things?

 

[aatrek]

By failing the physicians, mil med is failing its patients.

very true.

 

[Galo]

very true.

At my last assignment, WPAFB, the pathologist (0-6) was under the exact same provisions. The junior, (but 100%) competent pathologists had to review and read all his reports, and review the specimen before they could be signed out!! The chief of Nuc Med (0-6), could not read stress thalliums. The chief of surgery (0-6), had been investigated TWICE for quality of care issues regarding vascular surgery, the last one resulting in a very clear instruction not to do certain kind of cases, but without credentials oversight, yet he killed a patient with one week left of active duty. A senior cardiologits (0-6), missed an ongoing MI on the deputy wing commander.

My point is that these people thrive in the military system. Their rank protects them like Tony Soprano is protected by being a made man. Do not think for once they are not harming patients.

G

 

[militarymd]

it seems we all agree here.
I can tell you, that I am currently dealing with putting one of my collegues (in our department) on a remediation program, where he has to run EVERYTHING by either myself or another physician.
You can not imagine the resistance I got from our DSS and XO, even though this mean a lot of work for only two people (myself and my other partner). I honestly told them that I can not in good faith have him treat any patients after all the mistakes he did in the last two months. Sadly, there is no system for this. In fact, the system is such that it acually protects these idiots. The sadest part is that most of these phsyicians have a "judgement" or "personality" issue, thus not easily corrected. Its not like they can just look things up. It more of they just don't know that they are clueless, and thus very very dangerous. They lack the judgement to take care of pts, but even worst, they lack the judgment to know when to ask for help.
Thus the strict program that he has to run even a simple hernia by one of us.

good luck everyone. I guess its a good thing there are people like you guys out there. At least someone care.lol

best of luck to all.
A.

ps. mil md, good to hear from you my friend. how are things?

Things are great in Private practice. There is no rank to protect someone. If you bring money to the table, that protects you, but You can't bring money to the table if you aren't competent....Sort of a built in safe guard.

The promotion process in the military assumes competence, so if you hang out long enough, you will become an O-6 with no skills....but lots of rank....

I think the military needs to stress clinical competence MORE.