Military Medicine: Find Your Exit Strategy

Fired Via E-Mail, And Other Tales Of Poor Exits
(p. F6)Laid Off/Let Go/RIF'd-- and Insulted Too

By Amy Joyce
Washington Post Staff Writer
Sunday, September 10, 2006; Page F01
http://www.washingtonpost.com/wp-dyn/content/article/2006/09/09/AR2006090900103.html

Fair Use Quote follows:

Management experts agree that there is no great way to fire someone. The
"respectful way is to let someone know in person," said Clay Parcells,
regional manager with Right Management Consultants, a company that helps
workers transition into new careers after they have been fired/downsized /let
go/RIF'd. "No one feels good about being let go, irrespective of if they are
being told in person or in an e-mail. They just gain a lot of respect as an
employer of choice if it's done respectfully."

That respect can help the company's reputation. Done poorly, employees leave
embittered, Siegel said. "They become the greatest unraveler of your best
marketing campaigns and go into the community with nothing but negative
assessments of the employer and make it difficult to recruit any new talent."

Click to expand...

If any of the members of this forum wonder why there seem to be so many
disgruntled ex-military physicians hanging around a medical student forum,
the article above explains a lot.

Several of us were essentially "fired" by the military for speaking out as
patient advocates for quality medical care. Instead of rewarding officers
for their courage and integrity, the U.S. military medical system engaged in vicious
attacks on our professional and personal lives. Some of us were ordered to get
psychological evaluations for being "troublemakers"...this after up to ten years of
successfully treating patients as clinical physicians, and teaching med students as
professors (hard to do with serious psych issues). Some of us got Letters of
Reprimand/Admonishment/Counseling with no prior notice. There was no RESPECTFUL
attempt by administrative coward Colonels and Captains to understand WHY we should
be sacrificing our careers and pensions to speak out for patient safety. There was no
RESPECTFUL attempt to say: "O.K., you found a problem. Here's some responsibility and
authority. You fix it." Instead, what we have found, to a man and a woman, is that the
mindset of those currently in charge of military medicine focuses on neutralizing and
destroying all sources of dissent. It goes beyond kneejerk institutional defensiveness:
it is really a strong, anti-intellectual streak which is positively rewarded by the system,
resulting in the stupidest and most craven attaining the highest positions on the org chart,
while the smartest and bravest flee with the tattered shreds of their personal and professional dignity.

For more on the anti-intellectual nature of the military in general, read
these provocative articles, published, not by a liberal rag, but by the U.S.
Army War College and Army Magazine (a publication of the AUSA):
http://www.carlisle.army.mil/USAWC/PARAMETERS/05winter/mastroia.htm

Occupations, Cultures, and Leadership in the Army and Air Force
by (Reserve LtCol) GEORGE R. MASTROIANNI

"There is an absolutist and anti-intellectual strain in Air Force culture (as
many have observed in military culture more generally) that resonates with a
view of the world as simple and clear. Confidence in the intellectual
superiority of the Air Force over the other services coexists with what
sometimes appears to be contempt for the rough-and-tumble of open
intellectual discourse. The paradox of Air Force culture is that it can be
decidedly anti-intellectual—a circumstance perhaps not uncommon in
authoritarian cultures such as the military—but nevertheless convinced of its
intellectual superiority. This tendency is perhaps stronger in the Air Force
than in the other services.

These aspects of global Air Force culture also affect organizational forms
and penetrate the thinking of the rank and file, implicitly modeling a more
hierarchical, executive, personal model of decisionmaking that shapes the
culture of leadership in the Air Force. The responsibility of the Air Force
for controlling a component of the American strategic nuclear deterrent may
also have led to broad institutional reliance on organizational models
characterized by concentration and elevation of decisionmaking power in
highly centralized structures."

Click to expand...

AND

http://www.ausa.org/webpub/DeptArmyMagazine.nsf/byid/CCRN-6CCS4R

The Uniformed Intellectual and His Place in American Arms: Part I
by COL. LLOYD J. MATTHEWS, USA Ret.

In 1890, U.S. Navy Captain Alfred Thayer Mahan published The Influence of Sea Power
Upon History, 1660-1783, the most influential book ever written by a serving officer
with the arguable exception of Clausewitz's On War. For this feat, his endorsing
officer, Rear Adm. Francis Ramsay, rewarded him on his fitness report with the
following glowing encomium: "It is not the business of a Naval officer to write books."
It is precisely this sort of attitude on the part of the bosses of military intellectuals
that has led such thinkers as H. G. Wells to claim that "the professional military
mind is by necessity an inferior and unimaginative mind; no man of high intellectual
quality would willingly imprison his gifts in such a calling." More amusing than Capt.
Mahan's poor fitness report but no less tragic in its import is this lament
from a Navy officer passed over for promotion: "I cannot understand why I
wasn't selected: I've never run a ship aground; I've never insulted a senior
officer; and I've never contributed [an article] to the Institute's
Proceedings."

Click to expand...

Of note, both articles criticize the Army as well as its sister services.

General Colin Powell asserted in his Powell Doctrine (http://en.wikipedia.org/wiki/Powell_Doctrine)
that the U.S. military needs a plausible exit strategy before committing blood and
treasure to an operation. What is your exit strategy from military medicine?

Hint: the best exit strategy, in warfare and in life, is not to enter a bad situation in the
first place.

--
R. Carlton Jones, M.D.
ex-LtCol, USAF, MC
ex-Medical Director of Anesthesia, Travis AFB, CA
ex-Assistant Chief Anesthesiologist, Andrews AFB, MD
ex-Assistant Professor of Anesthesiology, USUHS
Harvard '85, USUHS '90, WHMC residency 1994
Board-Certified Anesthesiologist since 1995
Patriotic American Civilian Veteran since 1 July 2005

http://www.medicalcorpse.com
webmaster_AT_medicalcorpse_D0T_com

Nemo Me Impune Lacessit, Y'all

So did you quit at 19 years? Or were you fired via email?

Mirror Form said:

So did you quit at 19 years? Or were you fired via email?

Click to expand...

Yes. No. My point is that the military services have mistreated several of the physicians on this forum. I will leave it to individuals to post links to their stories, as they wish. Some were involuntarily separated on bogus pretexts; others, such as myself, felt that, due to our mistreatment and the broken nature of military medicine, we could not in remain in the service and retain our honor, and thus separated voluntarily.

When I got in "trouble" in the military for speaking out, I usually found out about it by sticky note; I still have a notorious one that my spineless Flight Commander left on my computer monitor at Travis: "You have an appt. with Col. X at 1500 tomorrow". Before my first LOR, my absentee landlady Flight Commander called me at home the night before: "You and I have an appointment with Col. 'Rusty' at 0700; I'm sure he just wants to talk. If it were anything bad, he would have told me ahead of time." I never had a commander who possessed the basic humanity to come to my office, sit down, and talk to me physician to physician. They always...always made sure that subordinates were dragged to their personal throne rooms, awed by the majesty of their faux mahogany desks, and cowed by the explicit or implicit threats of UCMJ actions if any further truthful communication regarding problems with medical care in the Squadron/Group escaped the lips of the hapless peon.

When a corporation (or governmental entity) treats its employees poorly at the end of their employment, this creates a long-term bitterness and anger which will...must find form somehow. Some folks probably lose themselves in drink. Others suffer family strife leading to separation/divorce. Yet others sit in front of LCD screens and type monitory phrases into cyberspace, hoping to warn the next generation of idealistic medical students and pre-meds not to replicate our mistakes.

Q.E.D.

--
R
http://www.medicalcorpse.com
Veritas Vos Liberabit

MedicalCorpse said:

It goes beyond kneejerk institutional defensiveness:
it is really a strong, anti-intellectual streak which is positively rewarded by the system...

Click to expand...

Rereading my post, I realize that my intention might be easily misunderstood. I expect that some people reading this will dismiss the sentiment as the snobbish arrogance of a Hahvahd graduate. While there may be a kernel of truth in this (I try to be brutally honest with myself, as well), the essence of my argument is that the military medical establishment is mired in perverse anti-rationality, which is, right now, directly threatening the lives of patients.

I will not bore y'all with a paean to Ayn Rand and Objectivism, and its relationship to my decision to do a John Galt and walk away from the system I loved, but which needed me to leave in order that it might die and be reborn anew. Instead, with regard to my anti-rationality claim above, I would just like to point out that A is A. No matter how many commanders calls and pep rallies and bake sales and photo ops the military arranges, A is not B.

--Doctors are not Nurses.
--Doctors are not Pilots
--Nurses are not Navigators
ergo, the Objective Medical Group is anti-rational

--PAs and NPs are not doctors
--Physician "extenders" without physicians for oversight cannot provide the same quality of care as either physicians alone, or physician "extenders" with oversight
Ergo, the overarching assumption upon which military medicine is based in 2006 is anti-rational (less trained folks providing the same quality of care as the more trained folks who have left)

--3000 patients in a panel is more than 1000
--It's hard enough to provide quality care to 1000 patients, given the lack of support systems in the military
Ergo, it's irrational to expect that an overnight increase in panel size can possibly result in the same, rather than much worse, care.

--Slashing funding for the medical side and transferring it to the line has consequences.
--You can't buy as many hamburgers with $1.00 as you can with $5.00
Why then would the services expect to maintain the same quality of patient care with less money (and personnel, infrastructure, training) as it could when times weren't as "tough" for medical corps funding? Easy: blind irrationality. Do more with less. Suck it up. Service Before Self. Fill in tomorrow's irrational, motivational buzzword _________ here.

--Ordering a soldier to take a hill, at the cost of his life, is part of military service.
--Disobedience on the part of the soldier would be treason.
--Ordering a doctor to tell you how to poison pizza, in violation of the text of the Hippocratic Oath (http://www.medicalcorpse.com/poisonedpizza.html), or to risk his/her patient's life via shoddy medical care, is not part of military service.
--"Disobedience" on the part of the physician when she refuses to tell non-medical types how to poison humans, or when she refuses to give propofol to a patient posturing from increased ICP for pediatric MRB, is, in essence, disobedience of an anti-rational, illegal order.
I was taught, from 1981 forward, that this is what the military expected, nay, demanded of its officers, after the tragic lessons of My Lai had sunk in. Sadly, from 1997 onward, the first Air Force Core Value: "Shut The F*** Up and Do As We Say" trumped all other ethical concerns.

The military paid good money to fill my brain with the knowledge of what is right and what is wrong with respect to medical care of perioperative patients. Asking me to act against my medical judgment is, to paraphrase Rand, like asking me to act against my own sight. It is anti-rational to presume that highly educated physicians will permit rank, position on the org chart, political considerations, or any other ancillary factor to negate their medical judgments. Yet this is precisely the position I was put in time after time, from 1997 onward. "The surgeon wants to do the case, so your objections regarding standards of care written in textbooks of medicine are overruled". I stood up, time after time, to pronounce the one word they would not tolerate.

"I saw that there comes a point, in the defeat of any man of virtue, when his own consent is needed for evil to win-- and that no manner of injury done to him by others can succeed if he chooses to withhold his consent. I saw that I could put an end to your outrages by pronouncing a single word in my mind. I pronounced it. That word was 'No'.

I quit that factory. I quit your world. I made it my job to warn your victims and to give them the method and the weapon to fight you. The method was to refuse to deflect retribution. The weapon was justice."

--Ayn Rand, Atlas Shrugged, p. 960 of Signet edition.

Yes, I quit. I was not fired by e-mail. But the result is the same: because of the mistreatment heaped upon me and many other outspoken, patriotic, dedicated, ex-career military physicians, we have become a medical recruiter's worst nightmare. Our weapons are Truth and Rationality. To those who want me to shut up because they have already signed their rights and lives away in HPSP and USU, I say: I am so very sorry for you. Sadly, I cannot comply, because premeds and undecided med students read these forums...and they MUST hear the truth I experienced for 15 years as an active duty physician.

A is A...and Murder Will Out.

--
Rob Jones, M.D.
http://www.medicalcorpse.com

The military is basically like the Borg empire from Star Trek. It's a socialist system where everyone is exactly the same (haircut, uniform, pay). Any attempt to stand out, question authority or give special treatment bucks the Borg system. Rob how can you change that? It's the nature of any military.

As doctors we are like Borg with special weaponry and we require a little special treatment. The Borgs don't like this they feel threated and confused especially since they don't get treated half as well as we do. We have a little wiggle room to change things but not much.

To me it is a question of understanding the system and making a cost/benefit analysis. I believe my situation is atypical and military medicine worked out for me. I strive to remain a true professional until I leave and will do what I can with the system.

IgD said:

The military is basically like the Borg empire from Star Trek. It's a socialist system where everyone is exactly the same (haircut, uniform, pay). Any attempt to stand out, question authority or give special treatment bucks the Borg system. Rob how can you change that? It's the nature of any military.

Click to expand...

So, resistance is futile? I cannot accept this. The nature of medicine, as 7by11 has pointed out, is radically different from the line: healing people vs. blowing up people and things. If, after 200 years, the U.S. military has not yet found a way to integrate the questioning nature of intelligent physicians (a la Hawkeye Pierce) into the mainstream, then the system has to change. To accept the status quo is to capitulate to the forces which are stripping command billets from doctors, and giving them to non-physicians 4 years of school away from janitors.

Do you think that the founding fathers/mothers of our Republic would want military physicians to accept a "socialist" system whereby any and all dissent is quashed? Is this what our forefathers and foremothers shed their blood for? Good G-d, man, think about what you are saying: you are accepting fascism, plain and simple. As a German-American, this is something, to quote Churchill, up with which I shall not put.

By the way, as you know, special treatment is *always* given to high ranking military/civilian Pentagon types and their spouses...often to their detriment. Generals' wives/husbands get a lower standard of care when their appointments are made through the back door...and forget about Assistant Secretaries of Defense:


The preop clinic calls me at 1000 on a day when I am scheduled to see patients in the preoperative clinic starting at 1300. The nurse tells me that a certain very very high-ranking civilian in the Pentagon is much too busy to see anesthesia preoperatively as the surgeon requested. Instead, his secretary wants to go over the preop questionnaire over the phone in lieu of the patient presenting in person for preoperative evaluation. I explain to the preop nurse the following:

1) I do not know what surgery the patient is having…and we don't have the blue folder which would enlighten us.
2) I do not know why the surgeon specifically consulted anesthesia to see the patient; most healthy patients are seen on the day of surgery. Perhaps the patient is not healthy. We don't know.
3) Without patient records, which are convienently kept at the Pentagon beyond our grasp, I cannot rationally gauge whether the patient needs to see us.
4) Speaking with a secretary is not the same as examining a patient. It would, however, be a HIPAA violation to discuss sensitive medical information with a non-authorized non-relative in a non-emergency situation over the phone.
5) I will have to call the surgeon to find out why he asked this extreme VIP to see anesthesia before I can authorize the patient not to see anesthesia, lest his case be canceled on the day of surgery for inadequate workup. That would not be good.
6) I really don't care that having the patient present to the preop clinic for appropriate evaluation in person would involve an inconvenient motorcade. Our primary duty is to the patient, not the taxpayers who would foot the bill or the motorists who might get stuck in traffic.

After explaining the scenario to my anesthesiologist office-mate, and bemoaning the substandard care that our arrogant VIPs receive due to their adamant desire to game the medical system to assuage their inflated senses of self-importance, I said:

RCJ: "It's just so frickin' substandard!"
DM: "Rob, when do we do anything not substandard?"

--LtCol (Dr.) M., staff anesthesiologist, 28 Sep 04 1348

I am not Locutus...and I refuse to be assimilated. If you and others in the current incarnation of military medicine decide to kowtow to assimilative forces which rob you of the capacity to provide good medical care, then I say: Shame on you for not resisting assimilation. Unlike diamonds, nanites are not forever.

--
R
http://www.medicalcorpse.com

IgD said:

The military is basically like the Borg empire from Star Trek. It's a socialist system where everyone is exactly the same (haircut, uniform, pay). Any attempt to stand out, question authority or give special treatment bucks the Borg system. Rob how can you change that? It's the nature of any military.

As doctors we are like Borg with special weaponry and we require a little special treatment. The Borgs don't like this they feel threated and confused especially since they don't get treated half as well as we do. We have a little wiggle room to change things but not much.

To me it is a question of understanding the system and making a cost/benefit analysis. I believe my situation is atypical and military medicine worked out for me. I strive to remain a true professional until I leave and will do what I can with the system.

Click to expand...

I wonder if after reading Rob's responce you are cringing at having put up such an analogy. Especially in view that you have been 100% secretive about your situation, and despite repeated name calling and lambasting you have yet to elucidate even a tiny bit, other than professing you were some king of chief resident.

You really do not get it. Unfortunately the majority of the people who sign up and have not read this forum do it on the equation of money you so ardently hold on to. IT IS WRONG. Especially if you know what we know. You are whoring yourself into a position where you will find yourself at odds with the profession of a physician and an officer, in a system where if you choose to be a physician you are designed to loose, or be kicked out of the collective.

I am so glad I have gotten rid of all my implants, but the ghost memories still haunt me. So much that given the chance to rip the spine off the borg queen and skull f%$* her till her electrodes pop and the collective dies, will be a longing wish. (sorry for the graphic, but hey I'm scarred).

Till then, articles like the 98 expose will hopefully continue. So will the disillusionment of hundreds of young enthusiastic but naive physicians, and the continued decline of medicine and abuse of the American soldier.

You really need to think of your place in the collective. If you only do that once, you will already be on your way out. Better yet, take a chance down the rabbit hole, if you are offered the blue pill, take it. But I wonder if you've got a supply of red ones you keep close by?

Good luck

Galo said:

You really do not get it. Unfortunately the majority of the people who sign up and have not read this forum do it on the equation of money you so ardently hold on to. IT IS WRONG. Especially if you know what we know. You are whoring yourself into a position where you will find yourself at odds with the profession of a physician and an officer, in a system where if you choose to be a physician you are designed to loose, or be kicked out of the collective.

Click to expand...

(bowing deeply)

So.

--
R.