IDMTs

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
The White Coat Investor

The White Coat Investor

Practicing Doc and Blogger
Verified Member
Partner Organization
Physician
20+ Year Member
Joined
Nov 18, 2002
Messages
5,220
Reaction score
2,436
So, I've been on active duty (EM) for a month now after a civilian residency. I'm working along one day in my urgent care when along comes an IDMT (don't ask me what it stands for) who walks in, scans the rack, grabs a chart and heads into a room to see the patient. Later that day, I find out what an IDMT is. They go to technical school (you know, the enlistee thing where they get trained for a few months on their job) then at some point go back to a 13 week course...after which they are qualified to see patients, diagnosing and treating their illnesses and injuries! 13 weeks! Hell, I've had more than 13 weeks of surgical training and you don't see me taking out any appys. The only rules these guys seem to have are:
1) They can only see active duty patients
2) They're supposed to see "just the colds and easy stuff"
3) They're supposed to run their plan by the physician
4) They can write orders after they talk about them with the doctor

What the hell? Why go to medical school at all? Why even go to COLLEGE?! Look, I've got nothing against a well-trained PA/NP working under appropriate supervision, but these guys don't even have paramedic level training, much less any significant training in the pathophysiology and diagnosis of disease. Anyone had experience with IDMTs, how to utilize them, how to protect your patients from them etc. I'd be interested in hearing it. Is the military so desperate now that it can't even get PAs?
Members don't see this ad.
 
I am not sure what IMDT's are, but I have ahuge amount of experience working with army medics and LPNs. You can let them see the patient, and then go in your self and check their work. They can work to get vital signs and maybe give out OTC meds, but check their work and write a blurb in the charts as well. IT can work to your advantage to get the people with nonacute things seen, but keep an eye on them. Supervision is expected.
 
I have had some Independant Duty Corpsman who were simply outstanding. Don't discount them, they have just paid different dues. They also get paid significantly less than we do.
 
  • Like
Reactions: 1 user
Members don't see this ad :)
the idea is to give the non doctor's the easy stuff so all your contacts are stressful and high risk... That way you can burn out faster by having no lay ups. They can have less actual doctors but the same number of patients. But don't worry, you are still the focus of things when it comes to lawsuits. Who do you think is the sucker whose license is being f'd with? Have you ever heard of somebody suing a high school graduate with a stethoscope or an actual physician who should have stepped in and taken over. Maybe you will get to see how will a Z pack treats congestive heart failure or endocarditis some day.
 
DES- I don't know what service you are in but the idc folks in the navy do a 1 yr course after the basic corpsman school. these guys aren't up to md or pa standards but as far as medics go they are fairly sharp. there were a few idc's in my pa program and they all did very well. they were basically trained as paramedics then taught some basic procedural skills so they can handle basic sick call and things like simple lac repair, ingrown toenails, etc
the ones I met were good at knowing what they didn't know and passing folks up the ladder who did not have a very well defined problem.

from the navy website:

Navy Course: SURFACE FORCE INDEPENDENT DUTY CORPSMAN (IDC)
Length: 52 weeks

Objective: Provides instruction in advanced principles and techniques required to perform duties relating to a medical department, ashore, and at sea, including patient care, first aid and emergency procedures, preventive medicine, industrial safety, and administrative duties, with emphasis on duty independent of a medical officer.

Scope: The training program includes medical history taking and physical examination techniques and procedures, advanced medical and surgical procedures, environmental sanitation and preventive medicine, pharmaceutical mathematics, clerical procedures, fiscal management, and supply management.

"Is the military so desperate now that it can't even get PAs?"
yes, in fact they are. they are offering huge loan repayment and sign on bonuses and great benefits but very few takers. a buddy of mine just signed up for 6 yrs of active reserve(army) and they will give him a 30,000 sign on bonus( 10k/yr x 3 yrs) and pay off 180k in school debt over 6 yrs(he went to private undergrad and pa school ).
 
Help, Is there An IDMT in the House!​

former military said:
the idea is to give the non doctor's the easy stuff so all your contacts are stressful and high risk... That way you can burn out faster by having no lay ups. They can have less actual doctors but the same number of patients.
Click to expand...

Here's the rub: when it comes to patient care, what's the "easy stuff" and what's "a medical/surgical emergency" is not always evident by looking at the chart in a rack on the wall.

8 y.o. in the E.D. with abdominal pain: Gastroenteritis or acute appy? (The Andrews E.D. got this wrong twice in a row with the same patient, until she ruptured).

30 year old AD NCO with chest pain: esophageal spasm, atypical CP, MI, or anterior mediastinal mass? Travis found out that thrombolytics do not fix anterior mediastinal masses (and this was after a cardiologist got involved).

23 year old who got an inadvertent "epi lock" instead of a hep lock in the E.D. with chest pain: anxiety or MI? Everyone was in denial until the enzymes came back positive.

Fussy 2 year old with vomiting and blood in the stool...probably just AGE...anyway, the radiologists refuse to come in to perform a BE to rule out intussusception, the pediatric surgeon is deployed, and the Commanders have been hammering us for sending too many patients downtown, thus draining our pitifully-inadequate budget...I'll just give the parents some rectal tylenol and reassurance...

Even the most experienced, board-certified physicians can get stuff wrong. How much more, then, can non-experienced, non-board-certified, non-physicians get stuff wrong...to the permanent detriment of patients?

Look, it's a major tenet of military medicine that the most experienced physician should be responsible for initial triage of patients, not the least experienced non-M.D., non-RN, non-PA IDMT or housekeeper.

CF. NATO guidance: http://www.nato.int/shape/community...riage "military medicine" "most experienced""

Rules of Surgical Triage:

1) It must be carried by competent and experienced personnel.
2) The most experienced person should be in complete control of the triage process.

I will leave it as an exercise for the rest of you to find references in U.S. textbooks of military medicine that echo the above rules.

I must shamelessly quote from my own U.S. Medicine Letter to the Editor:

http://www.usmedicine.com/article.cfm?articleID=1324&issueID=88

"Ten years from now, our active duty troops, their families, and our honored military retirees will be treated by civilian contractor FMG [foreign medical graduate] physicians and non-physician active duty 'providers'-- the bottom of the barrel caring for the 'tip of the spear.' "

Erratum: Please replace the phrase "Ten years from now" with "tomorrow". The author regrets any undue optimism engendered by his previous phraseology.

Here's the bottom line:
1) Care by non-physicians is cheaper.
2) Active Duty cannot sue for malpractice (note the patient population to whom the IDMT was restricted, for obvious reasons); derivative suits are similarly barred by the Feres Doctrine.
3) Medicine is hard.
4) Patients deserve the best.

Although there are critical and important roles for non-physician health care providers to play, quality medical care cannot be provided without adequate numbers of experienced physicians/surgeons to provide oversight and back-up. It is unfair to PAs, NPs, and IDMTs to expect them to be the "provider" of last resort; it is unfair to M.D.s to expect them to provide oversight to an excessive number of (often higher-ranking) physician "extenders"; and it is unfair to the patients to expect them to know the difference between "Doc Smith, IDMT", "Doc Jones, PA", "Doc Johnson, NP", and "Doc Wilson, Board Certified Family Physician".

No, I do not "Hate" non-physician health care workers; it's in my FAQ:
http://www.medicalcorpse.com/faq.html

Every single day, as a civilian anesthesiologist, I work together with our CRNAs and our PA to provide the best care I know how. All of them, to a person, like working with me, because I give them respect and leeway to do their jobs without excessive micromanagement; BUT I am also always around to bail them out in emergencies, or to serve as a consultant/"textbook" reference for challenging cases. I don't think any one of them would feel more comfortable doing their jobs without my presence; as I always tell the CRNAs and PA: "If you're happy (with the preop workup, anesthetic plan, intraoperative course, post-operative analgesia plan, whatever), that means the patient is happy and safe."

My problem with military medicine in 2006 is that the experienced clinical docs have left the service, are deployed and unavailable, are terminally demoralized and embittered, or were never hired in the first place. Each of you can consider, as an exercise, in which of the above categories you fit.

--
R. Carlton Jones, M.D.
ex-LtCol, USAF, MC
http://www.medicalcorpse.com
 
  • Like
Reactions: 1 user
MedicalCorpse said:


My problem with military medicine in 2006 is that the experienced clinical docs have left the service, are deployed and unavailable, are terminally demoralized and embittered, or were never hired in the first place. Each of you can consider, as an exercise, in which of the above categories you fit.

http://www.medicalcorpse.com​
Click to expand...


I actually fit two categories, deployed, AND terminally demoralized and embittered.

i want out​
 
emedpa said:
DES- I don't know what service you are in but the idc folks in the navy do a 1 yr course after the basic corpsman school. these guys aren't up to md or pa standards but as far as medics go they are fairly sharp. there were a few idc's in my pa program and they all did very well. they were basically trained as paramedics then taught some basic procedural skills so they can handle basic sick call and things like simple lac repair, ingrown toenails, etc).
Click to expand...

I'm in the USAF...the IDMT himself told me 13 weeks and I found him in a back room with a needle halfway into a guy's knee (without anesthesia I might add).

You tell me why an IDMT is performing arthrocentesis...without my knowledge or permission in my UC/ED?

Maybe I've just got a cowboy on my hands, if so well I'll just have to guard the chart rack a bit more closely. At least a one year course gets someone into paramedic league. I've worked with fantastic paramedics (none of which considered in-hospital diagnosis and decision-making part of his scope of practice) but the only thing I've ever encountered in the civilian world with similar length of training is a tech, and where I'm from they're allowed to do EKGs and draw blood, but not start IVs.
 
NavyFP said:
I have had some Independant Duty Corpsman who were simply outstanding. Don't discount them, they have just paid different dues. They also get paid significantly less than we do.
Click to expand...

Perhaps because they spent approximately 10 1/2 less years in school?

While I agree that a certain amount of medical practice is just experience and pattern recognition, I think the PA route is the shortest route to semi-independent practice that I am comfortable with. PA school was designed for people with tons of medical experience but not as much academic schooling as a doc, yet we still expect a college degree and 2 years of formal classwork. We can debate the merits of PAs treating patients all day, but I don't think any reasonable person can argue that they wouldn't mind being treated by an IDMT if they understood exactly what their training consists of.
 
These guys think they know more than they actually do. When I was an active duty pharmacist I got really sick of policing them and stopping them from "prescribing" Accutane and other items that most physicians wouldn't touch unless they were specialists or really knew what they were getting into. Maybe they are ok in field...but for routine sick call, chronic disease state management, womens health issues? Hell no...

The oversight system was functionally non-existent where I was stationed. A physician was required to review 10% of their charts, but even if an error or omission was detected the horse was already out of the barn.
 
PharmD2MD said:
The oversight system was functionally non-existent where I was stationed. A physician was required to review 10% of their charts, but even if an error or omission was detected the horse was already out of the barn.
Click to expand...

In my opinion, as an anesthesiologist who works with CRNAs successfully on a daily basis, IDMTs should be required to run every case past an M.D., just as a resident M.D. is required to do. Is anyone prepared to argue that a Senior Resident in his/her final year of training in any medical specialty has less knowledge of pathophysiology/pharmacotherapy than an IDMT? Then why does an IDMT have the capability of practicing essentially independently? Oh, yeah, it's only active duty that face the risk of assault and arthrocentesis being committed on their persons...and (in unison) THEY can't sue.

One slight problem with my Modest Proposal: a good chunk of the clinically-experienced, honorable military physicians who deeply care about patient safety have left the military; those few who remain simply don't have the time to do their own work PLUS that of an unqualified person. Remember the Laws of the House of God (http://en.wikipedia.org/wiki/The_House_of_God#Laws_of_the_House_of_God):Show me an IDMT who only triples my work and I will kiss his/her feet. Managing the complications of mismanagement takes 10 times longer than correct management from the get go...as the PA at Travis who cut basal cell off a patient's chest in the derm clinic, exposing the sternum without informing the clinic M.D., resulting in osteo, near-sepsis, and sternectomy under GA found out. It's never good when I can look over the drapes and see a patient's entire heart in a facility sans CT surgeons. Sadly, he's probably a Group Commander by now...

--
R
http://www.medicalcorpse.com
 
One slight problem with my Modest Proposal: a good chunk of the clinically-experienced, honorable military physicians who deeply care about patient safety have left the military; those few who remain simply don't have the time to do their own work PLUS that of an unqualified person. Remember the Laws of the House of God (http://en.wikipedia.org/wiki/The_House_of_God#Laws_of_the_House_of_God):Show me an IDMT who only triples my work and I will kiss his/her feet. Managing the complications of mismanagement takes 10 times longer than correct management from the get go...as the PA at Travis who cut basal cell off a patient's chest in the derm clinic, exposing the sternum without informing the clinic M.D., resulting in osteo, near-sepsis, and sternectomy under GA found out. It's never good when I can look over the drapes and see a patient's entire heart in a facility sans CT surgeons. Sadly, he's probably a Group Commander by now...

--
R
http://www.medicalcorpse.com[/QUOTE]


Rob tell the story about the PA asking our good ENT doc "how can I do it as good or what ever the quote was - that would be good here...
 
7by11thenout said:
Rob tell the story about the PA asking our good ENT doc "how can I do it as good or what ever the quote was - that would be good here...
Click to expand...

Your wish, as always, 7by11, is my command:

It's actually online in the published excerpts from my second book, which I will finish one of these days, as soon as can tear myself away from this entertaining and critically-useful forum:

Adapted from: http://www.medicalcorpse.com/fithexcerpt.html
-------------------------------------------------------------------------
A 7 year old patient comes into the hospital at night bleeding severely after a tonsillectomy several days prior. After we put the patient to sleep, the ENT surgeon allows the PA (physician assistant) to attempt to cauterize the bleeding. The PA is woefully unsuccessful. When the surgeon finally takes over, the PA says: "How could I learn to do this better, the way you do it?"

To which RCJ responds: "Go to medical school, become a physician, do an ENT residency…" --27 Aug 04 2200

The Air Force leadership thinks that they can provide quality care to our troops and their loved ones without providing highly trained (and expensive) specialist physicians. They think that PAs, nurse practitioners, or even techs with minimal training can equal the judgment and competence of (most!) residency-trained doctors. They have been proven wrong time after time (see my other book: http://www.medicalcorpse.com/mmcexcerpt.html).
---------------------------------------------------------------------

I was about thirty seconds away from making a big stink in the Operating Room when the ENT surgeon finally took over the case from the PA. I mean, yes, it was the ENT surgeon's purview to allow his PA to get some experience, but, really, when would a PA be the sole provider in this situation, even on the battlefields of Iran? I really give myself quite a bit of credit for not screaming: "Look, anesthesia does not make children healthier, so please stop the bleeding NOW before I have to transfuse this young man needlessly!" I know that any surgeon, civilian or military, who watched a CRNA attempt to intubate a patient for ten minutes, while the anesthesiologist stood back passively without taking over the laryngoscopy, would go absolutely ballistic and medieval on the buttocks of the anesthesiologist...with good reason. Yet another double standard we "shift workers" have to deal with...to the first approximation, we never tell you how to do your jobs; sadly, every single day in the military, someone without my board certification tried (tried) to tell me how to do my job.

How to Do Anesthesia Preop Evaluation, Physical Examination, and Informed Consent according to one Surgeon:

"Just tell her she could die."
--Dr. D., staff general surgeon, 16 Sep 98 1415, on how carefully to evaluate a patient preoperatively for a fem-pop bypass.

--
R
http://www.medicalcorpse.com
 
Members don't see this ad :)
Just so everyone is aware, every note written by an IDMT requires review and a co-signature by an md. Also, to the pharmacist claiming he/she had to "police" the IDMTs: any medication prescribed by an IDMT which is filled at the pharmacy must also be co-signed by the physician before it can be filled. Nice try guys.

IDMTs aren't by any means specialists and do not claim to be. The idea behind an IDMT is NOT to have someone who can handle all on their own. However, they do try to soak up as much knowledge as possible so when they do find themselves in an austere environment, they can recognize when they need to get their patient to a higher echelon of care. So, rather than picking apart their flaws and lack of training, make it a point to mentor them and fill in the knowledge gaps. Share all the infinite wisdom you walked away from school with so if they do find themselves in a situation, they can do what is best for the patient. Let's face it, with all the AO's the military is occupying right now, there aren't enough physicians to send one to every location. More often than not, IDMTs are the only option.
 
Man, you really showed all of these guys who posted on this thread over 8 years ago. Are you also here to tell us about the upcoming Great Recession?
 
Last edited:
  • Like
Reactions: 1 user
great recession? as long as that senator from illinois doesn't win the presidency we should be ok.

--your friendly neighborhood put some money on the colts caveman
 
  • Like
Reactions: 1 user
Holy 9th grade US History flash back!
 
I've worked with IDC's and I don't believe that they are any inferior to PA/NPs in the outpatient context. That's just my opinion based on a limited sample size.
 
The White Coat Investor said:
So, I've been on active duty (EM) for a month now after a civilian residency. I'm working along one day in my urgent care when along comes an IDMT (don't ask me what it stands for) who walks in, scans the rack, grabs a chart and heads into a room to see the patient. Later that day, I find out what an IDMT is. They go to technical school (you know, the enlistee thing where they get trained for a few months on their job) then at some point go back to a 13 week course...after which they are qualified to see patients, diagnosing and treating their illnesses and injuries! 13 weeks! Hell, I've had more than 13 weeks of surgical training and you don't see me taking out any appys. The only rules these guys seem to have are:
1) They can only see active duty patients
2) They're supposed to see "just the colds and easy stuff"
3) They're supposed to run their plan by the physician
4) They can write orders after they talk about them with the doctor

What the hell? Why go to medical school at all? Why even go to COLLEGE?! Look, I've got nothing against a well-trained PA/NP working under appropriate supervision, but these guys don't even have paramedic level training, much less any significant training in the pathophysiology and diagnosis of disease. Anyone had experience with IDMTs, how to utilize them, how to protect your patients from them etc. I'd be interested in hearing it. Is the military so desperate now that it can't even get PAs?
Click to expand...
Thank you for your genius opinion! Now that you are in the military I'm certain your probably running a hospital now without administrative skills. As you have ascertained the military doesn't give you the option of yes or no in regards to what "they" want. I realize your post is way past old but felt compelled to add a bit of clarity being a former IDMT. A bit of history regarding my experience may help. My first assignment was Wilford Hall in Labor and Delivery in 1985 straight out of tech school. Yup six weeks and knew nothing about it and one of the few males assigned to it at that time.
Had four years of high risk OB experience. Was a scrub tech on an emergency C-section and the 4th year resident cut the woman's bowel that required a bowel resection and hysterectomy after she developed coagulopathy and the senior attending had to come in and repair it. She lost her residency. My experience after a 6 hour surgery was draining because I had NEVER done any surgery assistance coming close to that. Had limited training on instruments albeit 2 weeks in OR having nothing to do with OB. Watched medical student break bag with thick meconium on baby and he had no clue that heart rate was non-existant on Doppler. I was a tech and took it upon myself to yell down the hall to prepare for C-section because he didn't try to put electrode on head. No nurse present. Baby died. 2 years primary care experience after that, 1 year sterile supply, 3 years ER then IDMT school. Choice? No. You either passed the course or you got in trouble. IDMT school was intense and it was 8-5 mon-fri for 4 months. My experience was already suturing, casting, IM injections, medication administration, breathing treatments. First deployment as IDMT? Somalia. Daunting? Well doctor, next time you feel the need to chastise anybody then look no further than your employer, not the guy grabbing the chart. Experience goes ALOT farther than you think and trust me that my training was no where close to what it needed to be to do the job expected of me. Unless your willing to deploy to ****holes and do the job then by all means deploy. All of us do the best we can with what we have and the military decided we as enlisted had to fit that bill. Hell no it wasn't right and still isn't. Now I want that pharmacist to go out in the field with his education and see patients, examine, diagnose, differential diagnosis, and treat with limited equipment or drugs. I am comfortable with my twenty year career as an uneducated provider of patient care because I had too and I harmed no one. In fact very proud of my accomplishments. I assisted with a baby delivery in Somalia on a COT, diagnosed appendicitis on patient after two visits with a DOCTOR, and assisted with his surgery to remove it. Assisted with anencephalics, hydrocephalus, quadruplets, diabetic emergencies, dental emergencies, put temporary fillings, checked water samples, food inspections, Gram stains, urine tests, performed hematocrits,, assisted with pap smears, minor surgeries, removed toenails, packed wounds, trained in medications, head to toe exams, EMT, ACLS, CPR instructed, Ambulance Instructor, IVs, chest tubes. Assisted with sigmoidoscopies, ent, urology and minor surgeries, orthopedic and internal medicine. Anything else you would like to know about IDMTs? What the hell? I've seen my share of ****ty doctors regardless of education. We do/did the best we could and in most cases had no choice.
 
When the ship shifts colors, so much for getting the chart cosigned. Getting advice over the red phone was difficult. Glad they have better communication now.
 
Idmt said:
Thank you for your genius opinion! Now that you are in the military I'm certain your probably running a hospital now without administrative skills. As you have ascertained the military doesn't give you the option of yes or no in regards to what "they" want. I realize your post is way past old but felt compelled to add a bit of clarity being a former IDMT. A bit of history regarding my experience may help. My first assignment was Wilford Hall in Labor and Delivery in 1985 straight out of tech school. Yup six weeks and knew nothing about it and one of the few males assigned to it at that time.
Had four years of high risk OB experience. Was a scrub tech on an emergency C-section and the 4th year resident cut the woman's bowel that required a bowel resection and hysterectomy after she developed coagulopathy and the senior attending had to come in and repair it. She lost her residency. My experience after a 6 hour surgery was draining because I had NEVER done any surgery assistance coming close to that. Had limited training on instruments albeit 2 weeks in OR having nothing to do with OB. Watched medical student break bag with thick meconium on baby and he had no clue that heart rate was non-existant on Doppler. I was a tech and took it upon myself to yell down the hall to prepare for C-section because he didn't try to put electrode on head. No nurse present. Baby died. 2 years primary care experience after that, 1 year sterile supply, 3 years ER then IDMT school. Choice? No. You either passed the course or you got in trouble. IDMT school was intense and it was 8-5 mon-fri for 4 months. My experience was already suturing, casting, IM injections, medication administration, breathing treatments. First deployment as IDMT? Somalia. Daunting? Well doctor, next time you feel the need to chastise anybody then look no further than your employer, not the guy grabbing the chart. Experience goes ALOT farther than you think and trust me that my training was no where close to what it needed to be to do the job expected of me. Unless your willing to deploy to ****holes and do the job then by all means deploy. All of us do the best we can with what we have and the military decided we as enlisted had to fit that bill. Hell no it wasn't right and still isn't. Now I want that pharmacist to go out in the field with his education and see patients, examine, diagnose, differential diagnosis, and treat with limited equipment or drugs. I am comfortable with my twenty year career as an uneducated provider of patient care because I had too and I harmed no one. In fact very proud of my accomplishments. I assisted with a baby delivery in Somalia on a COT, diagnosed appendicitis on patient after two visits with a DOCTOR, and assisted with his surgery to remove it. Assisted with anencephalics, hydrocephalus, quadruplets, diabetic emergencies, dental emergencies, put temporary fillings, checked water samples, food inspections, Gram stains, urine tests, performed hematocrits,, assisted with pap smears, minor surgeries, removed toenails, packed wounds, trained in medications, head to toe exams, EMT, ACLS, CPR instructed, Ambulance Instructor, IVs, chest tubes. Assisted with sigmoidoscopies, ent, urology and minor surgeries, orthopedic and internal medicine. Anything else you would like to know about IDMTs? What the hell? I've seen my share of ****ty doctors regardless of education. We do/did the best we could and in most cases had no choice.
Click to expand...

Good for you!!!!!
tumblr_na049rhtIp1t6cr7go1_500.gif
 
  • Like
Reactions: 3 users
Idmt said:
I am comfortable with my twenty year career as an uneducated provider of patient care because I had too and I harmed no one.
Click to expand...

You harmed no one in 20 years of practicing uneducated medicine? Someone get Dr. House here a commendation medal.
 
  • Like
Reactions: 1 users
Idmt said:
blah blah blah I'm super awesome and don't need no fancy medical degree blah blah blah
Click to expand...

Reminds me of an Onion post... which I will cut n paste here...

I'm Not One Of Those Fancy College-Educated Doctors

I'm a doctor, and I'm damn good at it. Why? Because I learned to be a doctor the old-fashioned way: gumption, elbow grease, and trial and error. I'm not one of these blowhards in a white coat who'll wear your ears out with 10 hours of mumbo-jumbo technical jargon about "diagnosis" this and "prognosis" that, just because he loves the sound of his own voice. No sir. I just get the job done.

Those fancy-pants college-boy doctors are always making a big deal about their "credentials." But I'm no show-off phony with a lot of framed pieces of paper on the wall—I'm the real deal. I got my M.D. on the street. These people think they're suddenly a "doctor" because they memorized a lot of big words and took a bunch of formal tests. But there's plenty of things about being a doctor they'll never learn in their ivory-tower medical school.
For example, did you know that human intestines, if they spill out of the abdomen during surgery, can spool out all over the floor if you're not careful? You won't find that in a book, my friend.

When it comes to practicing medicine, I focus on the basics. In a life-threatening situation, you've got to think on your feet. I don't waste time going on and on about which virus is which or whose blood type is whose. I get out the tools, roll up the shirt sleeves, slick back my hair, and get in there all the way up to the elbows. The patient's not going to magically heal just because you know a lot of complicated terms like "bovine spongiform encephalitis," or "antibiotics."

You want to know where I got my doctor's degree? At the Medical School of Hard Knocks, that's where. No matter what they say, advanced graduate studies won't teach you when somebody needs a shot of whiskey. Yale and Harvard don't tell you when to throw a bucket of water on a patient. And they can never teach you how to tell when someone just needs a good solid punch in the nose to bring them around.
While they were cooped up in some dorm roomreadingabout being a doctor, I was out there in the real world,beinga doctor. And there's no substitute for hands-on experience.

Not to mention, my rates are a hell of a lot more reasonable than what one of those college- and med-school-educated doctors will charge you, because I take out all the bells and whistles. You won't catch me pressuring my customers into paying for expensive MRIs and IV drips and electronic X-Ray Vision machines and who the hell knows what else.

Jesus, you ever look at one of those scans? They're just a lot of crazy shapes. The only sure-fire method for figuring out what's inside a man's body is to go in there and take a look for yourself. And if you want to put a shunt or a valve into a person, you don't rely on gimmicks like tubes and syringes. You get your hands a little dirty, you open them up, and shove it right in there where it belongs.

I hate these elitist doctors almost as much as I hate their Ivy League glee-club buddies, the lawyers. Between their constant "writs" and "summons" and all their hot air about "malpractice" and "licenses," they're enough to drive a man to the point where he can't even practice medicine under his own name anymore, and is forced to pull all his ads from bus-stop benches.

If you need a good doctor, you just keep your ears to the ground, and my name will eventually come up—people know how to get ahold of me. When all is said and done, the customer can tell the difference between a real doctor and some dime-store college-educated phony decked out in stethoscopes and ear-flashing things who's never put in an honest day's work in his life. But me, I'm the real deal, salt of the earth, and I don't need a diploma to tell me that.
 
  • Like
Reactions: 4 users
Idmt said:
Thank you for your genius opinion! Now that you are in the military I'm certain your probably running a hospital now without administrative skills. As you have ascertained the military doesn't give you the option of yes or no in regards to what "they" want. I realize your post is way past old but felt compelled to add a bit of clarity being a former IDMT. A bit of history regarding my experience may help. My first assignment was Wilford Hall in Labor and Delivery in 1985 straight out of tech school. Yup six weeks and knew nothing about it and one of the few males assigned to it at that time.
Had four years of high risk OB experience. Was a scrub tech on an emergency C-section and the 4th year resident cut the woman's bowel that required a bowel resection and hysterectomy after she developed coagulopathy and the senior attending had to come in and repair it. She lost her residency. My experience after a 6 hour surgery was draining because I had NEVER done any surgery assistance coming close to that. Had limited training on instruments albeit 2 weeks in OR having nothing to do with OB. Watched medical student break bag with thick meconium on baby and he had no clue that heart rate was non-existant on Doppler. I was a tech and took it upon myself to yell down the hall to prepare for C-section because he didn't try to put electrode on head. No nurse present. Baby died. 2 years primary care experience after that, 1 year sterile supply, 3 years ER then IDMT school. Choice? No. You either passed the course or you got in trouble. IDMT school was intense and it was 8-5 mon-fri for 4 months. My experience was already suturing, casting, IM injections, medication administration, breathing treatments. First deployment as IDMT? Somalia. Daunting? Well doctor, next time you feel the need to chastise anybody then look no further than your employer, not the guy grabbing the chart. Experience goes ALOT farther than you think and trust me that my training was no where close to what it needed to be to do the job expected of me. Unless your willing to deploy to ****holes and do the job then by all means deploy. All of us do the best we can with what we have and the military decided we as enlisted had to fit that bill. Hell no it wasn't right and still isn't. Now I want that pharmacist to go out in the field with his education and see patients, examine, diagnose, differential diagnosis, and treat with limited equipment or drugs. I am comfortable with my twenty year career as an uneducated provider of patient care because I had too and I harmed no one. In fact very proud of my accomplishments. I assisted with a baby delivery in Somalia on a COT, diagnosed appendicitis on patient after two visits with a DOCTOR, and assisted with his surgery to remove it. Assisted with anencephalics, hydrocephalus, quadruplets, diabetic emergencies, dental emergencies, put temporary fillings, checked water samples, food inspections, Gram stains, urine tests, performed hematocrits,, assisted with pap smears, minor surgeries, removed toenails, packed wounds, trained in medications, head to toe exams, EMT, ACLS, CPR instructed, Ambulance Instructor, IVs, chest tubes. Assisted with sigmoidoscopies, ent, urology and minor surgeries, orthopedic and internal medicine. Anything else you would like to know about IDMTs? What the hell? I've seen my share of ****ty doctors regardless of education. We do/did the best we could and in most cases had no choice.
Click to expand...
You just bragged about participating in dangerously unqualified care to soldiers that deserved better...that's not something to brag about
 
  • Like
Reactions: 1 user
sb247 said:
You just bragged about participating in dangerously unqualified care to soldiers that deserved better...that's not something to brag about
Click to expand...
He did his best in whatever situation he came upon, and is confusing his honorable service during which he thinks everything went OK, to be evidence that the system that put him in that position is just fine. Common logical fallacy 'round these parts, c.f. GMO tours.

Throw in some defensive shoulder-chippiness as he perceives insult, and there you go.
 
  • Like
Reactions: 4 users
pgg said:
He did his best in whatever situation he came upon, and is confusing his honorable service during which he thinks everything went OK, to be evidence that the system that put him in that position is just fine. Common logical fallacy 'round these parts, c.f. GMO tours.

Throw in some defensive shoulder-chippiness as he perceives insult, and there you go.
Click to expand...

Comparing a GMO to a seasoned, salty corpsman is unworthy praise. They have years of hands on experience that we could only dream of.
 
  • Like
Reactions: 1 user
j4pac said:
Comparing a GMO to a seasoned, salty corpsman is unworthy praise. They have years of hands on experience that we could only dream of.
Click to expand...
I stand corrected.

If only there were some nurses around, 'cause you know nurses treat the patient, not the disease. On the front lines of healthcare, no less. Long hours. They even work at night! We should just put nurses in charge of healthcare in this country. Oh. Wait. We already have, haven't we?
 
  • Like
Reactions: 1 user
pgg said:
I stand corrected.

If only there were some nurses around, 'cause you know nurses treat the patient, not the disease. On the front lines of healthcare, no less. Long hours. They even work at night! We should just put nurses in charge of healthcare in this country. Oh. Wait. We already have, haven't we?
Click to expand...

As Oncologists say..."Kill the disease or kill the patient."
 
  • Like
Reactions: 1 user
How much experience is usually required to apply to IDMT school? E6 with 10 in? E4 with 5 in? Can you go straight from your A school? I'm curious how they match up to IDCs.
 
How much experience do you think IDCs have?

Just the fact that we have a lower standard of care for AD than everyone else is so incredibly damning. I don't make much of our new friends statement that he never hurt a patient. It's obviously ridiculous but irrelevant to the discussion.
 
  • Like
Reactions: 1 user
Oh, and you are massively selling yourselves short if you think that a GMO provides worse care than an Experienced IDC. I hate the GMO system but at least you can determine sick most of the time.
 
  • Like
Reactions: 1 users
sb247 said:
You just bragged about participating in dangerously unqualified care to soldiers that deserved better...that's not something to brag about
Click to expand...
Just curious, have you worked in OB yet? What I found appalling was a medical student doing a procedure without the resident in the room? You miss that sentence?
 
pgg said:
He did his best in whatever situation he came upon, and is confusing his honorable service during which he thinks everything went OK, to be evidence that the system that put him in that position is just fine. Common logical fallacy 'round these parts, c.f. GMO tours.

Throw in some defensive shoulder-chippiness as he perceives insult, and there you go.
Click to expand...
I beg to differ, the system is not fine. Every patient deserves the best care by the most experienced doctor available, PERIOD. Now tell me how your going to be in 20 places at once? I have yet to hear of any doctor refusing to supervise an IDMT, IDC, PA, NP. why is that? If anything is to change it must come from the doctors. Attacking the messenger is par for the course. I was doing my job, and as I said, to the best of my ability. Never claimed to be a doctor, never claimed experience replaces what doctors must go through to achieve MD. How about somebody in the medic hierchy
take a stand.
 
Idmt said:
Just curious, have you worked in OB yet? What I found appalling was a medical student doing a procedure without the resident in the room? You miss that sentence?
Click to expand...
Your defense for doing tasks you aren't quakified to do should be stronger than listing other people also doing things they aren't qualified to do.......that's not a defense
 
So then you agree with the concerns from 2006 from the OP? Except you said the opposite further up the thread. Now you think that what you've done for your career is unethical but it's other people's job to stop you.

You aren't qualified to discuss supervision policies for physician trainees.
 
  • Like
Reactions: 1 user
sb247 said:
Your defense for doing tasks you aren't quakified to do should be stronger than listing other people also doing things they aren't qualified to do.......that's not a defense
Click to expand...
Aren't qualified to do? AF says I was. You in the military?
 
Gastrapathy said:
So then you agree with the concerns from 2006 from the OP? Except you said the opposite further up the thread. Now you think that what you've done for your career is unethical but it's other people's job to stop you.

You aren't qualified to discuss supervision policies for physician trainees.
Click to expand...
You ARE THE DOCTOR RIGHT? The military tells you what you need to do. No is not an option. I worked under a doctors supervision, and I also agree that the system is broken. Unethical? You broach that subject with the military and see how far you get.
I don't have to be qualified to discuss a medical student doing a procedure he isn't qualified to do, I was there.
 
Perrotfish said:
No one answered my question. How much experience to IDMTs have, on average, in addition to their 4 months of training?
Click to expand...
When I went to course it was at least an NCO, ER experience, an EMT or higher, IV, suture, medication qualified. I retired in 04 so I am sure that has all changed
 
Idmt said:
When I went to course it was at least an NCO, ER experience, an EMT or higher, IV, suture, medication qualified. I retired in 04 so I am sure that has all changed
Click to expand...

Good to know. Sounds like the main difference between an IDC and an IDMT, then, is the length of the education.
 
Perrotfish said:
Good to know. Sounds like the main difference between an IDC and an IDMT, then, is the length of the education.
Click to expand...
Absolutely. They have more education due to their responsibilities on board ship. We on the other hand had docs usually stationed with us or on nearby bases we could contact. Believe me I used them ALOT.
 
You must log in or register to reply here.
Next unread thread

Similar threads

IDMT-2-MD
All Branch Topic (ABT) IDMT selected for EMDP2, questions about USUHS
Replies
18
Views
10K
CTI-2-MD
CTI-2-MD
Top