Some Things You All Should Read

[island doc]

There are some important things you all should read at www.usmedicine.com

There are several very relevant Letters to the Editor in the September 2000 issue. I know that for some that may seem like a long time ago, but history teaches valuable lessons and is a window on the future.

Kudos to Dr. Harold Koenig.

Let the dialogue begin...

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[RichL025]

ALot of good responses there, but alot of whining as well.

Let me qualify this before you pummel me (again) - well, tell you what, let me take away "whining" from the above, I merely betray my background, and I'll use _that_ to shed some light on the problem.

Many of the complaints from the letter-writers seem to be clash-of-cultures. They come in and put on a uniform as physicians, highly-trained professionals who have gone to school for anywhere from 11-16 years of higher education (and maybe more!) before being qualified to "do their job". In the civilian world they are held in high esteem by people in most walks of life, and usually very well compensated for it.

But when they put on a uniform, the first thing the maneuver unit (or garrison) commander sees is a captain or major. Who is frequently fat, out of shape, wearing the uniform sloppily, ignorant of basic military courtesies, and cannot handle a weapon safely. To add insult to injury (in the line's eyes), the physician is higher educated, frequently better-read, and has job prospects on the outside that the average battalion commander lacks. Add to this the natural arrogance that is bred into many medical specialties and you have a recipe for colossal clash of cultures.

Here are some statements that jumped out at me:

In my duty station’s case this is a post commander who is requiring all, docs included, to document PT three times a week, even if the PT test is passed. This is an affront on many different levels. If the standard is being met, what business is it of his?

As a former member of the muddy-boot army, I would commiserate with this poor physician that the line commander doesn't understand the environment he must practice in, but I would point out that this physician obviously feels that just "passing the PT test" is adequate. This is what the army would call the "minimum standard", and the term "minimum standard soldier" is NOT a compliment in the army, trust me!

Furthermore, this bit is rather illustrative:

If the standard is being met, what business is it of his?

Obviously the "clash of cultures" is going both ways here. If the letter writer had spent any time in the military as a non-physician, he would understand what command means, and that the peculiar nature of the military means that EVERYTHING can be considered the commander's "business", ESPESCIALLY the physical fitness of his troops.

(The distinct possibility exists that the garrison commander giving that order was NOT the physicians' commander. In which case there are tactful ways to point out to the commander that the physicians at his clinic do not belong to him.)

Lastly, there has been a movement in the Army (I cannot speak to the Navy or Air Force) to hold physicians to the same standards as other officers for promotion and career advancement. The requirements for military schools and mixes of deployments/overseas tours are not compatible with delivery of medical care in the present workload mix. The Medical Corps has both a peacetime mission (care for dependents) as well as a wartime mission (casualty care). While most combat arms units spend the majority of time training and preparing for the deployments, the Medical Corps is fulfilling the peacetime mission. Time for training (weapons qualification, physical fitness training and testing, common task training-soldier skills, staff schools) is added on top of a full clinical schedule.

Excellent points, but the problem is not the added training, the problem is with the full clinical load. It is inconceivable to the rest of the army that an officer (regardless of branch) feels that all he has to do is his job, and let all that "other, soldier stuff" fall by the wayside permanently.

From the same letter:

At the same time, see how many line officers expect to work anywhere from 4 to 10 nights a month on top of a full daytime work schedule.

Man, that's pretty INSULTING. Not only are there many line officers (and enlisted) who are working 4-10 nights a month, but when they do, they're getting rained on, freezing, and have to help dig a fighting position or repair a tank tread while doing it. No cots in the on-call room.

So before anyone jumps in to pummel me here, please realize that I was just hoping to point out what I feel some of the problems are - and that some of the "dissatisfaction" stems from failure of some medical practitioners to appreciate what it means when they put on a uniform. Maybe we can all lay the blame at the feet of the recruiters (always a convenient target), but I find it somewhat odd that people so intelligent in one field of endeavor can be so naive in another....

Flame away....

 

[ARguy]

ALot of good responses there, but alot of whining as well.

Let me qualify this before you pummel me (again) - well, tell you what, let me take away "whining" from the above, I merely betray my background, and I'll use _that_ to shed some light on the problem.

Many of the complaints from the letter-writers seem to be clash-of-cultures. They come in and put on a uniform as physicians, highly-trained professionals who have gone to school for anywhere from 11-16 years of higher education (and maybe more!) before being qualified to "do their job". In the civilian world they are held in high esteem by people in most walks of life, and usually very well compensated for it.

But when they put on a uniform, the first thing the maneuver unit (or garrison) commander sees is a captain or major. Who is frequently fat, out of shape, wearing the uniform sloppily, ignorant of basic military courtesies, and cannot handle a weapon safely. To add insult to injury (in the line's eyes), the physician is higher educated, frequently better-read, and has job prospects on the outside that the average battalion commander lacks. Add to this the natural arrogance that is bred into many medical specialties and you have a recipe for colossal clash of cultures.

Here are some statements that jumped out at me:
As a former member of the muddy-boot army, I would commiserate with this poor physician that the line commander doesn't understand the environment he must practice in, but I would point out that this physician obviously feels that just "passing the PT test" is adequate. This is what the army would call the "minimum standard", and the term "minimum standard soldier" is NOT a compliment in the army, trust me!

Furthermore, this bit is rather illustrative: Obviously the "clash of cultures" is going both ways here. If the letter writer had spent any time in the military as a non-physician, he would understand what command means, and that the peculiar nature of the military means that EVERYTHING can be considered the commander's "business", ESPESCIALLY the physical fitness of his troops.

(The distinct possibility exists that the garrison commander giving that order was NOT the physicians' commander. In which case there are tactful ways to point out to the commander that the physicians at his clinic do not belong to him.)



Excellent points, but the problem is not the added training, the problem is with the full clinical load. It is inconceivable to the rest of the army that an officer (regardless of branch) feels that all he has to do is his job, and let all that "other, soldier stuff" fall by the wayside permanently.

From the same letter:

Man, that's pretty INSULTING. Not only are there many line officers (and enlisted) who are working 4-10 nights a month, but when they do, they're getting rained on, freezing, and have to help dig a fighting position or repair a tank tread while doing it. No cots in the on-call room.

So before anyone jumps in to pummel me here, please realize that I was just hoping to point out what I feel some of the problems are - and that some of the "dissatisfaction" stems from failure of some medical practitioners to appreciate what it means when they put on a uniform. Maybe we can all lay the blame at the feet of the recruiters (always a convenient target), but I find it somewhat odd that people so intelligent in one field of endeavor can be so naive in another....

Flame away....

As a former enlisted dude I'd say you hit the nail right on the head, Rich. I was shocked at the comments of some of the crybabies on here. Back when I was in we used a phrase I think all of the guys doing military medicine should learn, "Suck it up." If you don't want to deal with the military then don't do the HPSP program. Period. If you do use the program, then shut your mouth and do your job. Uncle Sam paid your way through school and is giving you invaluable training that employers will seek out if/when you enter the civilian workforce. If you feel like you were "suckered" into the program by recruiters or by false advertising then I guess you're not as smart and as well-educated as you think you are. I'm not saying the system isn't f'ed up or that things don't need to be fixed. What I'm saying is have some class. The best example you can set for those you work with is to stop the constant whining and treat your patients to the best of your ability. Now I know I'll be torched for saying this and I'll get the "you don't know what it's like man" or any of a number of responses from people that places blame anywhere other than on themselves. That's fine, I can deal with adversity. I'm a true military man.

 

[USAFdoc]

As a former enlisted dude I'd say you hit the nail right on the head, Rich. I was shocked at the comments of some of the crybabies on here. Back when I was in we used a phrase I think all of the guys doing military medicine should learn, "Suck it up." If you don't want to deal with the military then don't do the HPSP program. Period. If you do use the program, then shut your mouth and do your job. Uncle Sam paid your way through school and is giving you invaluable training that employers will seek out if/when you enter the civilian workforce. If you feel like you were "suckered" into the program by recruiters or by false advertising then I guess you're not as smart and as well-educated as you think you are. I'm not saying the system isn't f'ed up or that things don't need to be fixed. What I'm saying is have some class. The best example you can set for those you work with is to stop the constant whining and treat your patients to the best of your ability. Now I know I'll be torched for saying this and I'll get the "you don't know what it's like man" or any of a number of responses from people that places blame anywhere other than on themselves. That's fine, I can deal with adversity. I'm a true military man.

rebuttle;

1) Whether uncle Sam paid my way or not is NO EXCUSE to run a healthcare system as poorly as described elsewhere on this site, and it is ADMIN and not the docs that are running the healthcare system.
2)As a former enlisted guy, I would say you just missed the nail and smashed your finger by stating that an officer should just be a "yes man" and ignore the state of the heathcare system. You need only read various other memos from former Surgeon Generals, Commanders etc, that support what myself and other docs (officers not afraid to take your criticism or that of superior officers) are stating about military med. The easy way is to look the other away when you see waste and mismanagement, unecessary poor patient outcomes etc. That appears to be the way you advocate.
3)Some people on this site continue to think that if military docs would just work hard and stop pointing out deficiencies in the system, that all would be well. What a pipe dream that is! Myself and other docs are not expecting perfection from our military healthcare system, but there are certain things that just cannot be tolerated in either a civilian or military healthcare system

 

[USAFdoc]

ALot of good responses there, but alot of whining as well.

Let me qualify this before you pummel me (again) - well, tell you what, let me take away "whining" from the above, I merely betray my background, and I'll use _that_ to shed some light on the problem.

Many of the complaints from the letter-writers seem to be clash-of-cultures. They come in and put on a uniform as physicians, highly-trained professionals who have gone to school for anywhere from 11-16 years of higher education (and maybe more!) before being qualified to "do their job". In the civilian world they are held in high esteem by people in most walks of life, and usually very well compensated for it.

But when they put on a uniform, the first thing the maneuver unit (or garrison) commander sees is a captain or major. Who is frequently fat, out of shape, wearing the uniform sloppily, ignorant of basic military courtesies, and cannot handle a weapon safely. To add insult to injury (in the line's eyes), the physician is higher educated, frequently better-read, and has job prospects on the outside that the average battalion commander lacks. Add to this the natural arrogance that is bred into many medical specialties and you have a recipe for colossal clash of cultures.

Here are some statements that jumped out at me:
As a former member of the muddy-boot army, I would commiserate with this poor physician that the line commander doesn't understand the environment he must practice in, but I would point out that this physician obviously feels that just "passing the PT test" is adequate. This is what the army would call the "minimum standard", and the term "minimum standard soldier" is NOT a compliment in the army, trust me!

Furthermore, this bit is rather illustrative: Obviously the "clash of cultures" is going both ways here. If the letter writer had spent any time in the military as a non-physician, he would understand what command means, and that the peculiar nature of the military means that EVERYTHING can be considered the commander's "business", ESPESCIALLY the physical fitness of his troops.

(The distinct possibility exists that the garrison commander giving that order was NOT the physicians' commander. In which case there are tactful ways to point out to the commander that the physicians at his clinic do not belong to him.)



Excellent points, but the problem is not the added training, the problem is with the full clinical load. It is inconceivable to the rest of the army that an officer (regardless of branch) feels that all he has to do is his job, and let all that "other, soldier stuff" fall by the wayside permanently.

From the same letter:

Man, that's pretty INSULTING. Not only are there many line officers (and enlisted) who are working 4-10 nights a month, but when they do, they're getting rained on, freezing, and have to help dig a fighting position or repair a tank tread while doing it. No cots in the on-call room.

So before anyone jumps in to pummel me here, please realize that I was just hoping to point out what I feel some of the problems are - and that some of the "dissatisfaction" stems from failure of some medical practitioners to appreciate what it means when they put on a uniform. Maybe we can all lay the blame at the feet of the recruiters (always a convenient target), but I find it somewhat odd that people so intelligent in one field of endeavor can be so naive in another....

Flame away....

rebuttle;
1) PT and work hours are the LEAST of current military medicine problems, so your above discussion/opinion is somewhat unimportant in my opinion.

2)"clash of cultures" is a nice way to put it. I would say that the clash is between high achieving, self motivated, excellence demanding physicians that are trying their best to function and serve in a low acheiving, poorly efficient, mediocre-accepting medical care system.....and it frustrates and limits them in delivering the high level of care they could otherwise give.

3) I don't, nor do I think any of the docs here "blame" recruiters, they are just doing their job. I lay the responsibility at the feet of the Surgeon General who untimately designs the system and looks the other way when problems have arisen. Senior admin have presented the same problems to the SG office and still no change years later.

 

[USAFdoc]

ALot of good responses there, but alot of whining as well.

Let me qualify this before you pummel me (again) - well, tell you what, let me take away "whining" from the above, I merely betray my background, and I'll use _that_ to shed some light on the problem.

Many of the complaints from the letter-writers seem to be clash-of-cultures. They come in and put on a uniform as physicians, highly-trained professionals who have gone to school for anywhere from 11-16 years of higher education (and maybe more!) before being qualified to "do their job". In the civilian world they are held in high esteem by people in most walks of life, and usually very well compensated for it.

But when they put on a uniform, the first thing the maneuver unit (or garrison) commander sees is a captain or major. Who is frequently fat, out of shape, wearing the uniform sloppily, ignorant of basic military courtesies, and cannot handle a weapon safely. To add insult to injury (in the line's eyes), the physician is higher educated, frequently better-read, and has job prospects on the outside that the average battalion commander lacks. Add to this the natural arrogance that is bred into many medical specialties and you have a recipe for colossal clash of cultures.

Here are some statements that jumped out at me:
As a former member of the muddy-boot army, I would commiserate with this poor physician that the line commander doesn't understand the environment he must practice in, but I would point out that this physician obviously feels that just "passing the PT test" is adequate. This is what the army would call the "minimum standard", and the term "minimum standard soldier" is NOT a compliment in the army, trust me!

Furthermore, this bit is rather illustrative: Obviously the "clash of cultures" is going both ways here. If the letter writer had spent any time in the military as a non-physician, he would understand what command means, and that the peculiar nature of the military means that EVERYTHING can be considered the commander's "business", ESPESCIALLY the physical fitness of his troops.

(The distinct possibility exists that the garrison commander giving that order was NOT the physicians' commander. In which case there are tactful ways to point out to the commander that the physicians at his clinic do not belong to him.)



Excellent points, but the problem is not the added training, the problem is with the full clinical load. It is inconceivable to the rest of the army that an officer (regardless of branch) feels that all he has to do is his job, and let all that "other, soldier stuff" fall by the wayside permanently.

From the same letter:

Man, that's pretty INSULTING. Not only are there many line officers (and enlisted) who are working 4-10 nights a month, but when they do, they're getting rained on, freezing, and have to help dig a fighting position or repair a tank tread while doing it. No cots in the on-call room.

So before anyone jumps in to pummel me here, please realize that I was just hoping to point out what I feel some of the problems are - and that some of the "dissatisfaction" stems from failure of some medical practitioners to appreciate what it means when they put on a uniform. Maybe we can all lay the blame at the feet of the recruiters (always a convenient target), but I find it somewhat odd that people so intelligent in one field of endeavor can be so naive in another....

Flame away....

rebuttle;
1) PT and work hours are the LEAST of current military medicine problems, so your above discussion/opinion is somewhat unimportant in my opinion.

2)"clash of cultures" is a nice way to put it. I would say that the clash is between high achieving, self motivated, excellence demanding physicians that are trying their best to function and serve in a low acheiving, poorly efficient, mediocre-accepting medical care system.....and it frustrates and limits them in delivering the high level of care they could otherwise give.

3) I don't, nor do I think any of the docs here "blame" recruiters, they are just doing their job. I lay the responsibility at the feet of the Surgeon General who untimately designs the system and looks the other way when problems have arisen. Senior admin have presented the same problems to the SG office and still no change years later.

 

[militarymd]

I'm a true military man.

Good for you.

 

[USAFdoc]

I'm a true military man.[/QUOTE]

wow, will you be signing autographs anytime soon?

 

[RichL025]

rebuttle;
1) PT and work hours are the LEAST of current military medicine problems, so your above discussion/opinion is somewhat unimportant in my opinion.

2)"clash of cultures" is a nice way to put it. I would say that the clash is between high achieving, self motivated, excellence demanding physicians that are trying their best to function and serve in a low acheiving, poorly efficient, mediocre-accepting medical care system.....and it frustrates and limits them in delivering the high level of care they could otherwise give.

And that's great that there are so many motivated, excellent physicians (I have met many of them).

But when those same physicians mix in their (valid) complaints about the system with requests for special treatment, exemption from PT (and *ahem, height and weight standards no doubt) and every other facet of being a military officer, who the heck is going to LISTEN to their complaints?????

When they, in the same breath, extoll how no one else in the army could possibly work as hard as THEY do (and, heavens forbid, these doctors have to work nights sometimes!!!!!! ), when they complain about pesky commanders actually trying to command them (the nerve!), well, is it any wonder their complaints have fallen on deaf ears????

I would go one step further and say that some of their failure to reform military medicine has been their own fault, by deliberatly flaunting the system they supposedly are trying to help fix.

This does not , of course, apply to all (or even most, I'm sure) military physicians who complain about their system.... but I'll tell you, from 19 years of military service, if I were to count the officers I have seen who were fat, out of shape, couldn't wear the uniform, and had absolutely ZERO idea of military discipline ("call me Bill."), well, ALL of them were in the medical corps.

 

[DieselDoctor]

ALot of good responses there, but alot of whining as well.

Let me qualify this before you pummel me (again) - well, tell you what, let me take away "whining" from the above, I merely betray my background, and I'll use _that_ to shed some light on the problem.
..........
So before anyone jumps in to pummel me here, please realize that I was just hoping to point out what I feel some of the problems are - and that some of the "dissatisfaction" stems from failure of some medical practitioners to appreciate what it means when they put on a uniform. Maybe we can all lay the blame at the feet of the recruiters (always a convenient target), but I find it somewhat odd that people so intelligent in one field of endeavor can be so naive in another....

Flame away....

RichL025 - great post. I'm a former enlisted man, and have been reading this forum to try and decide if I should go for the HSPS and pursue military medicine. Your post was very insightful and has helped assuage some fears I've had about military medicine.

 

[militarymd]

if I were to count the officers I have seen who were fat, out of shape, couldn't wear the uniform, and had absolutely ZERO idea of military discipline ("call me Bill."), well, ALL of them were in the medical corps.

And they are usually the senior leadershp in the medical corps

 

[USAFdoc]

And that's great that there are so many motivated, excellent physicians (I have met many of them).

But when those same physicians mix in their (valid) complaints about the system with requests for special treatment, exemption from PT (and *ahem, height and weight standards no doubt) and every other facet of being a military officer, who the heck is going to LISTEN to their complaints?????

When they, in the same breath, extoll how no one else in the army could possibly work as hard as THEY do (and, heavens forbid, these doctors have to work nights sometimes!!!!!! ), when they complain about pesky commanders actually trying to command them (the nerve!), well, is it any wonder their complaints have fallen on deaf ears????

I would go one step further and say that some of their failure to reform military medicine has been their own fault, by deliberatly flaunting the system they supposedly are trying to help fix.

This does not , of course, apply to all (or even most, I'm sure) military physicians who complain about their system.... but I'll tell you, from 19 years of military service, if I were to count the officers I have seen who were fat, out of shape, couldn't wear the uniform, and had absolutely ZERO idea of military discipline ("call me Bill."), well, ALL of them were in the medical corps.

nearly all of the docs at my last base were in excellent shape; I am still kickin it and beating the 18 year old at hoops and ran the 1 1/2 mile in 11 -12 minutes. But your focusing on PT etc. misses the point. And who said other officers (non medical) aren't bustin their butt also? As a family doc, I get to discuss lots of mil stuff with lots of different officers, and it seemed to me that alot of officers were getting "burned out" and either looking fwd to that 20 year point or getting out. Many senior Colonels (my patients) also voiced their displeasure with the current state of the USAF and the continued pressure to do more and more with less and less and how that has adversely affected shop morale and retention. The USAF "no longer takes care of their own" was a frequent quote.

 

[RichL025]

nearly all of the docs at my last base were in excellent shape; I am still kickin it and beating the 18 year old at hoops and ran the 1 1/2 mile in 11 -12 minutes. But your focusing on PT etc. misses the point. And who said other officers (non medical) aren't bustin their butt also? As a family doc, I get to discuss lots of mil stuff with lots of different officers, and it seemed to me that alot of officers were getting "burned out" and either looking fwd to that 20 year point or getting out....

That's excellent that you & the other docs at your last base took being a military officer seriously.

_I_ was not focussing on PT, the letter writer I was.... "critiquing" was. What I was focussing on was the failure of many military physicians to appreciate the fact that they are soldiers (sailors, airmen) and officers in addition to physicians.

As for the other officers "not busting their butts", that was another direct quote from one of the letter writers in the OP's link, above.

 

[Mirror Form]

As a former enlisted dude I'd say you hit the nail right on the head, Rich. I was shocked at the comments of some of the crybabies on here. Back when I was in we used a phrase I think all of the guys doing military medicine should learn, "Suck it up." If you don't want to deal with the military then don't do the HPSP program. Period. If you do use the program, then shut your mouth and do your job. Uncle Sam paid your way through school and is giving you invaluable training that employers will seek out if/when you enter the civilian workforce. If you feel like you were "suckered" into the program by recruiters or by false advertising then I guess you're not as smart and as well-educated as you think you are. I'm not saying the system isn't f'ed up or that things don't need to be fixed. What I'm saying is have some class. The best example you can set for those you work with is to stop the constant whining and treat your patients to the best of your ability. Now I know I'll be torched for saying this and I'll get the "you don't know what it's like man" or any of a number of responses from people that places blame anywhere other than on themselves. That's fine, I can deal with adversity. I'm a true military man.

It's funny that you finished your post by saying "I'll get the 'you don't know what it's like man'" reponses. I take it that's b/c you know that you don't know what it's like? How much experience do you have a physician in the military? I'm assuming it must be zero b/c you're embarrassing yourself be being so ignorant and presumptous.

Obviously your time spent enlisted qualifies you as an expert on how things should be run in military hospitals and GME programs

 

[ARguy]

It's funny that you finished your post by saying "I'll get the 'you don't know what it's like man'" reponses. I take it that's b/c you know that you don't know what it's like? How much experience do you have a physician in the military? I'm assuming it must be zero b/c you're embarrassing yourself be being so ignorant and presumptous.

Obviously your time spent enlisted qualifies you as an expert on how things should be run in military hospitals and GME programs

Not going to go into my background. Just assume I know what I'm talking about. You can say I'm ignorant all you want. It doesn't change the fact that you are one of the biggest whiners on this forum and everybody is getting tired of it. Either do something to fix the situation or stop whining about it.

 

[orbitsurgMD]

Not going to go into my background. Just assume I know what I'm talking about. You can say I'm ignorant all you want. It doesn't change the fact that you are one of the biggest whiners on this forum and everybody is getting tired of it. Either do something to fix the situation or stop whining about it.

If you are former enlisted and now a pre-dental/dental student or practicing dentist, why not say so?

 

[aatrek]

As I sit here on my balcony.. trying to figure out why Arug is so angry.. and really really really trying hard to put my self in his shoes... I find that to get him (and many others in the military) to understand our role as physician is like trying to explain to a person who is born blind what is "blue" or what is "red". Its just not going to happen.

Just remember, "Not everything that can be counted counts, and not everything that counts can be counted."

I am there to help people, save lives, and ease the burden on others. The more time you take from me to do things I was never good at or trained to do, the less time I have to do what I am good at. Hense the state of "mediocrity" that we are in.
It amazes me how the military has embraced the concert of speciliazation in the field, but not in this???

on another note, good to hear from you guys.( USAFDOC , MIl MD .. you guys make me laugh.. every time.. thanks for the comments).

A.
A.
oh.. the quote above is Einstein's.. I just sent it as a comment to a paper that I was editing.. oh.. was the auther not happy..

 

[Mirror Form]

Not going to go into my background. Just assume I know what I'm talking about.

Sorry, but after your last ridiculous post I think that everybody who has much experience in military medicine has already made the obvious assumption that you have no clue as to what you're talking about.

You can say I'm ignorant all you want. It doesn't change the fact that you are one of the biggest whiners on this forum and everybody is getting tired of it. Either do something to fix the situation or stop whining about it.

Wow, I've never heard somebody say "do something to fix the situation" before. Many people on here have already discussed how that's a lot easier said then done. Perhaps you should educate yourself by going back reading some of those threads before barging in here acting like you know everything.