“So you need a waiver for what now?”

[John1513]

In the military there are real world repurcusions for infractions ranging from being late to work to marriage infidelity.

Are there any consequences for lying to a Medical Officer?

In terms of utility and practicality, is there really anything a military physician can do to encourage honor, courage and commitment?

I know many SDN seniors have taught many times the fine balance between being a physician and military officer.

What were some ways you were able to establish: “Hey I’m here to help you but I’m not an idiot FNG to be taken advantage of.”

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[HighPriest]

But....treating medical officers as idiots to be taken advantage of is the whole point of military medicine....

 

[d2305]

There's a balance between being a hard arse and a compassionate physician.

 

[Perrotfish]

Are you residency trained or are you a GMO?

 

[narcusprince]

In the military there are real world repurcusions for infractions ranging from being late to work to marriage infidelity.

Are there any consequences for lying to a Medical Officer?

In terms of utility and practicality, is there really anything a military physician can do to encourage honor, courage and commitment?

I know many SDN seniors have taught many times the fine balance between being a physician and military officer.

What were some ways you were able to establish: “Hey I’m here to help you but I’m not an idiot FNG to be taken advantage of.”

You must be very early in your career. Just like the civillian world lying, dishonesty, and gaming the system occur. As a physician you have to take patients at face value. And use your evidence to back up your actions. You are a physician first and an officer as a loose second. Sometimes those conflict and the physician should always win.

 

[HighPriest]

Agree with narcusprince. Much more often than not the filters of algorithmic, evidence-based medicine and time will weed out malingerers and fakes. If you have a very good reason to think a patient is lying to you, you should bring it up to them in an non-accusatory manner and talk it out. If you simply suspect that they're dishonest, take them at face value and run them through the process. If you're worried about hurting them, just remember to not treat them any more aggressively than you would someone you don't suspect, and be very clear about the risks of the treatments you're providing, and the expected outcomes. Usually a patient who is being dishonest, when faced with risk and possible injury, will either come clean or disappear from your practice. Medicine now-a-days is a guided, but joint decision. Tell the patient what their options are. Let them know what the risks and benefits of each option is. Let them know if you have a preference based upon your skill, experience, and research, but let them weigh in on the decision. There will always be patients who just want you to tell them what to do, and that's fine, but I tend to try not to do that with someone I suspect is being less-than-forthright. Often, their decisions will make their goals clear. Malingerers will steer themselves away from being injured. If it really looks like they're steering themselves into a wall, send them for a second opinion. It's a good way to get more input, to give the patient an out, and to CYA. If you think everyone is being dishonest, well that's a personal issue.

The hard part about military medicine is the lack of financial risk for the patient. Which is usually a very good thing, but which actually becomes burdensome when someone is malingering or trying to game the system.

 

[HighPriest]

I was having a conversation with a cousin the other day. He's a mechanic. I made the comment that I'm basically a mechanic as well, it's just that the engines I work on have ulterior motives, opinions, and feelings. And they do google searches.

 

[HighPriest]

To answer your other questions:

1 - Yes, but rarely does anyone enforce them. I've seen people get the book thrown at them for infidelity, and then I've seen it swept under the rug. Showing up late? Meh.
2 - What are we talking here? Don't let it get under your skin if it's something minor.
3 - You can lead by example. That's really about it. I guess you could hang motivational posters and have mandatory pep sessions like the hospital commands do, but I always found that to have the opposite of the intended effect.
4 - Be professional and do your job well. That's the best way to not be taken advantage.

 

[narcusprince]

I say try your best to treat your patients how you would want your family treated. All of my patients get the best from me including the ones who are not honest. I once had a patient not tell me about a family history of an allergy to muscle relaxants. I then do the case adminster the muscle relaxents and they had a prolonged response to them. At no point did I choose to blame the patient. Why the patient knew they had the deficiency and did not want to get med boarded. The military in general in many ways incentives dishonesty. And true Hipa does not exist. Your medical record determines if you can fight. Can’t fight people are going to want to know why. These values go against the core values of military service. Whom do you choose to honor your family or your CO or your own health? What makes you courageous lying to doctors in hopes of stay in? Commitment to whom? Those that come in expecting a morally superior environment quickly learn like myself that the military is not morally superior to any other hospital system. In fact civilian hospitals have controls in place to keep occupation separate from medical conditions.

 

[John1513]

Are you residency trained or are you a GMO?

@Perrotfish : BC , but civ residency. Finished utilization tour. Going green side now. Maybe way different experience with this new PCS.

 

[John1513]

@narcusprince @HighPriest thank you for your time and wisdom. I am far from a hardarse... I give my all in milmed. I try to show these service members what good thorough medical care is like. I treat everyone like family. I click through old notes and I treat the whole patient. I order base line labs and care about root causes each service member’s issues. I am deeply mindful of MEBs and these folks’ careers and families. I am reminded of operational needs often. Thus, it irks me find out that I’ve been duped one way or another here and there. But, maybe it is my relative newness and salty folks could tell. I know we are all human and have different motivations. My intention of this post was to gather advice, see it as it is, and move on - meaning getting over myself and continue giving my all to the service members.

 

[Perrotfish]

@Perrotfish : BC , but civ residency. Finished utilization tour. Going green side now. Maybe way different experience with this new PCS.

BC in what and greenside where?

 

[narcusprince]

@narcusprince @HighPriest thank you for your time and wisdom. I am far from a hardarse... I give my all in milmed. I try to show these service members what good thorough medical care is like. I treat everyone like family. I click through old notes and I treat the whole patient. I order base line labs and care about root causes each service member’s issues. I am deeply mindful of MEBs and these folks’ careers and families. I am reminded of operational needs often. Thus, it irks me find out that I’ve been duped one way or another here and there. But, maybe it is my relative newness and salty folks could tell. I know we are all human and have different motivations. My intention of this post was to gather advice, see it as it is, and move on - meaning getting over myself and continue giving my all to the service members.

Giving it all to those on the table is the only thing in my mind that keeps me happy and helps me sleep at night.

 

[Perrotfish]

@narcusprince @HighPriest thank you for your time and wisdom. I am far from a hardarse... I give my all in milmed. I try to show these service members what good thorough medical care is like. I treat everyone like family. I click through old notes and I treat the whole patient. I order base line labs and care about root causes each service member’s issues. I am deeply mindful of MEBs and these folks’ careers and families. I am reminded of operational needs often. Thus, it irks me find out that I’ve been duped one way or another here and there. But, maybe it is my relative newness and salty folks could tell. I know we are all human and have different motivations. My intention of this post was to gather advice, see it as it is, and move on - meaning getting over myself and continue giving my all to the service members.

Well it sounds like you're handling this well, and you have enough training that I doubt your concerns are a sign of overconfidence. I think the trick is to forget about the uniform. It's not like civilian docs don't deal with people that are, consciously or not, there for sick notes/insurance/workers comp/an advantage in divorce court. Those docs don't get frustrated, they just shrug and do the work up. If you focus on the doctor-patient relationship, and stop being disappointed in your patients as Sailors/Marines, I think you will find that your job gets a lot easier.

Acting like an officer, to me, is about your relationship with your subordinates in the medical corps. If you're greenside that means training and taking care of your GMOS and Corpsmen. Get them adequate training and supplies. If your GMOs want back into to residency mentor them, get them TAD time, and push them to publish some research. Do what you can to get your Corpsmen promoted. Don't reflexively throw everyone under the bus when something bad/embarrassing inevitibly happens (not saying to shield everyone from everything, but advocate for due process and proportionate consequences). When you see patients, though, be 100% in doctor mode.

 

[Kingfisher]

In the military you wear a lot of hats (covers). For you, there is the hat of physician as well as the hat of officer (among others). Sometimes you need to take one hat off and put another one on.

There are different leadership styles. You will have to get a feel for how much Gunnery Sergeant Hartman you will need to channel to deal with it.

Example 1: Sometimes it's just a little..."We talked about how important your blood pressure Meds are to your health. I see that you never filled them. I need you to get onboard with this because if you don't take your Meds, it can affect your ability to deploy."

Example 2: Sometimes it is a lot more..."SHIPMATE, remember last year when we talked about your blood pressure? Well, you never filled them and your blood pressure is 190/110. You are not going to be able to transfer to Sigonella until we can get it under better control. Here is the plan going forward and I am going to need to talk to your Chief."

You tend to use the second example more in an operational command. Believe it or not it's OK to use some force from time to time. Your patients should expect it and often actually want it (this is the military after all). If it comes from a place of love they will appreciate it and respect you.

 

[John1513]

Thank you all for your thoughtful replies, I will definitely process them all and pass them onwards one day.

Happy Fathers’ day to all you dads and surrogate dads out there.

 

[244913]

Here's some advice since you are going to the Greenside from a hospital job and are- I presume- not prior service.

Tread very lightly at your first command for the first 6 mos- 1 yr. Do a lot more listening then talking. You are new to this. It will take time to cultivate trust with the Line officers and the troops. Lean heavily on your NCO's. Go to every command and staff mtg, drop by the troop bays, do PT with the troops, do weapons training. Go to hail and farewells. Wear the uniform correctly and with pride. Get in the best shape of your life. If you want to really know how a Marine is doing, then you should have his NCO on your cell phone and you can find that out.

Your command will welcome you, but they will be watching you very carefully. Don't lean too heavily on young Marines- even if you think they are FOS. Focus on being a really good "Doc" and ingratiate yourself with the company commanders and esp. the XO (your Boss). As time passes, after you deploy to combat- if you do- you will have earned respect the hard way and will fit in seamlessly with the unit. Life will be a real joy, Greenside can be a fantastic experience.

If you come in pants on fire as a greenhorn you will burn a lot of bridges. I say this kindly- but a lot of your posting seems faintly "autistic." I don't know if you are like this in real life but the Greenside will chew you up if you don't tread with caution.

Good luck

- ex 61N

 

[John1513]

Thank you very much, will absorb all of this!!