military nurses driving me crazy

[whathaveIdone]

This is a ranting post. I guess I'm looking for folks to commiserate with me just to make me feel better. I'm a flight surgeon at your local MTF and the active duty nurse contingent is driving me crazy with their incompetence, their arrogance and just simple disrespect. The nurses, both male and female, are put in positions of power. Incompetence and authority is the worse combination.

Yes, I'm "only" an O-3 but I am a physician. Not that being a physician entitles me to unconditional respect and admiration, but it does entitle me to the same professional courtesy due to any adult in a professional workplace.

Where do these 0-4, O-5, and O-6 nurses get off treating physicians like crap? Only in the military would this kind of behavior be tolerated. Can you imagine a nurse in the civilian setting telling a CT surgeon that they should wait for all the other nurses and techs to get their fill of pharm rep food before the doc can get any? Unbelievable!

Of course, since it is the military, there's nothing I can do since RANK is above all else. This perverted system could only thrive in the military which is why docs get out as soon as possible leaving behind incompetent, power hungry nurses to continue the cycle. Never mind, line commanders calling and emailing on a daily basis trying to influence your decisions so they can get their troops back to work. The medical corps would be much better off without rank. It has it's own inherent rank structure as it does in the civilian world: senior attendings, junior attendings residents, nurses, med students, techs, etc. That is all. Anyone have similar experiences? Any suggestions on how to get through the next couple years? I have 19 months to go and have had it.

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[IlDestriero]

Welcome to the suck.
All you can do is keep your head down and push on through. At the end of the day always do what is right for your patients, ignore helpful (******ed) suggestions by nurses and the line. Pick your battles, and hold the line. Keep your patients health as the #1 priority, and recognize your limits.
Buy lots of scotch and sleep well.
In a few years it will be a bad memory.
Cheers!
Have one on me.

 

[AF M4]

Yep, been there, done that for the past few years, still here for another 7 months. Here's what I got, hope it helps.

Never let them see you aggravated; then they have you by the short hairs.

Everything changes, so don't be afraid.

In this world, if the people above you aren't pissed off at you for some reason nine days out of ten, then you aren't doing your job right.

Write every note as if you believe that it will one day be thrown back at you by a patient, commander or lawyer in an investigation of some sort. Because it will be, and it has nothing to do with how good or bad a physician you are. People have their own agendas and motivations for what they do, and sometimes you will simply be in the wrong place at the wrong time.

Avoid favors and VIP medicine like the plague. It will only cause more problems.

You're never as good as they say you are, and you're never as bad either.

Take leave as often as possible. The building will still be intact when you return. Turn off your phone sometimes.

Never buy a pilot a drink.

If the SME GMO says it's definitely just a cold, then it's probably pneumonia. Chest Xrays are cheap.

Three sessions with a good physical therapist and an honest effort will improve just about any musculoskeletal complaint.

 

[haujun]

This is a ranting post. I guess I'm looking for folks to commiserate with me just to make me feel better. I'm a flight surgeon at your local MTF and the active duty nurse contingent is driving me crazy with their incompetence, their arrogance and just simple disrespect. The nurses, both male and female, are put in positions of power. Incompetence and authority is the worse combination.

Yes, I'm "only" an O-3 but I am a physician. Not that being a physician entitles me to unconditional respect and admiration, but it does entitle me to the same professional courtesy due to any adult in a professional workplace.

Where do these 0-4, O-5, and O-6 nurses get off treating physicians like crap? Only in the military would this kind of behavior be tolerated. Can you imagine a nurse in the civilian setting telling a CT surgeon that they should wait for all the other nurses and techs to get their fill of pharm rep food before the doc can get any? Unbelievable!

Of course, since it is the military, there's nothing I can do since RANK is above all else. This perverted system could only thrive in the military which is why docs get out as soon as possible leaving behind incompetent, power hungry nurses to continue the cycle. Never mind, line commanders calling and emailing on a daily basis trying to influence your decisions so they can get their troops back to work. The medical corps would be much better off without rank. It has it's own inherent rank structure as it does in the civilian world: senior attendings, junior attendings residents, nurses, med students, techs, etc. That is all. Anyone have similar experiences? Any suggestions on how to get through the next couple years? I have 19 months to go and have had it.

I feel your pain. And sadly it does not get better.I know O-5 physician hating his life as his nurse O-5 who has "authority" over him micromanaging him. Military runs by both rank and position. I just don't have will or patience to deal with these nurses who have all time in world to perform admin duties.

I agree with other poster's advice. I am ready to PCS out of here...

 

[IgD]

My advice: try to understand things from their perspective. Are they lazy? Are they hyperpolitical and doing things to make themselves look good? Are they just psychopaths trying to torture you? Maybe they are a control freak. Whatever it is that makes them tick use it to your advantage. Always try to balance the needs of the patient against the military and you will come out on top. Don't get sucked in.

 

[haujun]

My advice: try to understand things from their perspective. Are they lazy? Are they hyperpolitical and doing things to make themselves look good? Are they just psychopaths trying to torture you? Maybe they are a control freak. Whatever it is that makes them tick use it to your advantage. Always try to balance the needs of the patient against the military and you will come out on top. Don't get sucked in.

This sounds good, but I do not have a time or ability to psychoanalyze my nursing staff. You are most welcome come back into military and show us.

 

[Galo]

I feel your pain. And sadly it does not get better.I know O-5 physician hating his life as his nurse O-5 who has "authority" over him micromanaging him. Military runs by both rank and position. I just don't have will or patience to deal with these nurses who have all time in world to perform admin duties.

I agree with other poster's advice. I am ready to PCS out of here...

Hajun,

You clearly remember me and the painful description of my trials and tribulations with the military system including the horrendous, vindictive, psychopathic, self serving, clipboard carrying cows (that one is someone else's description, but I like it).

I agree with the attempts at learning to deal with them, and especially with documentation. IF ever, a nurse tries to tell you how to manage a patient, let them know you are the physician and will be documenting whatever ridiculous thing they want you to do, on the patients chart, and how it would impact their care.

Back to Hajun: Obviously you have now experienced first hand some of the frustrations many here have described. Do you intent to stay in the military beyond your mandated time?, and if not, besides the ovbious, what has helped in making or not making that decision. I would be interested to know and hope you can share.

Thanks

 

[haujun]

Hajun,

You clearly remember me and the painful description of my trials and tribulations with the military system including the horrendous, vindictive, psychopathic, self serving, clipboard carrying cows (that one is someone else's description, but I like it).

I agree with the attempts at learning to deal with them, and especially with documentation. IF ever, a nurse tries to tell you how to manage a patient, let them know you are the physician and will be documenting whatever ridiculous thing they want you to do, on the patients chart, and how it would impact their care.

Back to Hajun: Obviously you have now experienced first hand some of the frustrations many here have described. Do you intent to stay in the military beyond your mandated time?, and if not, besides the ovbious, what has helped in making or not making that decision. I would be interested to know and hope you can share.

Thanks

I still have few more years to go and I did not make decision to stay or leave at this point. Even if I were to leave the military this should not be interpret as my negative views toward the miltary, but as my decision to "move on." Certainly most HPSP students if not all sign up not for the career, but a way to pay for the medical school. I did this as well slightly more informed than others as I was prior service.

Although I point out some negative aspects there are many positive aspects in the military that one should consider. I look forward to sharing more points as I spend more time here during post utlization tour. But I agree with you on two issues: Skill Atrophy and Mad Nurses.

I hope that my next duty station will address those two issues. Everything changes in the military.

 

[244913]

When I was doing my internship, a crusty prior service Infantry type turned 04 Surgeon was being hassled by some 05 Nurse. His words to her, spoken very publicly and loudly:

"Don't ever confuse your rank with my authority."

He got called to the carpet for this if I recall correctly, but he will always be a hero to me.

- 61N

 

[Gastrapathy]

This is a ranting post. /QUOTE]

You're getting out. They are absolutely powerless to hurt you. See clinic. Skip the meetings (when they call, you are stuck with a patient...its easy to time it so this is true). Do the notes as you go. Exercise at lunch.

Use every single day of leave. If your immediate supervisor denies your leave, run it up the chain.

When you see them struggle to climb out of a desk chair, smile just a little.

 

[Perrotfish]

The medical corps would be much better off without rank. It has it's own inherent rank structure as it does in the civilian world: senior attendings, junior attendings residents, nurses, med students, techs, etc. .

Unrelated to your rant, but thanks for putting the medical students above someone else in your inherent chain of command. It's a nice gesture.

 

[whathaveIdone]

I think it's accurate. Med students rank above techs, the 4-8 years more of education and tons more sacrifice should mean something, even for the little ol' med student.

As for the suggestions, I like 'em. Skipping meetings since "I'm with a patient" is a good one. As for them not being able to hurt me since I'm getting out in 18 months, I don't know. 18 months is a lot of @ss pain to suffer. I suppose, aside from just being annoying, all they can really do at its worse, is take away the ASP bonus; short of me committing malpractice, seriously breaking the law or what else?

How many months from terminal leave does one have to be before they pretty much just laugh and the pointy-haired line commanders and the clipboard carrying cows? 6 mos, 12 mos, or 1 day?

 

[AF M4]

I think it's accurate. Med students rank above techs, the 4-8 years more of education and tons more sacrifice should mean something, even for the little ol' med student.

As for the suggestions, I like 'em. Skipping meetings since "I'm with a patient" is a good one. As for them not being able to hurt me since I'm getting out in 18 months, I don't know. 18 months is a lot of @ss pain to suffer. I suppose, aside from just being annoying, all they can really do at its worse, is take away the ASP bonus; short of me committing malpractice, seriously breaking the law or what else?

How many months from terminal leave does one have to be before they pretty much just laugh and the pointy-haired line commanders and the clipboard carrying cows? 6 mos, 12 mos, or 1 day?

I suggest the moment when you're driving off base for the last time.

 

[Fabio001]

Is the whole scenario of nurses pulling rank on physicians prevelent throughout all branches of the military, or does it seem to be particularly worse in one or two?

 

[whathaveIdone]

To be clear, I've never had any real attempts by a nurse to change patient care or pull rank in that way. But I've had MANY experiences where the nurses pull rank on docs for everything but patient care (clean up your office, get those un-framed pictures off the wall, stand when you're being addressed by me, you can't eat the free food that was bought by a pharm rep for the clinic until everyone else has had some, show me how you wash your hands for this infection control inspection, this drug is expired in your med cart and i'm gonna raise holy hell to the clinic commander about it, etc., etc., etc.) Moreover, the nurse commanders bend over and take it on daily basis from the line commanders and throw the docs under the bus. "sure we can come in early and leave late for your troops, whatever works best for you! (anything for me to get promoted or get a super great bullet for my OPR)" Ugh, doing your job with the sole idea of promotion behind every action you do is a horrible way to run an organization; unfortunately, it seems to be the way business is done in the military.

 

[a1qwerty55]

To be clear, I've never had any real attempts by a nurse to change patient care or pull rank in that way. But I've had MANY experiences where the nurses pull rank on docs for everything but patient care (clean up your office, get those un-framed pictures off the wall, stand when you're being addressed by me, you can't eat the free food that was bought by a pharm rep for the clinic until everyone else has had some, show me how you wash your hands for this infection control inspection, this drug is expired in your med cart and i'm gonna raise holy hell to the clinic commander about it, etc., etc., etc.) Moreover, the nurse commanders bend over and take it on daily basis from the line commanders and throw the docs under the bus. "sure we can come in early and leave late for your troops, whatever works best for you! (anything for me to get promoted or get a super great bullet for my OPR)" Ugh, doing your job with the sole idea of promotion behind every action you do is a horrible way to run an organization; unfortunately, it seems to be the way business is done in the military.

I shared your post with my nurses - we all enjoyed a good belly laugh.

1. Your an intern - you aren't a CT surgeon - even if you were, your degree in no way makes you superior or even more intelligent than your nurses.
2. Let your people eat first - a basic tenet of good manners, and military leadership.
3. Yes Francis - handwashing matters - as a physician I'm embarassed by how many doc's fail in this regard and then are indignant when it is pointed out to them.
4. Expired drugs on your cart? Perhaps not a big deal to you but a patient safety issue and a RFI from the JC when they come a visiting.

P.S. Civilian nurses don't treat interns any better, nor docs they don't respect.

 

[a1qwerty55]

Moreover, the nurse commanders bend over and take it on daily basis from the line commanders and throw the docs under the bus. "sure we can come in early and leave late for your troops, whatever works best for you! (anything for me to get promoted or get a super great bullet for my OPR)" Ugh, doing your job with the sole idea of promotion behind every action you do is a horrible way to run an organization; unfortunately, it seems to be the way business is done in the military.

use of the term OPR tells me you are USAF correct?
With regards to troops - that is your mission - many of us start early and leave late to accomplish the mission - keep troops, healthy and fit for deployment/duty. You seem very very entitled, what were you expecting when you joined the military? Were you expecting eveyone to fawn over you and jump to attention when you walk in the room? Be respectful of your colleagues, excel in the performance of medicine and accolades and respect will follow.

 

[a1qwerty55]

Is the whole scenario of nurses pulling rank on physicians prevelent throughout all branches of the military, or does it seem to be particularly worse in one or two?

3 hospitals, 2 deployments, 17years of service - never ever had it happen to me.

Army

 

[pgg]

Is the whole scenario of nurses pulling rank on physicians prevelent throughout all branches of the military, or does it seem to be particularly worse in one or two?

I've never had a nurse pull rank to direct my medical care.

As an intern & resident, I had nurses try to talk me into doing stupid things for patients, but that wasn't really a rank issue.


There are plenty of examples I could give of military medical administrators (usually nurses) creating useless work, assigning collateral duties, or otherwise wasting my time, but I have a noon meeting for Sigma Six training now.

 

[whathaveIdone]

3 hospitals, 2 deployments, 17years of service - never ever had it happen to me.

Army

you've clearly bought in and can't be reasoned with. remember the three I's of military medicine.

 

[AF M4]

To be clear, I've never had any real attempts by a nurse to change patient care or pull rank in that way. But I've had MANY experiences where the nurses pull rank on docs for everything but patient care (clean up your office, get those un-framed pictures off the wall, stand when you're being addressed by me, you can't eat the free food that was bought by a pharm rep for the clinic until everyone else has had some, show me how you wash your hands for this infection control inspection, this drug is expired in your med cart and i'm gonna raise holy hell to the clinic commander about it, etc., etc., etc.) Moreover, the nurse commanders bend over and take it on daily basis from the line commanders and throw the docs under the bus. "sure we can come in early and leave late for your troops, whatever works best for you! (anything for me to get promoted or get a super great bullet for my OPR)" Ugh, doing your job with the sole idea of promotion behind every action you do is a horrible way to run an organization; unfortunately, it seems to be the way business is done in the military.

Yes, all familiar and all military bases that I've heard of have some level of these same frustrations. I hear you.

I reached the same point as you have awhile back. Then I found something that does help:

1. You are in a negative and sometimes hostile work environment that generally relies on passive-aggressiveness as its main component.
2. You are leaving. As Gastrapathy mentioned, aside from committing a crime or flagrantly endangering a patient, there is nothing your annoying superiors can do to you aside from annoy you further during your time on active duty. No one on the outside will give a damn if you have an LOC or a bad OPR. 99/100 civilians do not know what these are, and how would they find out if you did anyway? No one brings their PIF to their civilian job interview.

Sooo.....you find yourself in a VERY advantageous position if you are a mischievious sort.

You can turn the entire situation into a laboratory on "how to survive and thrive in a poor work environment." Plan and execute different responses to passive-aggressiveness and see what works. Pick goals or different things to achieve, play mob boss and form alliances, practice some political football.

These skills will serve you extremely well in ways you cannot yet imagine as you go on in life, and you have the perfect opportunity to practice them here because in 18 months NONE OF YOUR MISTAKES WILL MATTER. And at the end, oh baby, your commanders can't give you enough terminal leave to get you out of their hair sooner.

Remember, you're not trapped in here with them, they're trapped in here with you.

 

[IgD]

I saw an Admiral tell a Navy O6 physician that if he wanted to make it to a flag officer leadership position he'd have to resign his commission and become a nurse.

 

[georgearms]

When I was doing my internship, a crusty prior service Infantry type turned 04 Surgeon was being hassled by some 05 Nurse. His words to her, spoken very publicly and loudly:

"Don't ever confuse your rank with my authority."

He got called to the carpet for this if I recall correctly, but he will always be a hero to me.

- 61N

Haha that's awesome

 

[DeadCactus]

Maybe there's some miscommunication, but the complaints you presented are:

1) Having to wait until the lower ranked folks under you have gotten some food.
2) Getting chewed out for not washing your hands.
3) Getting chewed out for stocking expired drugs in your medical cart.
4) Having line officers come to you trying to get their mission and their people taken care of.

Your post focuses on the action being scolded/requested and not the nature of the scolding/request; which is your complaint? Your post reads like it's the former which is providing a rather weak argument for the tyranny you've suffered at the hands of nurses...

 

[244913]

It is nice to see the usual suspects and apologists for military medicine jump all over this guy. Read his complaints carefully, and you will see they have merit.

He's not complaining about having to wait for the enlisted to eat first. What he's complaining about is likely having to be served last after not only enlisted but nurses of equal and greater rank have eaten. Officership aside, this is not a line unit, he's not waiting in a chow line at a COP, its an MTF, where the .mil BS should be toned down in order to create a collegial atmosphere in which professional courtesy and standing rather than rank take precedence. As usual, the "officers" who glorify rank above all else are those who embody few or no traits of being an officer other than wearing rank- portly, lazy, profiling, incompetent clipboard carrying nurses/murses who went to a 4 wk OBC and think they are all proteges of Curtis LeMay, who perform no clinical duties whatsoever, in spite of the fact that they are MEDICAL PERSONNEL, not line officers.

Asking a colleague, particularly a physician, to stand in your presence, may be allowable by military etiquette, but is it APPROPRIATE? I am in a line combat unit, the only time I ever stand is when I am addressing my Battalion Commander, a REAL officer with real responsibilities, who deserves this courtesy and respect. Demanding this in an MTF/clinic setting is really just a passive-aggressive attempt to embarrass the Docs and "put them in their place." My XO/S3, who are O4's, again, REAL officers, would think I had a screw loose if I snapped to every time I came into their office to help them or ask a question.

Good handwashing is important of course. But demanding that a physician "show me how you wash your hands" is juvenile and akin to what a Kindergarten teacher would ask of her 5 yr old students. Again, I perceive this not as an way to be helpful, but a passive-aggressive attempt to put the Docs in their place. A respectful, more appropriate tact would be to say, "Doctor so and so, I'm trying to make sure we are in compliance with handwashing regs, could you make sure that you and your subordinates are doing this properly before every patient encounter?"

Finally, the last vignette has nurses/murses fellating the line command by saying, "we'll stay until sunup to take care of your guys" meanwhile they make no patient care contribution at all and I guarantee are driving out of the parking lot at 1600 every day while the Docs get to stay behind with the medics and take care of the influx. Furthermore, would it not be appropriate to gather your subordinates and say, "Guys, we've got some additional line taskings here, how can we work this in to take care of our flyers while still ensuring everyone here gets appropriate rest and time with their families?"

Finally, leadership is not about carrying a God-damn clipboard and wearing a maternity uniform. You lead by example. If you are asking your docs to stay, then your fat ass better be in the clinic too until they leave. Treat subordinates like adults and with respect. If you are an RN, take the time every so often to help out with clinical duties- screen some patients, do some vaccinations, do some patient counseling and education. This is what you were trained for, after all.

I guess the take home point here is do not join the USAF. Their Medical Corps seems to be overrun by nurses/murses mad with power who go out of their way to make physician's lives miserable. I am so glad to be in a line unit as a Squadron Medical Element because I have almost no contact with nurses whatsoever. As usual, the farther you go to the front lines, the fewer prancers/pretenders you find. I'll take year on/year off deployments to escape the spectre of stateside clinic hell.

To the OP, good luck to you my friend. Get out and never look back. Mil Med is so broken, so far gone, so overrun by incompetent time servers and useless bureaucrats that it is an absolute shadow of what it used to be. I applaud the hard working idealists who choose to stay in and try and change things, but as others have said that's like rearranging deck chairs on the Titanic.

Good advice from AF M4 too, as usual. Take care brother, 2 yrs 2 mos left for me....


-61N

 

[a1qwerty55]

you've clearly bought in and can't be reasoned with. remember the three I's of military medicine.

Bought into what? Working with others, placing others ahead of my own self interest, keeping the patient #1? Perhaps if I can't be reasoned with it is that there was no reason in your post.

 

[a1qwerty55]

Yes, all familiar and all military bases that I've heard of have some level of these same frustrations. I hear you.

I reached the same point as you have awhile back. Then I found something that does help:

1. You are in a negative and sometimes hostile work environment that generally relies on passive-aggressiveness as its main component.
2. You are leaving. As Gastrapathy mentioned, aside from committing a crime or flagrantly endangering a patient, there is nothing your annoying superiors can do to you aside from annoy you further during your time on active duty. No one on the outside will give a damn if you have an LOC or a bad OPR. 99/100 civilians do not know what these are, and how would they find out if you did anyway? No one brings their PIF to their civilian job interview.

Sooo.....you find yourself in a VERY advantageous position if you are a mischievious sort.

You can turn the entire situation into a laboratory on "how to survive and thrive in a poor work environment." Plan and execute different responses to passive-aggressiveness and see what works. Pick goals or different things to achieve, play mob boss and form alliances, practice some political football.

These skills will serve you extremely well in ways you cannot yet imagine as you go on in life, and you have the perfect opportunity to practice them here because in 18 months NONE OF YOUR MISTAKES WILL MATTER. And at the end, oh baby, your commanders can't give you enough terminal leave to get you out of their hair sooner.

Remember, you're not trapped in here with them, they're trapped in here with you.

Or... you could be an adult, step up and lead rather than engage in your own passive aggressive games. I come from the mind set that most people (nurses included here) don't get up hoping to screw with someone. There are certainly pathologic people out there, but I don't believe they are the majority or even a large minority.

 

[a1qwerty55]

It is nice to see the usual suspects and apologists for military medicine jump all over this guy. Read his complaints carefully, and you will see they have merit.

He's not complaining about having to wait for the enlisted to eat first. What he's complaining about is likely having to be served last after not only enlisted but nurses of equal and greater rank have eaten.
-61N

Apparently you were able to read details which were not actually provided. We really don't know the specific circumstances, or how the OP behaves/interacts with others. Trust me, if you are a jerk (which he/she may or may not be) people with rank will try to stick it to you. Honestly, I've never seen or heard of a nurse asking a doctor to stand in their presence. This nurse bully/rank thing seems to continue to be described by USAF personnel. There are dramatic difference between the USN and USA medical systems and the USAF. As I've pointed out before, the USAF tends to be more toxic and demeaning towards their docs resulting in the worst retention.

 

[Gastrapathy]

Dude. A1, did you really run off to show this thread to your nurses? Thats just lame.

You talk about being respectful and yet you showed that little respect to a fellow physician who was blowing off a little steam.

 

[haujun]

Apparently you were able to read details which were not actually provided. We really don't know the specific circumstances, or how the OP behaves/interacts with others. Trust me, if you are a jerk (which he/she may or may not be) people with rank will try to stick it to you. Honestly, I've never seen or heard of a nurse asking a doctor to stand in their presence. This nurse bully/rank thing seems to continue to be described by USAF personnel. There are dramatic difference between the USN and USA medical systems and the USAF. As I've pointed out before, the USAF tends to be more toxic and demeaning towards their docs resulting in the worst retention.

Interestingly, as a Army physician I work with AF medical personnel. AF nurses have tried to control me. Hello, I am in the Army and I have different chain of command.

Interestingly, there exist strong animosity between physicians and nurses. No respect. This hate turns to apthy and there is no communication. O-5 Nurse talking with O-5 physician about non-clinical stuff and then telling him to get his hands out of his pocket.

All this hate/apathetic environment can only hurt patient's care.

 

[pgg]

1) Having to wait until the lower ranked folks under you have gotten some food.

The scene in Office Space where Milton doesn't get any cake?

Seriously, you can't compare
- sandwiches from Panera or some other foofy deli courtesy of a trio of photogenic blondes
- a field mess with tray rats being served to guys who are so hungry and dirty that the tray rats actually look tasty

4) Having line officers come to you trying to get their mission and their people taken care of.

There's a difference between making clinic hours available to accomodate troops with a heavy training schedule and making yourself a subservient peon willing to jump through absurd hoops. As a GMO, I'd happily work early or late when the Marines were going to or returning from the field, or in the days/weeks immediately preceding a deployment. Your average work day - there is no reason to have an operational/GMO clinic open at 0500 or 1800. There just isn't, unless someone's trying to prove a point at your expense.

 

[AF M4]

Or... you could be an adult, step up and lead rather than engage in your own passive aggressive games. I come from the mind set that most people (nurses included here) don't get up hoping to screw with someone. There are certainly pathologic people out there, but I don't believe they are the majority or even a large minority.

Spend a month with the AFMS, you'll find some decent pathology.

In the history of the world, no one has ever said the phrase "be an adult" to another person without also including - in the same breath - some sort of admonishment to take one up the keister.

And I am not necessarily advocating being passive-aggressive, though one should never discount that tactic simply because it's gotten a bad rap.

What I am advocating is a change in mindset. Everyone needs to vent and commisserate sometime, and that's all well and good. Eventually though, one can move past that by acknowledging that what one perceives as problems are actually facts.

You are not going to "solve" the problem of there being large numbers of passive-aggressive bureaucrats in the AFMS who like to mess with docs. Sorry. So instead, accept it as a given. This allows you to think much more clearly about how you're going to deal with the situation.

And yes, you gradually realize that you can actually control a lot of things that previously gave you problems. Here's a "for instance" that I've actually done.

With the new healthcare bill, Congress left in that big 23% Medicare pay cut that they keep kicking down the road every 6 months. The next expiration is Dec 1. Since Tricare is tied to Medicare rates, this means that all of the civilian consultants that my base uses will suddenly have much less reason to see our patients. So I could wail and bawl and talk angry about Congress and policies during the lunch hour (and I do) and leave it at that.

Or, I could take note of the oncoming problem, and use all those notes and phone numbers I have of my favorite consultants. I could give all their offices a call, talking with the docs or secretaries. This takes a couple hours, tops. I tell them how much I and my flyers appreciate them, and that the Dec 1 deadline is coming up. I don't want them to get hosed for their service to our active duty and veterans, so I tell them that I am going to be pushing every consult referral possible through before Dec 1, so that if they can get them in before then then they can still get the full rate and not have to worry as much about Congress passing the extension.

So now I've taken a big problem, and turned it around. My patients are actually getting seen SOONER because the consultants's secretaries know to slot them in before Dec 1. Our consultants love us now because they know that we're looking out for their interests too, even though they know we don't have to. And it's really fun to see the look of astonishment on a senior doc's face when I simply call up a consultant that they're having a hard time getting an appointment with and because it's me the consultant's office suddenly finds room in their schedule for that afternoon.

That's prestige, and it's power you can't buy no matter how many metrics you fill or ranks you ascend. The more of this that you acquire, the less that the bad people around your office will bother you. You may even find them starting to suck up to you a bit, which of course you can also use to your advantage.

Anyway, sorry for the long post. Just wanted to let the OP know that there ARE ways to turn the situation on its head, despite all the negative aspects.

 

[DeadCactus]

The scene in Office Space where Milton doesn't get any cake?

Seriously, you can't compare
- sandwiches from Panera or some other foofy deli courtesy of a trio of photogenic blondes
- a field mess with tray rats being served to guys who are so hungry and dirty that the tray rats actually look tasty




There's a difference between making clinic hours available to accomodate troops with a heavy training schedule and making yourself a subservient peon willing to jump through absurd hoops. As a GMO, I'd happily work early or late when the Marines were going to or returning from the field, or in the days/weeks immediately preceding a deployment. Your average work day - there is no reason to have an operational/GMO clinic open at 0500 or 1800. There just isn't, unless someone's trying to prove a point at your expense.

I was simply asking for clarification. I have no experience in AD milmed other than a few weeks of entry-level training in a different branch from the original poster.

Those of you on AD have your own experiences that impact how you interpret his post and I have mine. I'm simply trying to get passed the biases and figure out what actually happened to make up my own opinion...

 

[BomberDoc]

whathaveIdone,

The coven is strong. They hate and fear doctors because we have more training/experience than they do. We make life and death decisions and advocate for our patients. They wipe rear ends and change sheets until they make enough rank to carry a clipboard. Then they unleash all of the pent up rage generated by washing nether-regions and exchanging urine stained linens for soon-to-be urine stained linens.

Been there, done that. Got out, never looked back. Those pathetic nurses are still worrying each and every day that their incompetence and politicking will be discovered. Your strength lies in the fact that you aren't trying to make rank. You don't care about getting a stellar OPR with no whitespace. You can walk up to a line Colonel and tell him your honest assessment of a crappy situation without worrying about the political fallout.

I quit going to meetings and stupid extra things about a year before separating. It significantly helped my happiness. You always have patient care as an excuse. Even if you are an MTF flight doc, spend more time out at the squadrons or go on a ton of shop visits just to get out of the MTF. Schedule flights as often as possible. Try to fly with the wing king, group commanders, squadron commanders, etc. When a stupid nurse asks you where you are going, reply "Flying with Col X." Nothing will shut them up faster. It will make her insanely jealous and make her wonder for the rest of the day what you and the Boss are talking about. The great thing is that you will be talking about fishing and war stories, not trying to further your career. The Boss probably appreciates that, too. Go to the club on Friday afternoons and hang out with the other CGO aviators. You wear a bag, enjoy it. While you're out stretching the truth and having a few beers, those useless nurses will be sweating over OPR bullets or submitting award packages for themselves. Now tell me again, who is happier?

 

[bogatyr]

The scene in Office Space where Milton doesn't get any cake?

Seriously, you can't compare
- sandwiches from Panera or some other foofy deli courtesy of a trio of photogenic blondes
- a field mess with tray rats being served to guys who are so hungry and dirty that the tray rats actually look tasty

I think we're all missing the big picture... Where in the military are drug reps still allowed to bring food? It's been verboten at my place since at least 2004.

 

[whathaveIdone]

is that really the big picture???

 

[AF M4]

It can be if you're really hungry or the drug rep is hot.

Mmm, pasta/Nexium girl...

 

[DD214_DOC]

Interesting thread. I have had the opposite experience. The military nurses I have worked with have been very respectful and willing to do things I ask of them (such as their job). Granted, I haven't worked directly with a nurse above O2 on the ward yet since ours seem to be run by butter bars. I have had infinitely more problems with CIVILIAN NURSES at the MTF. They make it well known that they are completely outside of any chain of command and will not hesitate to ignore orders or generally make your life suck more than it already does.

 

[pgg]

I think we're all missing the big picture... Where in the military are drug reps still allowed to bring food? It's been verboten at my place since at least 2004.

The free snacks dried up around late 2008 at my last command.

They still show up around here from time to time, but there are some hoops they have to jump through. I'm not sure how it works. There's usually some kind of quasi-independent person giving a talk, and I'm not certain who actually pays for the food. But I'm not about to look a gift sandwich in the mouth.

is that really the big picture???

I told the Zemuron rep that I'd start using vecuronium if she didn't bring lunch at least once per month, but she called my bluff.

 

[NavyFP]

I saw an Admiral tell a Navy O6 physician that if he wanted to make it to a flag officer leadership position he'd have to resign his commission and become a nurse.

....and have a clipboard grafted to my arm....and grow my gluteal region by 3 fold....and get a few cats.

 

[haujun]

Interesting thread. I have had the opposite experience. The military nurses I have worked with have been very respectful and willing to do things I ask of them (such as their job). Granted, I haven't worked directly with a nurse above O2 on the ward yet since ours seem to be run by butter bars. I have had infinitely more problems with CIVILIAN NURSES at the MTF. They make it well known that they are completely outside of any chain of command and will not hesitate to ignore orders or generally make your life suck more than it already does.

I had no issues during my residency (w/ O-1 to O-3 Nurses). But you will get to interact with them after residency (O-4 to O-6 Nurses) esp in setting of clinic....

I can't imagine what events that take place between O-3 and O-4 that can explain their animosity towards doctors other than their general increased BMI?

I look forward to be assigned to hospital on my next duty station...

 

[glamqueen]

I had no issues during my residency (w/ O-1 to O-3 Nurses). But you will get to interact with them after residency (O-4 to O-6 Nurses) esp in setting of clinic....

I can't imagine what events that take place between O-3 and O-4 that can explain their animosity towards doctors other than their general increased BMI?

I look forward to be assigned to hospital on my next duty station...

Fascinating thread, but one question:

You guys keep mentioning the growing BMI's (LOL) of the nurses as they grow in rank, yet just a few threads away is the thread by the resident and the PFT etc.

Sooo...why on earth can the nurses with their growing BMI's escape the PFT standards, yet docs can't?

Or did I just open another can of worms?

 

[244913]

@ Glamqueen

Female PT standards

Female USAF PT standards

Permanent profiles

Administrative sleight of hand

- 61N

 

[ArmyGrad]

If you haven't run into discourteous and completely unprofessional behavior from ranking nurses, you haven't been in very long. And if you have forgotten that this happens frequently and does often stand in the way of patient care, then you have been behind a closed door and in a leather chair far too long. It happens, and there is no excuse other than the nurses have no reason not to treat physicians this way- nothing happens when they do. Camaraderie is not part of their vocabulary.

My suggestion: smile. They hate it when you do that.

 

[Mirror Form]

My advice: try to understand things from their perspective. Are they lazy? Are they hyperpolitical and doing things to make themselves look good? Are they just psychopaths trying to torture you? Maybe they are a control freak. Whatever it is that makes them tick use it to your advantage.

The problem with this is that it's always the same answer. The motivation of that nurse or MSC officer who's pressuring you to increase some sort of meaningless metric is always: because it will make them look better and increase their chances of promotion.

Typically they have no concept of patient care. And they get to live in a blissful ignorance of how their BS affects medicine.

 

[Mirror Form]

3 hospitals, 2 deployments, 17years of service - never ever had it happen to me.

Army

You sound like someone who's been at a big medcen for a long time. For the most part, there are enough high ranking physicians at such locations to maintain sanity. MTF's are a completely different story.

Heck, I had such an issue just recently. I was pressured (by an MSC officer) to either rearrange my OR schedule in such a manner so as to make an elderly diabetic go NPO for over 16 hours, or to cancel the case the day before. This was because another patient cancelled, and the MSC officer felt that we had to either combine two rooms into one over-booked room, or cancel cases b/c it would be bad for our OR utilization otherwise.

Here's the kicker, our hospital is already one of the top hospitals in the army in regard to OR utilization (but wouldnt' it make that MSC officer look so great if we were ranked #1?). And no, his actions didn't save the hospital any money. We already had the staff to run two rooms there anyway, but half of them spent the day sitting around.

 

[pgg]

I was pressured (by an MSC officer) to either rearrange my OR schedule in such a manner so as to make an elderly diabetic go NPO for over 16 hours, or to cancel the case the day before.

So I assume you said no to him.

Did that MSC officer create any meaningful problems for you?


I ask because although we have a number of higher ranking MSC and NC officers here, they really don't interfere in any meaningful way. Occasionally some crackpot idea will get floated, but we say no (because of a, b, c, etc), and that's the end of it.

 

[Mirror Form]

Did that MSC officer create any meaningful problems for you?

I've had similar issues before and his response is always to either cut back or rearrange my OR time (he makes the OR schedule). Since good metrics also make his superiors look good, they love him and don't want to hear it when you try and tell them everything isn't actually rosy. He also is involved with the OR budget, so I can't really afford to be on his bad side.

 

[IgD]

The worst thing about all this is when a nurse or other healthcare team member doesn't care about the patient. They put their own needs ahead of the patients. Why are you in healthcare if you don't want to help?

 

[pgg]

(he makes the OR schedule)

Ugh, there's the problem.

Our surgeons go into S3 and book their own days. If they want to squeeze in extras, they ask anesthesia if we can support an extra room, and then they ask the periop nurses, and then they book it.

The only problem with this system is if a slower surgeon gets a bit ambitious and books a set of cases that the rest of us know will go very late.