That's just it though. What's the battalion commander going to do if you declare "I'm not that kind of doctor and it's inappropriate for me to take responsibility for it" and say NO. What's he going to do? Give you a bad fitrep, hurt your chances for promotion - maybe. Get rid of you - that seems more likely. The line has no power to make us practice in unsafe ways.
I'm not talking about (in an emergency when life/limb are at risk) reducing a fracture for transport or putting in a chest tube; any of us ought to be able to do that, and should do that. It's just ATLS ... though I think it's absurd that you were denied the chance to recert ATLS before deploying.
I'm talking about routine clinic work that's far out of our area of expertise. I just wonder how long I'd be left in that job if I medevac'd a bunch of non-lifethreatening injuries or issues (ankle sprains, abd pain). Or if I sent every depressed, anxious, or cluster-B-afflicted patient to a higher echelon of care to see someone else.
It would be an interesting series of conversations though, that's for sure ... and an interesting ADSO countdown too (or retirement countdown at your current now-terminal rank). 🙂
I also think it's a little different for medicine subspecialists. While it certainly sucks that they're being utilized as generalists after completing fellowship, at least they've completed a primary care residency.
I haven't done a pelvic exam in ten years and I wouldn't do one tomorrow because some colonel thought that's what people with acorny collar devices do.
Okay, let me just share my experience as a BN surgeon during OIF with everybody here. Let me also make it clear that everybody has a different experience.
Back in my day, during OIF, down in Baghdad, the Victory Base Complex (VBC) has a CSH with some subspecialists on staff, combat stress trailers, dental clinics, and even optometrist available. They also had a bowling alley, nice gyms, DFAC that served very good food four times per day, very nice PX buildings, and food vendors (Burger King, Pizza Hut, etc).
If you were manning a TMC at VBC, life was not so bad. At worst, you lived in an aircondition CHU.
Now, I was out with an infantry battalion at a FOB outlying Baghdad. We had old buildings that were broken down, wiring on the outside of the walls, internet that worked on occasion via the 1990s modems, a gym with broken equipments, and a DFAC manned by 92G that were the bulk of my battalion aid station injuries!!
We had water tanks on the barracks that were for the showers only and infested with coloform. WE had no drinking water but like all FOBs were supplied with water bottles.
My aid station was an old garage with good trauma equipment and lots of drugs. The job was simple stuff, minor complaints such as skin problems, musculoskeletal pain, etc. Nothing that was really rocket science.
Now, I was not in a surgical based or primary care specialty, but I had to do sort of a general medicine internship year. During that internship, colleagues laughed at me for wanting to learn general medicine and I always said, "well, what happens when I go out as a GMO" and they laughed harder. Well, I did go out as a GMO and I was surprised how much of that stuff I could recall on the fly.
I performed very well and buffaloed my command into thinking I was the most brilliant doctor they had ever seen!! Boy, they had no idea that everyday I lived in fear of what would happen if all hell broke loose and I choked!!! I count my blessing that it never happened that way. Medical evacuation was not always a choice for non-life threatening things that were beyond my scope so I had to suck it up. Medical evacuation for non-life threatening items meant that the unit would just wait until they were passing by VBC on a routine mission and the soldier could catch a ride. That could take days!!!
My FOB literally had sewage seeping down the sidewalk and possibly buildings (I say possibly because I cannot tell you that that green stuff coming down the side of the building actually was?). The only way I made it through that deployment was by having good support and morale from the unit I was tagging along with. The FOB was VERY small and I literally saw the commander every single day sometimes multiple times per day!!!! There was no escape and he was very engaged in what I was doing (and not doing).
I will tell you all right now that there were days that I could have shown up at the aid station and had been the most passive aggressive jerk you had ever seen!! There were days that I was tempted to do so!! But I can also tell you that they would have made my life a living hell if I did that!! It was not VBC, it was a tiny $hit FOB and there was no escape.
Now I simply did the best I could and at the end of the tour managed to perform well and earned myself a very nice OER. I then went back to work in my primary specialty and nailed the boards whenever I got back (I mean I had a whole year to study). The real crime was that my skills atrophied while practicing CONUS due to a restricted patient population.
So that was the double edged sword!! One year away from my primary specialty and two years of limited exposure.
I applied for a fellowship for a second time and was told that they could not give it to me (insert lame excuses from OTSG consultant) and realized that my skills would continue to detiorate. I also realized that I had colleagues that would never see a deployment, received fellowships, and would always be awarded spots at major MTFs.
Needless to say, I got out before the knowledge of my primary specialty completely faded. I am now see lots of pathology within my specialty and once again actually enjoy my job and remember why I pursued a career in medicine in the first place. I also make twice as much money than I did while in the Army (for what its worth).
Look, we all go through these phases. As medical students, we are defensive of our decisions, we do ADTs at major MTFs and love it. Then we move onto residency and start to see what happens to our attendings. Suddenly, are eyes are open a little bit more. Then we graduate residency and most of us take a slot at a MEDDAC or operational assignment, do a deployment, and our eyes are opened even further.
Try an experiment if you have time. Pick a person on this forum who is now a med student. Look at their posts now. Follow them over time and watch how their posts dramatically change over the years!!
I enjoyed my time in the Army and I am proud of what I did and accomplished during those years. However, it took a toll on my family and it surely would have stained my career if I stayed in. As a former attending of mine once said, "The Army is good place to be from".
