All Branch Topic (ABT) Another NY times article

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

Kilgoretrout 65

Full Member
10+ Year Member
Joined
Feb 5, 2012
Messages
273
Reaction score
43
Confusing article really. A couple of specific paid claims woven through the thesis that small hospitals provide bad care and then shown data that the big hospitals provide bad care.
 
There is only so much that reading books and articles will give you. There is no substitute for hands-on experience. Doing 2 surgeries a day (1 of them is pimple-ectomy), reading 3 CT scans a day, seeing 4 diabetes patients a week is not going to let you maintain (and certainly NOT increase) your skills. Shut it all down. Leave the major medical centers and open them up to civilians and VA-type patients, Redeploy your doctors to the MEDCENs. Get rid of non-MC (ie nurse) commanders.
 
Last edited:
  • Like
Reactions: 1 users
Members don't see this ad :)
I think this editor has been reading my diary. Some people feel connected to Hemingway, but I feel like the NYT speaks to my personal experiences in a way that others just don't understand.
 
  • Like
Reactions: 1 user
And they make the point that it is difficult to show real data for smaller hospitals because the DOD simply hasn't been tracking it. That in-and-of-itself should make you concerned. I have no doubt that since they started turning over rocks they have probably had anonymous statements about these issues because frankly what they're reporting here is nearly my exact experience with small Army hospitals. And no, I haven't contacted them.....yet.....
 
  • Like
Reactions: 1 users
I think this editor has been reading my diary. Some people feel connected to Hemingway, but I feel like the NYT speaks to my personal experiences in a way that others just don't understand.

My experience precisely. I was literally reading the article aloud in my office.

t-351d with vacations, TDY and weekends/holidays accounted for.
 
Whereas the previous NYT story seemed under-reported, I agree that this one hits many more nails square on the head.

This is the article I want on my Congressional reps desks. This is the article I want the ASD (HA) & SGs to be grilled on the next time they appear before Congress. This is the article I want the Chief of the Medical Corps to address rather than the importance of CCC.
 
  • Like
Reactions: 1 users
I was contacted by a NY Times reporter earlier today and spoke with her for approximately 45 minutes. I took the army to task on a number of issues including horrendous pay for specialists, lack of adequate support staff, rotating hospital commanders every 2 years, making patients wait in OR holding/clinic while physicians donate urine samples for UAs, lack of communciation between outpatient (i.e AHLTA) and inpatient (i.e Essentris) EMRs as well as assigning surgeons as brigade surgeons for 2 years and then putting them back into the OR claiming that not operating for this amount of time doesn't affect one's skills. I also went on the record stating that a nurse should NEVER be the surgeon general and thus in charge of MEDCOM. I hope this string of articles catches legs and causes some actual change, especially since a former hospital commander and surgeon general have also gone on the record. However, I am skeptical at best but feel like I have done my part by going on the record and giving my name and former position.
 
  • Like
Reactions: 3 users
I can't wait to get my chance to speak out. I try to be as honest as possible on this semi-anonymous board, but stuff always has to be held back.
 
I was contacted by a NY Times reporter earlier today and spoke with her for approximately 45 minutes. I took the army to task on a number of issues including horrendous pay for specialists, lack of adequate support staff, rotating hospital commanders every 2 years, making patients wait in OR holding/clinic while physicians donate urine samples for UAs, lack of communciation between outpatient (i.e AHLTA) and inpatient (i.e Essentris) EMRs as well as assigning surgeons as brigade surgeons for 2 years and then putting them back into the OR claiming that not operating for this amount of time doesn't affect one's skills. I also went on the record stating that a nurse should NEVER be the surgeon general and thus in charge of MEDCOM. I hope this string of articles catches legs and causes some actual change, especially since a former hospital commander and surgeon general have also gone on the record. However, I am skeptical at best but feel like I have done my part by going on the record and giving my name and former position.

Thank you for saying what some of us can't say yet.

Did the reporter know about this forum?
 
  • Like
Reactions: 1 user
Thank you for saying what some of us can't say yet.

Did the reporter know about this forum?

She did not know about the forum and I didn't think to tell her but I will send her the link via email.
 
  • Like
Reactions: 1 user
Chonal, for your own sake, I would delete that post if you're still in. I don't believe in the anonymity of this board enough to be sure no one will track you down if you leave the proverbial door ajar. Maybe denali is willing to delete the quote, too.
 
Chonal, for your own sake, I would delete that post if you're still in. I don't believe in the anonymity of this board enough to be sure no one will track you down if you leave the proverbial door ajar. Maybe denali is willing to delete the quote, too.

He's out. Was very vocal about it too. ;)
 
Members don't see this ad :)
She did not know about the forum and I didn't think to tell her but I will send haurehe link via email.
Would you mind not doing this? I don't think I'm particularly negative about the military, but some people on the board are and I don't think they'd like reporters using them as a sources.
 
Would you mind not doing this? I don't think I'm particularly negative about the military, but some people on the board are and I don't think they'd like reporters using them as a sources.

Why? I am quite negative about milmed and I have not made up any of the reasons why I feel that the system needs to be shut down. You may not feel that any of these reasons are that "negative," but that's why they report, and you decide. (I will volunteer my experience as soon as my resignation is effective)
 
Chonal, for your own sake, I would delete that post if you're still in. I don't believe in the anonymity of this board enough to be sure no one will track you down if you leave the proverbial door ajar. Maybe denali is willing to delete the quote, too.

I'm out and I really could care less if what I have to say offends any O6<. It is my 12-year cumulative experience in the Medical Corps (including residency) and I believe it should be heard for the sake of our soldiers more than anybody else.

Out of respect to all who post on this site, I will not tell the reporter about the forum.
 
It's a public forum. I don't see the problem of telling a reporter about it. Honestly, I can't imagine a reporter is going to report on a web forum. But, whatever, I'm not going to run to the NYT to discuss.

I'm done with my Navy time and am quite happy to be done. I'm much busier in my new job, but there's a lot less toxic leadership. The Navy was full of people working hard to keep the deck chairs just right while the Titanic was sinking.

I feel for some of the surgeons who had bad outcomes. I wonder if life was so slow that any excuse to do laparoscopy was worth it. Maybe these surgeons just hadn't learned to understand their own limitations and more importantly the limitations of the facility.

Finally, a lot of people like to give the my story post about their experience. I have not done so yet. My field is pretty small, and I don't mind staying somewhat anonymous. Though it's probably not too hard to figure out who I am. Anyway, as I have a new job, I don't really feel like getting known at the new place as the former military doc who flamed his old hospital. Probably not the best thing to do.
 
I think we would all like leadership to objectively look at the issues. All the platitudes about patient care and patient safety only go so far when your commander has 5 different number one priorities.
The most ironic part of the article to me was when the DoD wanted to shut down a few small hospitals the local congressmen stepped in and wouldn't let them take his/her pork away. Reminds me of when Katrina
flooded Keesler's hospital, a hospital about to be BRAC'd, and instead of condemning the place they fixed it.
 

Lots of anecdote, but not much actual data.

Every hospital has bad outcomes, and there's a story behind every bad outcome. Often that story involves medical errors, which we all know are common, to the tune of a million injuries and 100,000 deaths per year in the US. Anecdotal medical error stories don't tell us much very useful about a place, or a system, or even an individual - yet it's the core of both NYT stories. They sort of make the argument that those errors are more common at military hospitals, but then they (perplexingly) write things like
half of the military hospitals whose surgical data are submitted for outside review had higher than expected rates of surgical complications
I don't know what that means. It sounds like half are below average, leaving half above average? So a large collection of hospitals is ... average?

I don't really know how else to respond to the article. I know one of the places mentioned in the article very well, and without going into any details, there are shadows of events that sort of resemble things I remember happening or hearing about, kind of ... and yet, after spending 5 years there, I left feeling good about the care I provided and witnessed there.
 
This article was much better than the previous one, but NYT is still better at getting angry people to tell their stories than data analysis. It's hard to compare an unspecified sample of civilian hospitals, Walter Reed's, and Fort Polk's patient safety data in the same sentence in any sort of meaningful way. If they had a way of getting higher fidelity data and comparing small, rural military hospitals to small, rural civilian hospitals and still came up with huge differences in care, then there's a lot more bite there. But it seems the military isn't tracking things at a lot of those places and good luck getting all of those civilian hospitals to hand over their data.

Shuttering the small hospitals and concentrating military physicians at the medical centers seems like a common sense idea, but such endeavors get political and messy very quick, which probably has a lot to do with why we have the current situation.
 
perspective from the other side of the fence (6 years Army Infantry at 3 different bases with the three types of Army hospitals: small, medium, and very large). Honestly, it was a total mixed bag. The worst I saw by far were the diploma mill trained mental health providers hired in mass to screen us post-deployment for PTSD. Also dangerous, when I was at a small base (only 1 BC EM doc in the "ER") the outcomes were really bad for Soldiers with heat stroke, rhabdo, etc who were deemed "less severe" and thus treated at the on post facility compared to those triaged as more severe and sent to the major civilian hospital with an ER residency another 15 minutes away. I helped one Soldier contact a civilian attorney after she left through an MEB that was the result of a simple ankle surgery gone horribly wrong (as in it took 3 more surgeries to correct it).
However, it can't help improve things when the concerns of your most important consumers are insane: my old BNE and BDE CDRs made it their personal vendetta to bring "basic Soldiering" into the hospital after a PFC in training got seriously injured and a nurse let her call her parents, who then had the gaul to fly cross country and bring her basic civilian comforts. As my BN CDR lamented to me, "the only thing they give a damn about over there is making people feel good, they could give a rats ass about real Soldiering. Army medicine in the hospitals is a disgrace to the uniform." He is now the G3 of that post...

On the other hand, I and my Soldiers always received excellent primary care as well as mental health treatment from the actual specialists. When I had a significant training injury I was really impressed by the ortho docs at the major medical center and they were part of what inspired me to go into medicine. My wife still raves to civilian women that each OB she encountered was better than any civilian one she has seen. So from the consumer perspective, I would trust getting any procedure I can imagine at the MAMC/BAMC/TAMC of the world. But there were definitely some concerns outside of primary care at the smaller posts, a lot of horror stories about surgeries gone bad, etc.
 
This article is amazing. It accurately pinpoints the frustration of those of us that were (some still are) stuck working in those small sub-par hospitals with a culture of sweeping incidents under the rug in order keep leadership looking good for their 2 year tour.
 
Last edited:
  • Like
Reactions: 1 users
I was contacted by a NY Times reporter earlier today and spoke with her for approximately 45 minutes. I took the army to task on a number of issues including horrendous pay for specialists, lack of adequate support staff, rotating hospital commanders every 2 years, making patients wait in OR holding/clinic while physicians donate urine samples for UAs, lack of communciation between outpatient (i.e AHLTA) and inpatient (i.e Essentris) EMRs as well as assigning surgeons as brigade surgeons for 2 years and then putting them back into the OR claiming that not operating for this amount of time doesn't affect one's skills. I also went on the record stating that a nurse should NEVER be the surgeon general and thus in charge of MEDCOM. I hope this string of articles catches legs and causes some actual change, especially since a former hospital commander and surgeon general have also gone on the record. However, I am skeptical at best but feel like I have done my part by going on the record and giving my name and former position.

this is what is compelling about the story to me. that they have people willing to step forward, be named, and tell it like it is. much more impactful than anecdotes-- enough ex-DCCS, OICs, and commanders step forward and it will be difficult to ignore.

you gave them a lot to chew on, hopefully they do some due diligence.

and as for people worrying about reporters finding the site-- google "military medicine" and see what comes up, lol.

--your friendly neighborhood waving at the NYT reporter reading the forums caveman
 
It's my hope that prospective medical students read articles like what has recently been published in the NY Times as well as opinions on this forum so they realize what a disaster military medicine has become. In the end, the military is about war-fighting and we (physicians) are viewed as monetary liabilities that take money away from bullets, bombs, ships, tanks, etc. That mindset will NEVER change. This is the exact opposite of civilian practice where physicians generate revenue for practcies, surgery centers and hospitals. Is it any wonder why the treatment of doctors in the military is so vastly different than civilian practice (see better salary, preferential parking, free meals, pay for call)?
 
Another article came out in the New York Times today.

This new article sums up my experience as a staff after graduating. There is an emphasis on having bullet points for one's OER to help with promotion. That deputy of whatever is looking for that next job that may springboard a promotion in rank/pay etc. The Commanders, DCCS and all the supporting deputies are rotated every 2 years. Every year there's always an emphasis on meaningless metrics that will help with bullet points on OERs. It's always a race to try to reinvent things and change up policy to show novel thinking instead of just honing and improving operational policies. No one who is serious about being a physician could ever choose to spend a 20+ year career in the military. Those who have long-term obligations (Academy+HPSP, ROTC+HPSP, or USUHS) are unfortunately captive audiences.
 
I'm so so glad this is getting some attention. I routinely saw this stuff. When our CO was spouting lies to the public about our small hospital study changes, the PAO (GS) disagreed. with all of the re-shaping of the entire hospital, there was only one GS job the CO tired to get rid of...teh public affairs officer, no docs, no nurses, no administrators. Just ridiculous.

A co-worker voiced concerns about a hostile workplace and the CO and XO literally FELL ASLEEP in the meeting.

To those, stuck on the inside. The grass really is greener on this side!
 
That was a better article than the preceding ones. Though I have no first hand knowledge of the people or hospitals mentioned and have no opinion on the accuracy ... the comments about promotions having no relation to clinical work or ability are spot on.

A promotion system that works well for the line is wholly unsuited for evaluating and ranking physicians. It leads to situation where newly graduated residents are heavily "encouraged" to take on admin and leadership roles when they should be doing nothing but seeing patients and solidifying / developing clinical skills.

I knew that as a resident, and deliberately focused on clinical work out of residency anyway, and I paid for it. I had positions on a couple of committees, chaired one, was the dept head at a small MTF, but was still 90%+ clinical. It got me passed over for O5 despite EP fitreps, board certification, deploying, 3 years of good care with no sentinel events or significant complications, no problems / PFA failures. Following that failure to select, I sought and was selected for the DSS position, spent most of the next year about 90% non-clinical, and the Navy promoted me.

The Navy invests all this time and money to train doctors and then tries to turn them all into "leaders" right away. It doesn't make sense to me.
 
My favorite fiction is the "core privileges" for IM subspecialists. You aren't allowed to decline them and they included all sorts of procedures that I hadn't done in years (and even
Most general internists hadn't done). But you couldn't say that they shouldn't credential me in cardiac stress tests. Meanwhile I had to argue to get normal GI privileges and justify them. It's a deliberate lie.
 
I saw an orthopod get taken down by the system for trying to protect patients. They went after him via the Credentialing process and that will follow him forever.
 
That article is pretty scary!
I saw an orthopod get taken down by the system for trying to protect patients. They went after him via the Credentialing process and that will follow him forever.
Would you happen to know what are the 'core privileges' for general IM?
Thanks
 
Top