More from the Gray Lady

[Ziehl-Neelsen]

http://www.nytimes.com/2015/04/20/u...7EA229722E00F0C8AA7&gwt=pay&assetType=nyt_now

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[Gastrapathy]

Weak stuff. Of course they can find half a dozen stories. If the risk of a rare complication is 1:1000 and a system this big performs 10,000 procedures with that level of risk, some number of rare complications are inevitable. As for the sickle trait case, if they boarded everyone with sickle trait for this rare event, there would be an article branding the system as racist.

There is so much wrong with the system but all the NYT seems to be able to understand is that servivemembers can't sue and that must be bad. Maybe it's a credit to the power of bureaucracy. The reporters know there is a story here but just can't quite find it.

 

[ARMYDOCWIFE]

I am very disappointed in the article. There really is a story and the reporter just can't deliver. I may write to my congressional reps and explain it.

 

[HighPriest]

Not a story. 18 year old kids die on the football field every year from dilated cardiomyopathy, but no one at NYT writes an article blaming their physicians. Medicine is about education and recommendations, not directing people's lives.

 

[Shikima]

It's click bait. Easy to demonize due to the emotional appeal and the complicated grief from a mother. If the AF wanted to be really helpful, pay for her therapy.

 

[rbnsafsadgf]

I think the point of the article is the lack of disclosure to the families about how these outcomes happened, not that fact that they happened. The secondary point is lack of accountability, from the families' perspectives, to change this or even to obtain information.

 

[Homunculus]

in peds, the families can (and do) sue. so this is a little unfamiliar to me. do you adult folks just go willy nilly about your day carefree and whistling showtunes?

i agree it's a "nothing to see here" kind of thing. profiles are all just recommendations anyway-- it's up to the line to decide to follow them or not. that's not malpractice, it's just the system.

and not to defend the federal tort claims act too much, but without it I'm not sure how the system would work. you have a population of physicians being forced (at worst) and making do (at best) in systems they have no control over practicing in. physician extenders (all the cases and they dug up a delayed berast cancer diagnosis from a PA? geez) can operate with minimal oversight because no physician wants to expose themselves to that kind of risk without some kind of protection. a handful of cases with the right (or wrong) jury would take huge budget chunks with it. it's a cost containment mechanism, and i think for the most part works because we as physicians do our best regardless.

i also agree that the reporters do seem to be sniffing everywhere but not really finding the pulitzer bone they thought they'd find. this is bush league stuff-- the "case reports" of the journalism world. i could write a similar one about any healthcare system. still surprised they haven't found any traction with subspecialists filling operational admin slots for a couple of years or caseloads at the small MEDDACS.

they even mention a huge issue (but don't seem to press it): "Amid growing fiscal pressures, the Defense Department has ordered improvements and is pushing to close hospitals where surgeons and other specialists treat too few patients to keep skills honed. In a new report to President Obama and Congress, a blue-ribbon commission argued that the military hospitals are wrongly modeled after typical civilian hospitals and so are stumbling in their central mission — to train a medical corps for injuries in combat zones." i would argue this is the story.

--your friendly neighborhood staying healthy until 2018 caveman

 

[BigNavyPedsGuy]

I agree. I spent time on the phone with this reporter last fall and she doesn't have any experience writing about science/ healthcare and it shows. I told her about being forced to practice outside my scope, About being bullied by my command when I said our practice environment wasn't safe and our staff was undertrained, etc. But she writes about cases, not about the broken system.

 

[Shikima]

I agree. I spent time on the phone with this reporter last fall and she doesn't have any experience writing about science/ healthcare and it shows. I told her about being forced to practice outside my scope, About being bullied by my command when I said our practice environment wasn't safe and our staff was undertrained, etc. But she writes about cases, not about the broken system.

The emotional "story" is a better sell. Investigative journalism is dead.

 

[backrow]

Ugh. You know, I understand differences of opinions on milmed, and different experiences at different commands. But talking to these POS vultures? I just don't get it. They are, quite literally, the scum of the earth.

By and large I agree with your sentiment, BUT if you truly believe the millmed has some areas to improve then this really is one of the only ways to effect change within such a large organization with any real impact. It is a very fine, treacherous, line though.

 

[HighPriest]

Yeah, that's a tough call. I can't help but agree with both sides of the discussion. On one hand, there is no journalism anymore. There is editorialism and sensationalism. Journalism is dead. Because of that you cannot trust reporters - at least not at any major news organization. On the other hand, i do think the system is broken and no one within it is able to make changes, either because they cannot, will not, or disagree that changes need to be made.

 

[Homunculus]

Don't get me wrong, any of us have every right to raise concerns with the press, with few restrictions (and despite what some of our commanders try to tell us). I guess I just don't see where the press has ever sparked or caused change for us, except change for the worse. It seems like, even when they tell a story where we did something wrong or there is a real problem, they twist it and make it about something else unrelated and stupid.

For me personally, based on my limited interaction with them in the past (mainly overseas), I think they have nothing to offer us and are never our friend. I will take our commanders over the press any day, even the less-than-stellar ones.

tailhook led to some big changes. and the walter reed "scandal" led to increased visibility and the creation of WTUs and improved the "wounded warrior" system. on a more local level, i have personally witnessed changes made with even some local rag investigative reporting-- not major eath shattering changes but things like work environment and local policies (especially those dealing with civilians) have definitely been shaped by the press.

the issue is neither your command nor the press have our interests in mind. they each have their own agenda. occasionally their agenda and ours line up, and things work. otherwise it's a game, and playing the with press is one of the more risky ones since they aren't as controllable-- but save for a congressional investigation, it's one of the bigger sticks in the arsenal. at least with the press there is a chance to create dialogue-- commanders, especially hospital commanders and above, are jsut politicians in uniform. i've been to enough command calls and town halls to know they will cover their "talking points" and regurgitate whatever leadership principles happen to be en vogue at the time. "high reliability organization" and "surgeon general triad" are what they all work back to at the moment. the press just want readers, and like people have already said these emotional reports pull in more interest than the staffing/training/mission issue.

--your friendly neighborhood most dangerous game caveman

 

[Homunculus]

 

[Homunculus]

There are older stories too where the press seemed to spark good changes with the big military (e.g - Pentagon Papers), but I was specifically referring to medicine. We'll probably have to agree to disagree on the WRAMC issue. My recollection is that WWBs were starting up before the story broke, and regardless, that whole issue had quite literally nothing to do with the medical system except that the housing in question was on a base shared with a hospital. I have never been part of a smaller facility, only the OPFOR (where the press is very much not your friend), so I'll defer to you on that.

I worry about that idea of "aligning interests". Most doctors have only a limited vantage point on the MHS and miltiary, and however well-intentioned they are, they may lack a whole picture of why things are done in particular ways. And the press' interest seems to revolve entirely around sparking outrage. In my short career, I have yet to find an instance of outrage being particularly helpful in my workplace.

i was there when it happened. the issue was not so much the crappy facilities (which were, in fact, crappy) but the complete brush off of the issue ("this is not an issue" i think is a direct quote from kiley) and the defiant attitude showd to the press by the command at the time. i still remember footage of him walking through building 18 with amazingly freshly coated paint and hastily made "repairs." nothing gets the press more involved than saying "this is not a big deal" and trying to minimize and stonewall. he didn't get the big picture that it was more than rat **** and cockroaches. i'm sure there is an army lessons learned on the topic of dealing with situations like this, and you see it in the article above-- "we expect full transparency" instead of "this isn't a big deal, go away." what started as a facilities management issue (which kiley knew about for some time) snowballed into a larger issue of commanders not knowing wtf was going on in their own hospital and the mountains of red tape WTB's made their wounded warriors go through. you can definitely argue the pendulum swung too far, to the point where afterward WTU's were getting an inordinate amount of resources (nursing, staffing, $$$), but you can't really argue that the care being provided was efficient at the time.

i've always felt for weightman in the situation since he followed kiley into WRAMC and really had little to do with it.

i agree with you in that the press is not an ally. i view it more of a tool-- like a chainsaw or something. used in the right hands it can be very useful but understimate it and you'll be bleeding out from lopping off your own arm.

--your friendly neighborhood prefers a lightsaber caveman

 

[HighPriest]

Egon is dead.
God - 2014

 

[HighPriest]

Not speaking to WRMC directly.

Physicians usually do have a short-sighted view of how or why things are run the way they are run. That being said, I don't think that's an excuse to accept practices that you feel are unethical or inherently risky. I think if you're legitimately tried to bring your issues to your chain of command, and that you have been ignored, then you are well within your rights to take additional steps (within reason) to manufacture change. I've never spoken with the media, but it has crossed my mind secondary to multiple issues at my facility which I feel are dangerous and unprofessional - all of which I have brought up repeatedly to my chain of command which has resulted in nothing but being brushed off. I'm not a *****. If you have a legitimate reason for doing something to which I object, explain your reasoning to me. Help me understand that part of the bigger picture. If you cannot or will not explain your reasoning after a legitimate concern has been brought to your attention as a facet of leadership then either you don't care, or you don't feel that keeping your primary producers (your providers) content is a priority, or you don't really have a good reason - none of which are acceptable answers for a good leader. Because while you can lead most of the masses by simple telling them where to go, when you're dealing with an educated group who deal with people's lives as a trade, that isn't sufficient in many cases. I don't feel that blanketing the situation with a statement like "you don't see the bigger picture" is enough.

If these were minor issues (I feel like you should provide free coffee), then I am not surprised or upset to be blown off. If it is an issue of patient safety (which is has been here on more than one occasion), then I expect an explanation of some kind. I'm fully prepared to be wrong in my concerns, but I need to know that is the case.

 

[BigNavyPedsGuy]

I sat in on meetings with the command suite and NAVMEDWEST. I had a pretty good understanding of the big picture.

I tried going through formal channels to address unsafe conditions and a culture of punishing those who try and improve the system. (See thread titled "The Tale of BigNavyPedsGuy").

A few months after I separated, I reached out to her and had an off the record conversation outlining how hopeless it is for docs on the ground and how much the bosses just don't get it.

I don't feel bad about it at all. If you don't like it, court-martial me. Oh wait, I was separated....

 

[TurtleDO2012]

Just look at the VA situation over the previous year or so. A few docs and staff clearly pointed out problems at their Arizona location. Finally hits the news and a little overblown but nonetheless light is shined on their organization and new energy and money flows to help the problem.

Due to previous articles last may about reporting sentinel events, at my place at least that has greatly improved and overall visibility of being shared with other departments has improved tremendously.

 

[Shikima]

Just look at the VA situation over the previous year or so. A few docs and staff clearly pointed out problems at their Arizona location. Finally hits the news and a little overblown but nonetheless light is shined on their organization and new energy and money flows to help the problem.

Due to previous articles last may about reporting sentinel events, at my place at least that has greatly improved and overall visibility of being shared with other departments has improved tremendously.

Problems with the VA is far too much Governmental bull**** with a case of too many Chiefs. There is no accountability unless someone makes the news, and even then, they're still going to receive a bonus.
http://www.govexec.com/pay-benefits/2015/03/judge-tells-va-repay-former-senior-execs-bonus/107493/

 

[Gastrapathy]

Caveman nailed it. They are a blunt instrument. You have to be willing to cause some collateral damage, maybe get a little mud on yourself and fail to achieve your goals. But that doesn't mean it's always a bad choice.

 

[pgg]

There are older stories too where the press seemed to spark good changes with the big military (e.g - Pentagon Papers), but I was specifically referring to medicine.

Libby Zion comes to mind.

 

[pgg]

Not to spark a fight, but I don't consider the results of that tragic case to be positive.

I agree that the pendulum has swung too far, but some kind of work hour limits were needed.