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Air Force's top bosses forced to resign

Discussion in 'Military Medicine' started by deuist, Jun 5, 2008.

  1. deuist

    deuist Stealthfully Sarcastic
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    This story has been all over the news today. The Air Force's Chief of Staff and the Secretary of the Air Force have both been forced to resign over repeated mishandling of nuclear materials.
     
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  3. elderjack21

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    I think all the branches should have a culling of the top brass from time to time...it would be good for them.
     
  4. Galo

    Galo Senior Member
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    You can see the problems with leadership at the top in the handling of nuclear weapons. Think about how the top leadership for military medicine has let the troops and their physicians down, but you do not see any repercussions. Being at the top is like being a mob boss, there is very little anyone can do other than a bigger mob boss.
     
  5. elderjack21

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    The SECDEF fired the Army Surgeon General, Secretary of the Army and some other folks after the Walter Reed scandal.
     
  6. Galo

    Galo Senior Member
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    You're right. I forgot about that. The sad thing is that something absolutely horrendous, that gets out has to happen before people are held accountable. What about the miserable shape mil med is in and continues to sink, dive, whatever the army does? When is someone going to be held accountable?
     
  7. deuist

    deuist Stealthfully Sarcastic
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    Ah yes, but that was after the story was published in the popular press. Even then, newspapers had been writing about the declining quality of military healthcare for over a decade. In fact, a Pulitzer prize was given out in the mid-19 90s for stories related to military care.

    While I was happy to see the Secretary of Defense take such swift action after Walter Reed, problems and military medicine continue. Newspapers don't report that many of the doctors are inadequately trained to handle what they see. I'm sure that the public would be outraged if they discover that physicians had only one year of postgraduate medical education.
     
  8. elderjack21

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    I hear about the military medical shortcomings all the time on NPR. Just this week they ran two pieces. The first one was on all of the drug overdoses in the warrior transition centers due to the doctors not being trained enough or able to handle the complexity of the problems and the other one was a spinoff that covered some of the things the army is trying to do to fix those problems.

    NPR is never easy on the military.
     
  9. elderjack21

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    That is too bad. It isn't a story unless it is horrible. And I guess the media can always say...well milmed is bad, but what about the 40millon+ Americans with no health care...the military has so many problems right now though.

    The doc that I am currently working for just went to th ASNR (American Society of Neuroradiologists) conference last week and an army LTC presented on tramatic brain injuries as well as one of the top neurologists in the US who has volunteered twice to go over to Landstuhl for a couple months (although part me thinks that she just wanted to be part of the action for selfish reasons, it is nice that she was trying to help out I suppose). Anyway, my boss said that the pieces on tramatic brain injuries were very moving, but shocking too see. Such extensive injuries and yet we are able to keep them alive. It begs the question, how will we be able to take care of some of them in the long run in a broken VA and milmed system.
     
  10. deuist

    deuist Stealthfully Sarcastic
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    Doctors aren't actively killing them off.
     
  11. elderjack21

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    Yeah, I didn't really explain my point very well.

    There are plenty of problems with healthcare in general that are more applicable to the general populace...these issues will almost always crowd out the problems with milmed except for those extremely bad situations like at Walter Reed. That is just the way it is...
     
  12. a1qwerty55

    a1qwerty55 Attending
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    Let's not embellish the Walter Reed story.

    As pretty much everyone with first hand experience will acknowledge, it was more about facilities and outpatient follow up and NOT about the quality of healthcare provided. What was glossed over was that the rooms affected in only one of many Off Post housing buildings were a minority of rooms. The Walter Reed Commander had no funds to correct them b/c WRAMC was on the BRAC list so you couldn't improve the facilities. The conditions weren't that bad frankly, not any worse than a bad dorm in many college campuses, and what you may not be aware is that the affected soldiers have been offered alternate living arrangements and DECLINED, b/c it was so convient to WRAMC.

    My take on the Wash Post series was that it was a political hack job. There were some very valid issues which arose, in particular the very broken military board process, and the lack of accountability and care planning for soldiers. There is no question soldiers were lost in the system which is indefensible. Good things have come out of the series of stories in particular the WTB/WTU (warrior training units), and changes to the MEB process, plus money magically appeared for facility improvements in military hospitals world-wide.

    I'm going off topic here a bit but here's my 2cents on the OD issue.

    The overdoses are a tough one as in my opinion that military does not and will never have enough psychiatrists to deal with the PTSD issue. We are talking hundreds of thousands of servicemembers and some of what is labelled as PTSD is Major depression with anxiety, and other disorders. What I have seen is that some of these soldiers get started on a myriad of psychotropics and pain meds. It concerns me as you now have a depressed guy, possibly with PTSD with access to lots of narcotics a dangerous combo.

    As good pain specialists are rare, even in the civilian world, the pain regimen is being managed by providers often not facile with these drugs, as is the case in the civilian world as well. So they end up on escalating doses of narcs for conditions which aren't very narc responsive like headaches, myofascial pain syndromes, low back pain and psychogenic pain.

    My understanding is that most of the soldiers diagnosed with PTSD can remain on active duty and "recover". Those however too broken need to be boarded so they can get on with their lives and not have their OD count against the military.

    When you are talking about a system with over a million beneficiaries, it is very very easy to find examples of medcal errors, or dissatisfied patients. As anecdote is the lowest form of evidence better evidence is needed before one concludes that military healthcare is substandard. An example might be comparing OD rates among similar patients in other health systems, I bet this is being done.
     
  13. a1qwerty55

    a1qwerty55 Attending
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    Usual hyperbole from Galo
     
  14. a1qwerty55

    a1qwerty55 Attending
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  15. Galo

    Galo Senior Member
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    Yeah, I must have been mistaken, there are no problems with nuclear security, no problems with mil med, and Walter Reed just needed a new coat of paint.

    Its sad when you can't see reality in front of your own nose.
     
  16. Mirror Form

    Mirror Form Thyroid Storm
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    Given that the wash post article got almost all of their "poor care" examples (note they didn't use the word medical in their headlines, they just did their best to make people assumen that) from a barracks that wasn't even on WRAMC's campus, I'm interested in what "absolutely horrendous" things you're referring to?

    I've called you out on this before; you have ZERO information to back up your vitriol on this matter. It's amazing how somebody who is a physician is so easily manipulated by a reporter.
     
    #15 Mirror Form, Jun 9, 2008
    Last edited: Jun 9, 2008
  17. Mirror Form

    Mirror Form Thyroid Storm
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    The real problems are things that the public doesn't care about and wouldn't understand. They don't understand how long most physicians are in training. Nor do they care about what a nightmare navigating through WRAMC's med board process is and then transitioning to the VA.
     
  18. FizbanZymogen

    FizbanZymogen Guitar Hero Champion
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    Mirror Form has a point. The Walter Reed problem needs to be discussed truthfully and not loaded with the bull$h!t Galo spews from time to time. I really hope your out of the service Galo and if not I hope I never have to rotate under you. Your total lack of integrity and honesty when it comes to certain issues disgusts me.
     
  19. FizbanZymogen

    FizbanZymogen Guitar Hero Champion
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    Please feel free to spew your normal trash now. I won't be back on for another 2 months anyway.

    peace
     
  20. Galo

    Galo Senior Member
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    With that attitude, you'll do great in military medicine. Just make sure you always do as you are told.
     
  21. deuist

    deuist Stealthfully Sarcastic
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    Looking over the push by nurses to create DNP's, I wonder if these one-year residency toting primary care types can take over the GMO spots. That way, all of the real doctors can pursue residency training like they're supposed to.
     
  22. mitchconnie

    mitchconnie Member
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    I appreciate that you may want to defend the institution where you trained, and I agree that there are clearly no major problems at the attending/resident level. However, you can't deny that Walter Reed has some serious issues which go beyond cosmesis.

    After working there intermittantly for several years now, I have come to loathe the support staff and oppressive bureaucracy, and you can't deny that the physical plant really is bad. I may have previously mentioned the time I had a case cancelled because of sewage dripping throught the ceilling in my OR. My office also used to regularly have some sort of waste water dripping down through the ceiling and ruining anything hung on the walls. I'm sure you've seen the cockroaches in the surgeons locker room and experienced some of the crazy power outages for no particular reason.

    The incompetence of the civilian support personnel really is legendary and far beyond what I have experienced at any other MTF, even other facilities in the NCA. We used to regularly open up our clinic waiting room in the morning to find it strewn with fast-food wrappers and empty cans because the night cleaning staff had been hanging out and watching TV all night. We would go through several front-desk secretaries per year, because contracting could never hire anyone who had mastered such basic skills as showing up for work in the morning, dressing appropriately, and answering the telephone.

    Security is such that I had a lap-top stolen from my desk during normal clinic hours while I had stepped away from my desk to see a patient. And I'm sure you remember the incident where two security guards got into a gun-fight outside the back gate after one of them call the other a "tard."

    One could go on and on and on with ridiculous examples of incompetence. Do these support-staff and facility issues translate directly to poor medical care? Well...maybe not directly, but they certainly give pause to the casual observer. The problems are systemic, not just cosmetic.
     
  23. elderjack21

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    These are the same types of stories I have heard from physicians who have worked there.

    I guess the tours that they give at WR used to take the DVs through the really nice parts of the hospital, but side stepped the crappy parts as well.
     
  24. Galo

    Galo Senior Member
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    The above information enough for you?

    I think the disservice here is that people can turn their back on such deficiencies enough to ignore them and pretend that there is nothing wrong. I may have vitriol in my statements, because they directly affected me and patient care. Perhaps it will be impossible for anyone to understand that emotion until they have had it. Its a moment of total disbelief. How could something like that happen?? Then it will happen again, and again, and again. I will never have examples about WR, as I've never been there. But I can extrapolate from my experience and from what's being reported that there continue to be systemic problems throughout military medicine. Residents and attendings who react with maniacal anger and indifference when this is pointed out, have some deeper problem they have to deal with.
     
  25. a1qwerty55

    a1qwerty55 Attending
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    I couldn't agree more. There is a reason WRAMC is on the BRAC list. There isn't really much hope of addressing the civilian and facilities issues so long as it remains in DC proper. Thus the move to MD. That doesn't refute my contention that the care, provided between a patient, doctor, nurse, technician and the equipment necessary to do so remains good despite the major institutional issues.

    The implications of the Wash Post article and Galo's shallow posts was that care was substandard. This was not only NOT supported by the WP articles, is was NOT supported by the politically motivated JCAHO inspection - that occured as soon as the Post article broke.

    Imagine a joint facility leveraging the best of the Army and Navy, built to today's hospital standards/IM capabilities not 1970s (When WR was built)located accross from NIH, and the National Library of Medicine and next to a Medical School. This can and I expect will be a center of excellent, I find this very encouraging.

    My focus as always is in fleshing out the story. Something that the detractors of military medicine vehemently fight. Let's deal in facts rather than sound bites.
     
  26. Homunculus

    Homunculus SDN Caveman Administrator
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    WRAMC's infrastructure and support staff were definitely sub-par. the fire alarms go off so often that if a real one ever occurred it would jsut be business as usual, lol. we had mice in our call rooms, and bugs and glue traps in our peds clinic and in our ward rooms. i was, and still am, embarrassed of the facilities there. the medicine is good, and it's unfortunate that the facility doesn't reflect the providers that practice there. but then again, pediatrics is the bastard child of the military medical system, and we tend to be happy with whatever scraps are tossed to us at the end of the day. but that's another post.

    the issue with the WP story was the denial by those in charge when it first hit. a "thanks for bringing this to our attention, we will fix it" would have been received much better than the news bite of certain leaders denying there was a problem and that it wasn't a big deal.

    there, as here, i never saw my hospital commander walking around looking at the place. a simple tour of his own facility periodically would have done wonders. i know they're busy, but nothing is more informative than seeing it firsthand.

    and if you think the new behemoth walter reed megaplex is going to be on par with mayo or hopkins (like the initial press release said) you're in for a disappointment. to be a mayo or hopkins you have to support research and non-"battle oriented" (peds & OB, to name two) specialties, and NNMC and WRAMC both aren't geared for it. it would take a massive shift in culture and priorities, and i seriously doubt it will happen.

    the WRAMC/NNMC merge will looke more like cartman merging with trapper-keeper:

    [​IMG]

    the only problem is that unlike trapper keeper, rosie o'donnell and kyle won't be around to stop it :)

    --your friendly neighborhood south park loving caveman
     
  27. psychbender

    psychbender Cynical Member
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    bad pie...bad pie...
     
  28. Galo

    Galo Senior Member
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    I believe that "care" of a patient does not stop when you do what ever it is that you do as a physician. The nursing staff, support staff, nutrition, etc etc, all encompass "care" of a patient. The care of a patient may revolve around a physician, but that care is not totally dependent on the physician alone, (no matter how narcissistic you may be). So, care overall, was compromised, and in many military facilities continues to be. Often times the physician may have to provide care that may not be within the scope of their practice, just to offset the non-existence of ancillary services that should be there for complete care of the patient.

    I think this is one of the root problems of the cheerleaders of military medicine. They think that they give such good care, that whatever else happens is not on them, or their responsibility. It may not be, but it sure detracts from proper or total care of the patient.
     
  29. a1qwerty55

    a1qwerty55 Attending
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    Galo, try reading my posts, before commenting. I referred to the healthcare team, not the doctor alone. While cleaning crews and front desk staff matter and no one argues there aren't issues there at WRAMC, the nurses, techs, dieticians, etc. etc. work well together for the benefit of the patient.
     
  30. Galo

    Galo Senior Member
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    You started your usual tirade by calling my post shallow. Also this is the first time that I see you use the term "healthcare team". Part of that team is the infrastructure that allows for care of the patients, so healthcare WAS, and is currently being compromised at multiple facilities throughout the DoD. I gave examples of how, and others havealso.

    We keep going back and forth on semantics instead of focusing on what's true and real. Once again, your immediate bias in anything I have to say shows through, and is not conducive to a worthwhile conversation.

    There are multiple problems in military medicine. I believe they negatively impact patient care, and I experienced it. From your multiple opposing posts, you seem to continually downplay those problems, and therefore I think you ignore them.
     

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