Egyptian Rivers and Knee-Jerk Reactions: A Military Cultural Case Study

[MedicalCorpse]

Check this out:

http://www.medicalcorpse.com/Cultural_case_study.doc

Which category do you fall into?

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R

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[monkeybaronjr]

Well written...

I clearly fall into the "Denial" category as a lowly 3rd year HPSP student who is completely powerless to do anything but study and cross my fingers, hoping that none of this will happen to me. Since I do not have any military medical experience thus far, I am far too ignorant to make any opinions for myself and have nothing but this forum to rely upon for my information. I log onto the forum each time I feel like procrastinating and read post after post about the abysmal state of military medicine and wonder what exactly I have gotten myself into. I have no military experience or significant military connections, but felt a sense of duty and patriotism after the events of 9/11 that further fueled my desire to be more than just your typical doctor. I wanted to be a part of something "more significant" than simply opening up a private practice or becoming a hospitalist. I thought that becoming a military doctor would satisfy those desires. For all I know, it still may be the case. I have to at least have a shred of optimism lest I progress through the stages before I have even begun residency.

This entire forum is like a trainwreck to me - it's terrible to look at, but I just can't help but stare. I know that the vast majority of members on this forum have had undesirable experiences with military medicine, but I am positive that someone somewhere has had a positive experience while still considered to be a "good doctor" or a "competent physician". I just pray that I will end up being one of those minority and actually enjoy my time with the Army while getting solid residency training. However, I have begun to realize that it may be too much to ask.

What else can a third year do? I log onto the forum each day hoping the next post will be titled "MILITARY MEDICINE HAS BEEN FIXED! LET US ALL REJOICE!!!". Until then, I will just pretend that it's only isolated institutions that are in shambles and/or everything will be fixed by the time I get there...

DENIAL...'sigh'...

 

[delicatefade]

As a pre-med and first year, I was in denial (see the "anchoring" thread). As a second year, I was in anger and depression. As a third year, I think I've moved on to acceptance.

This, however, will likely revert back to depression once I start active duty. Maybe. Maybe not. I hope to be pleasantly surprised.

Wait a minute, that sounds an awful lot like denial, doesn't it?

 

[resxn]

Monkey, yours I believe is the best attitude to have. Your stuck, but your eyes are open to the experiences of others, so you are prepared.

My experience with the DABDA model went as follows:

The day I arrived on base the ED converts to a UCC. Operating hours move from 24hrs/day to 10AM to 8PM. Denial - I don't accept that I won't be able to enthusiastically put my graduated skills to the test as much as I'd hoped.

Denial again at the first words out of the mouth of my supervisor (a PA in my clinic) is, and I find it humorous that he actually is talking about another poster here on this forum is, "Rule 1, do not cross the street between intersections, you'll get an LOR." I had no idea what an LOR was, but he seemed to think it was a big deal.

Anger first reared it's head to a mighty degree when the JAG office came to our surgical department and said, "Henceforth, pre-typed consent forms are no longer acceptable. All IC documents must be handwritten top to bottom."
The reason for this? Handwritten documents, according to ACC lawyers, more effectively show the active role of the MD in the consent process. This post is not the place to go into the myriad of reasons that is simply assinine [sp?]. I informed my surgical chief that I simply would not do this. Period. I asked him if I did take that kind of stand what could happen and he said if it's written you could be court martialed for failure to obey a direct order. So good thing one of my best friends is an ADC in California. I asked him to defend me if it needed to come to that. He was gunning for me to get in trouble because he really, really wanted to jack around with that stupid policy in court. But being a pal, he made a call to the JAG office on base and the policy was cancelled and pre-typed consents remain appropriate.

Now I float somewhere between acceptance and anger. I never really have done the bargaining and depression modes--it's simply not worth the wasted energy I guess. Mostly I'm in acceptance, biding my time like most of my colleagues, but occassionally something strikes me as so insanely stupid that I lash out. I'm ok with that though, it tells me I'm still alive.

Homer Simpson's 5 stages.

Dr. Hibbert: Now, a little death anxiety is normal. You can expect to go through five stages. The first is denial.
Homer: No way! Because I'm not dying!
Dr. Hibbert: The second is anger.
Homer: Why you little! (Homer attempts to choke the doc)
Dr. Hibbert: After that comes fear.
Homer: What's after fear? What's after fear?
Dr. Hibbert: Bargaining.
Homer: Doc, you gotta get me out of this! I'll make it worth your while!
Dr. Hibbert: Finally, acceptance.
Homer: Well, we all gotta go sometime.
Dr. Hibbert: Mr. Simpson, your progress astounds me.


Oh, to be Homer

521 more days.

 

[delicatefade]

I love that episode. I sure hope I work with people like you when I get out there.

 

[MedicalCorpse]

Monkey, yours I believe is the best attitude to have. Your stuck, but your eyes are open to the experiences of others, so you are prepared.

My experience with the DABDA model went as follows:

The day I arrived on base the ED converts to a UCC. Operating hours move from 24hrs/day to 10AM to 8PM. Denial - I don't accept that I won't be able to enthusiastically put my graduated skills to the test as much as I'd hoped.

I was going to save this for my second book, but the presence of an ENT surgeon who groks DABDA makes sharing this anecdote irresistable:

Excerpt from:

A Fly In the Hand: Uncensored, Real Military Medical Quotes
copyright (C) 2006, R. Carlton Jones, M.D.
all rights reserved​

from pp. 65-66:​

Welcome to DABDALand, May I Take Your Order?​

A brand new ENT surgeon shows up at MGMC, fresh-faced and optimistic after graduating from an internationally-renowned program at the Minnesota Mecca. On his first day in the OR, he schedules 4 laser surgeries. Only problem: anesthesia does not have laser tubes. Regular tubes would catch fire in patient's airway; this is generally considered to be a Bad Thing. Now we enter the Tao of Dr. Kübler-Ross and her Stages of Grief:

Denial: "What do you mean we don't have laser tubes? Every 'Medical Center' should have them available. I can't believe this!"

(RCJ: "We're not really a medical center, dude, they just forgot to take the huge sign down from the wall of our sleepy community hospital, which is rapidly devolving into a super-clinic.")

Anger: "Why don't we have them?"

(RCJ: "We've never needed them before you showed up.")

Bargaining #1: "Can we get some from a nearby hospital, like [Hospital Name]?"

(RCJ: "Not in real time…maybe by next week.")

Bargaining #2: "Can we just wrap the standard tube in tinfoil or something and stuff gauze into the patient's throat?"

(RCJ: "No way, Jose. There have been recent Sentinel Event warnings about fires in the operating room…and I don't want my patient to have a fire in her throat when her plastic endotracheal tube melts and combusts from the laser. I'm just picky that way.")

Depression: "Well, I guess I'll have to cancel the cases, then."

(RCJ: "There you have it.")

Acceptance: Never happens…unless you get promoted to O-6 or above, at which time the mandatory lobotomy removes all concerns about resource limitations and patient safety, and you start to spout motivational slogans like: "Work smarter and harder or I'll reprimand your @$$."

--Episode with Dr. H. ca. Sep 03.

Final quote from this saga: RCJ to surgeon: "Dude, as I tell all incoming physicians, if you skip the preliminary steps of Kübler-Ross' stages and go directly to depression, you'll be way ahead of the ballgame."


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R

 

[resxn]

R,

First, I'm flattered that "grok" was used in relation to anything I post.

Second, thank you for linking it so I had an easy out; a way of looking up exactly what it meant with a bare minimum of effort.

Third, quite possibly my favorite funny post of yours to date, a fellow ENT's experiences not withstanding. Speaking of which. I got approval for an airway laser in my first 4 months. I was told it was funded completely and actually received the operating microscope with which it would work, but every time I inquire as to why it is not here yet I get answers varying from it being in final approval to it's back-ordered, to it's cancelled. This is one of the events about which now after 28months in I've moved on to acceptance. It may very well be in the supply room now, but like the dog and the floor-shock model of depression, I've resigned myself to the fact that the laser will never make it into a case. Perhaps that's because they've closed my hospital down and now it's just an ASC. ZAAAAAPPPPP! Did anyone feel something? Not me.