Power Trips

[IgD]

I've observed the military can be malignant at times. I was at an officer's call once and a flag officer showed a PowerPoint slide of a sheriff's badge with the caption "there is a new sheriff in town". He appeared to describe himself as a punisher or enforcer. Then he made a point about saying "It's not about the people, it's about the right people." Then he made a point about "We need to get the wrong people off the bus". The message I received was if you have a different idea or disagree you need to fired or punished. There is a reality to what he was saying since he held all the cards but on the other hand it left a foul taste in my mouth.

Is the civilian medical system like this too? I wanted to walk out.

Leadership styles vary from person to person. My style is being approachable, using tact and backing up decisions with logic and reason. I think threats should be an absolute last resort.

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[Galo]

I think this is where there is such a culture clash between medicine, and what this officer, (and the vast majority once they are in that level of power positions), calls officership. They truly see it as a dictatorship with absolute power and no accountability. When you throw medicine into that mix, you get the debacle that we have today. Especially when that bull is not a physician, or a physician who is so incompetent at his job that his/her way of life is to bully around other physicians. This is the type of people who will make your life hell.

A1querty could be a poster boy for this.

 

[IgD]

This has to happen in the civilian world too right? Does the hospital CEO walk into the operating room, flip over the tables and micromanage the schedules?

 

[Perrotfish]

No personal experience, but I've definitely heard micromanagement horror stories from the civilian world as well. For one example I had a friend do a residency at Duke that swears he heard the phrase 'That's not the Duke way to do it' at least a dozen times a day, for all five years.

 

[orbitsurgMD]

I've observed the military can be malignant at times. I was at an officer's call once and a flag officer showed a PowerPoint slide of a sheriff's badge with the caption "there is a new sheriff in town". He appeared to describe himself as a punisher or enforcer. Then he made a point about saying "It's not about the people, it's about the right people." Then he made a point about "We need to get the wrong people off the bus". The message I received was if you have a different idea or disagree you need to fired or punished. There is a reality to what he was saying since he held all the cards but on the other hand it left a foul taste in my mouth.

Is the civilian medical system like this too? I wanted to walk out.

Leadership styles vary from person to person. My style is being approachable, using tact and backing up decisions with logic and reason. I think threats should be an absolute last resort.

Academic departments can be equally malignant. A new chairman sometimes has an agenda to remake the department to his liking, and that is sometimes accomplished by forcing out those who are not part of the plan. How is that done? Easy. Changing work schedules, reducing faculty plan support, changing staffing in clinics, reducing or changing OR time available and basically ignoring any objections. It is easy to make a doctor unhappy enough to want to leave. I am grateful not to have that experience, but I have seen it happen lots of times.

 

[Galo]

Academic departments can be equally malignant. A new chairman sometimes has an agenda to remake the department to his liking, and that is sometimes accomplished by forcing out those who are not part of the plan. How is that done? Easy. Changing work schedules, reducing faculty plan support, changing staffing in clinics, reducing or changing OR time available and basically ignoring any objections. It is easy to make a doctor unhappy enough to want to leave. I am grateful not to have that experience, but I have seen it happen lots of times.

While I agree this is certainly true, never, does patient care become at risk for personal gain, as I have experienced in the military.

Certainly there are surgical programs known for their malignancy, and for individuals reigning with an iron fist. However, as an attending, you always have the choice to not work in that environment. In the military, you are STUCK till one of you leaves, and that could be measured in years!!!!

 

[350011]

This has to happen in the civilian world too right? Does the hospital CEO walk into the operating room, flip over the tables and micromanage the schedules?

Being an entering medical student I can't speak to this directly and will leave that to the attendings and residents on this forum. That said, I can point you in the direction of an interesting reference that is closely-related if you're interested.

While it isn't dead-center, Professor Charles L. Bosk's book "Forgive and Remember: Managing Medical Failure" is pertinent if you can get your hands on it. Its a sociological study of power structures and internal regulation at an academic hospital; the Chief of Surgery recommended it to me when I was shadowing my P.I. in the OR. The section on "quasi-normative errors" is particularly relevant, where such errors are "breaches of standards of performance [...] are eccentric and attending-specific". It's a pretty good read, especially if you're interested in surgery or how performance is regulated in an academic setting.

 

[The White Coat Investor]

However, as an attending, you always have the choice to not work in that environment. In the military, you are STUCK till one of you leaves, and that could be measured in years!!!!

This is huge. Not having the ability to leave really hurts your negotiating position for everything.

 

[alpha62]

Yeah it happens in civ. life. the little worm CEOs and admin pukes are just more passive aggressive about it.

where do you think MSCs go after the army ? Sometimes they go to congress... http://stevebuyer.house.gov/contact.htm

 

[tulane06]

That guy sounds like a complete tool.

 

[alpha62]

I wish the Army backed up their people as well as southwest airlines does...

http://www.azcentral.com/news/articles/1116toosexy16-on.html

SWA has very low employee turnover, their morale is very good... So good they can get their employees to lie for them about cracks in aircraft to protect the company.

The army could really learn from this outfit.

 

[mitchconnie]

Then he made a point about saying "It's not about the people, it's about the right people." Then he made a point about "We need to get the wrong people off the bus".

This business about getting people "off the bus" must come from some sort of civilian management text which is used at one of the military leadership courses. I have heard the exact same line a couple of different times from commanders. Unfortunately it's totally non-sensical in the military context, since virtually all the docs would be happy to be let off the bus at the very next stop.

But I do agree that there is more of this blow-hard type leadership around. Our commander recently had a meeting regarding JACHO-compliance where he loudly threatened "UCMJ action!" against anyone who failed to fill out certain pre-op paperwork in the prescribed manner. In such cases the command has totally lost credibility with its physicians and has only blustering and threats to motivate people. How sad.

 

[alpha62]

whenever I start hearing slogans, I know things are not going to go well.

Whenever I start hearing the word "challenge" to describe a problem, "touch base" meaning report to me on that, or the ever popular " team player" to describe a suck up... I just want to puke.

Had a hospital commander once gather everybody up and tell everybody if they don't do things " my way" he could expedite PCS to Alaska. He must have seen that on an old movie. Him and his sterile uniform, 0-6 and no combat patch and all. Obviously he'd had never done Alaska,because it beats hell out of the turd pile in Texas we were stuck in.

What I would have given to get Alaska instead of that crappy assignment.

 

[Perrotfish]

What is the current "process improvement" system the military is on now? I saw a "Six Sigma" book lying around in one of our clinics the other day, but I could have sworn that that program had already been dumped.

Not that I know what any of them mean . . .

Wow, Six Sigma, I remember that from interning in the Chemical Industry. So many different kinds of useless. What bothers me the most is that before Motorola came out with this motovational crap 'six sigma' used to be such a nice, mathamatical, engineering term.

 

[Mirror Form]

This has to happen in the civilian world too right? Does the hospital CEO walk into the operating room, flip over the tables and micromanage the schedules?

It doesn't happen anywhere near as badly in the civilian world b/c doctors would just quit and find another job. Yeah, there are definitely malignant CEO's, but if they piss off to many physicians they're going to get run out by the board of trustees.

 

[colbgw02]

Maybe not in medicine, but you know this crap goes on in the real world. It's pretty much the basis for that show The Office (great show, BTW).

 

[alpha62]

It happens in the civ world alot. You just have the freedom to tell these clowns to stick it, get on the internet, and have another job by sundown the same day now.

I've been in this field since 1980. I've had many run ins with managers, not really many physicians though. I've told them to shove it and left.

In every single case, the operation has gone on to close shop.

You can be the smartest guy in your class, but it only takes a freakin nurse with a management degree from the Univeristy of Phoenix to send you both to the poor house.

 

[opheracco]

By your post it seems that the officer could have been talking about something other than what you interpreted.

I've observed the military can be malignant at times. I was at an officer's call once and a flag officer showed a PowerPoint slide of a sheriff's badge with the caption "there is a new sheriff in town". He appeared to describe himself as a punisher or enforcer. Then he made a point about saying "It's not about the people, it's about the right people." Then he made a point about "We need to get the wrong people off the bus". The message I received was if you have a different idea or disagree you need to fired or punished. There is a reality to what he was saying since he held all the cards but on the other hand it left a foul taste in my mouth.

Is the civilian medical system like this too? I wanted to walk out.

Leadership styles vary from person to person. My style is being approachable, using tact and backing up decisions with logic and reason. I think threats should be an absolute last resort.

 

[alpha62]

By your post it seems that the officer could have been talking about something other than what you interpreted.

You're probably right. what he probably didn't really hear "we're here to get the right people on the bus"

What he probably heard was....

" We're here to throw a lot of people UNDER the bus "

 

[DiveMD]

What is the current "process improvement" system the military is on now? I saw a "Six Sigma" book lying around in one of our clinics the other day, but I could have sworn that that program had already been dumped.

Not that I know what any of them mean . . .

HAHAHA! So true! My previous CO started pushing this BS about a year ago. I wonder what happened to it.

 

[ILUvRVUs]

Quality patient care does not produce a fitrep bullet for NC/MSC divo's and DH's. It really suffers. Aparently neither does physician retention. Atleast not at the clinic level. Civillian docs have one thing that military docs don't; their freedom. I have limited experience in civillian medicine during med school, however, doctors were generally happy with their jobs. Despite bumps in the road, most are in the same practice for years when they have the option to leave and could easily find another job.

 

[BomberDoc]

My entire clinic got another "Shut up and color" speech today from the commanders. It was pathetic. They had the results from a climate survey that basically shows that we are all horribly depressed about our jobs and hate life in the most obscene way. They told us to "Suck it up" (direct O-6 quote) and that the mission remains and that no manning is on the horizon so we have to keep producing results with fewer and fewer resources. The nurses (even the lowly captain nurses who just got their shiny new clipboards) were of course cheering loudly because business as usual for them means leaving each and every day at 1630 and no additional duties. However, those of us who work for a living get to line up each day for an extra kick in the nuts so we can "take one for the team."

Lovely. I think I'm pretty much checked out at this point. Shut up and color my a$$. Try getting any quality work out of me in the next 51 days. Bitches.

 

[sethco]

climate survey that basically shows that we are all horribly depressed about our jobs and hate life in the most obscene way. They told us to "Suck it up"

Don't know if this is ture, but if so (and I don't doubt it, BTW) it is absolutely hilarious.

Future CEOs, pay attention. This is the best way to combat job dissatisfaction among your workers. I don't know about anybody else here, but this is the best way to increase job productivity: threats, demeaning comments, and disinterest in work conditions/prevailing attitude. Who wouldn't kill for a job like that???

 

[Galo]

My entire clinic got another "Shut up and color" speech today from the commanders. It was pathetic. They had the results from a climate survey that basically shows that we are all horribly depressed about our jobs and hate life in the most obscene way. They told us to "Suck it up" (direct O-6 quote) and that the mission remains and that no manning is on the horizon so we have to keep producing results with fewer and fewer resources. The nurses (even the lowly captain nurses who just got their shiny new clipboards) were of course cheering loudly because business as usual for them means leaving each and every day at 1630 and no additional duties. However, those of us who work for a living get to line up each day for an extra kick in the nuts so we can "take one for the team."

Lovely. I think I'm pretty much checked out at this point. Shut up and color my a$$. Try getting any quality work out of me in the next 51 days. Bitches.

You bring back fond memories of that crap. I remember, especially the last two years sitting and typing for HOURS on those surveys. Invariably, they would find a way to spin the most absolutely minor positive issue, while the obvious negatives were unmentioned, or something they were working on. It was the most useless form of patting itself on the back for an organization where the vast majority of professionals were exceedingly unhappy, (I am refering to the hospital, clinics, etc).

What a waste of time and paper.

 

[IgD]

Access problems? Maybe we should extend clinic hours and open a Saturday morning clinic...

 

[IgD]

By your post it seems that the officer could have been talking about something other than what you interpreted.

I had to sanitize the remarks otherwise it would have been more clear

 

[armymt]

error..error

 

[NavyFP]

Can you do that? That would be nice. I've noticed even in my hospital, the corpsmen are gone at 1600, regardless of how many patients are left to be seen.

Of course, it doesn't matter, since they don't really do much of anything anyway.

If there are patients to be seen, they should stick around. We own them as much as the docs. You should chat with your LPO.

 

[Founder]

You can't make the corpsmen and nurses stay around until everyone has been seen?

What about public embarrassment? Those who leave take them into the filled up waiting rooms and announce they don't care about your health and they just want to leave and go home... I don't know if that's allowed, but maybe it should be. I don't know...

 

[armymt]

Can you do that? That would be nice. I've noticed even in my hospital, the corpsmen are gone at 1600, regardless of how many patients are left to be seen.

Of course, it doesn't matter, since they don't really do much of anything anyway.

If they were civilians, it's understandable that they can leave at the end of their shift, but that does not apply to military personnel. They are not suppose to leave their post unless properly relieved. That is a Serviceman's General Order. The Soldier doesn't have the luxury to leave whenever he/she wants. NCO's should have straighten them out on the spot.

 

[alpha62]

jeez, you CAN'T make the enlisted stay late.

That would cause a ripple effect all the way down the line. That would cause the day care worker to have to stay late.

Making the day care worker stay late would in turn cause her to be late for her own booty call with an E-1 setting up their own social welfare safety net by pumping out more dependents.

If the number of dependents went down, less conus billets would be needed and that would free you up to get sent to Iraq.

Don't jack with the formula.

 

[armymt]

error

 

[Mirror Form]

If they were civilians, it's understandable that they can leave at the end of their shift, but that does not apply to military personnel. They are not suppose to leave their post unless properly relieved. That is a Serviceman's General Order. The Soldier doesn't have the luxury to leave whenever he/she wants. NCO's should have straighten them out on the spot.

Except that the NCO's have already gone home by that point.

 

[ILUvRVUs]

Can you do that? That would be nice. I've noticed even in my hospital, the corpsmen are gone at 1600, regardless of how many patients are left to be seen.

Of course, it doesn't matter, since they don't really do much of anything anyway.

Agreed. Whether they stay later, or arrive earlier for that matter, it doesn't help me out that much. Lunch time, PT time....

We are open on saturdays and sundays. Extending clinic hours does not mean increasing the amount of providers. The demand is very high and the supply is low.