The $#% of GMO life

Discussion in 'Military Medicine' started by ishii123, Dec 22, 2005.

  1. ishii123

    ishii123 Member
    10+ Year Member

    Joined:
    Mar 13, 2005
    Messages:
    78
    Likes Received:
    0
    Status:
    Attending Physician
    This is my venting session:

    Being a GMO really sucks. And don't delusion yourself into thinking being a Flight Surgeon or Undersea Medical Officer does not suck either. It just sucks less than being a GMO.

    Case in point. Today, I find out that one of my patients I take care of missed her freakin' mental health appointment yesterday. I worked hard last week to get her seen by the psychiatrist before she goes on vacation at the end of this week (routine appointments usually take 3 weeks). But she missed her appointment because she "got lost" going to the Naval Hospital and arrived late. How can you get lost if you've been living in this small town for the past 6 months?! Of course, she was non-chalant about it. Now she is rescheduled for an appointment next month. But my CO does not want to wait that long. He wants her seen before she goes on vacation. So my CO is pushing me to have her seen by the psychiatrist today or tomorrow even though this is entirely the patient's fault. And the psychiatrist is going on X-mas vacation tomorrow. Now I have to run through hoops to try and make this happen. But it is not an absolute emergency (the patient is not suicidal or homicidal). THIS IS ABSOLUTE CRAP!

    This type of crap happens regularly to all GMOs, Flight Surgeons (FS), and Undersea Medical Officers (UMO). Just because you get to fly as a FS or dive as a UMO doesn't mean you're free from it. Being a FS or UMO is the equivalent to being a "gloried GMO" who still deals with the same CRAP! CRAP I TELL YA! :mad:

    P.S. - Did I tell you I hate being a FS?! Six more months then I'm done with this $hi+!!!
     
  2. GMO2003

    GMO2003 Senior Member
    10+ Year Member

    Joined:
    Dec 27, 2003
    Messages:
    494
    Likes Received:
    13
    Status:
    Attending Physician
    I hear ya brother...but look at it this way..its only for 6 more months and you're done...finished, never again!!! Also keep in mind that it could always be a whole lot worse...I don't know about you...but my hours are 8-4 and no weekends...can't beat that...nontheless, I'd give it all up if I was back home with my wife and family...I'm counting down the days with you!
     
  3. pgg

    pgg Laugh at me, will they?
    Moderator Physician Faculty 10+ Year Member

    Joined:
    Dec 14, 2005
    Messages:
    11,610
    Likes Received:
    6,743
    Status:
    Attending Physician
    This is easy to solve. Talk to your CO again, this time without being a *****. Tell him two things:
    • It is not possible for the psychiatrist to see her because she's not an emergency. Period.
    • If he's unwilling to let her go on leave before she's seen by psych, then he can tell her she's not going on leave.
    This isn't hard. Your CO will either realize that he's making a ridiculous demand and back down, or he'll take it upon himself to cancel her leave and make her wait for the next appointment. Either way, this is not your problem.

    You don't have to jump through hoops to get an irresponsible, noncompliant patient (who's in no immediate danger) another appointment. Pick up the phone, once, call mental health, ask if there's an opening to get her seen, when they say no, then hang up and get on with your life.

    You're not there to be a yes man to your CO. Why is he telling you what is and isn't medically indicated? Because you let him, that's why.

    Only the ones who let themselves be pushed around, in my experience.

    Honestly, you're worrying about this way too much, and the last thing you should be doing is letting your CO dictate when and where and how and by whom your patients get seen. If you're a Navy FS with 6 months to go, then you've been there either 24 or 30 months already ... and it's no wonder you're miserable if you routinely cave in to ignorant demands.

    Yes, our COs have final say regarding our recommendations, and some are less cooperative than others. But part of our job is to persuade and cajole our COs into staying the hell out of our way ... especially when we're in garrison.


    My apologies if I'm ruining your venting session. :)
     
  4. swampthing

    swampthing Member
    5+ Year Member

    Joined:
    Jun 22, 2005
    Messages:
    61
    Likes Received:
    0
    Status:
    Resident [Any Field]
    I say "yes" and "no". It depends on the situation.

    Situation #1: There is the possibility that "ishii123" was selected for a military residency, will finish his flight surgery tour in 6 months, and then go on to a military residency in July 2006. If that's the case, then he cannot burn any bridges. His CO still writes up his FIT REP. His residency selection is dependent on him/her getting "promotable" or above on his FIT REP. If s/he gets an adverse FIT REP (ie, not promotable), then his/her residency selection can be taken away. FIT REPS are also important for moving up the ranks and an adverse FIT REP can affect the rest of your military career.

    Situation #2: If he's getting out of the Navy all-together, then I totally agree with you. Screw the CO and tell him how you see it :laugh:
     
  5. RichL025

    RichL025 Senior Member
    5+ Year Member

    Joined:
    Feb 6, 2005
    Messages:
    422
    Likes Received:
    4
    Status:
    Resident [Any Field]
    WRT situation number 1...

    OK, I'm not in the Navy, but have 19 years now in the army. Let me wargame this out... because he grows a backbone and stands up to his CO after having knuckled under for so long, the guy tanks his fitrep (assuming CO is dingus enough to do that for revenge)

    1. Wouldn't the residency folks find out about it when it's too late to do anything? I mean, in the army, these things are done yearly, and upon an individual's change of station (ie, _going_ to residency). By the time they find out about a "sub-par' fitrep, he will already have PCS'ed and signed into residency, so the PD would have a choice of sending him back (and being short one person in the program for a year), or accepting his story of an dingus CO and letting it go.

    2. Isn't there a mechanism for challenging sub-par fitreps in the navy? My experience is mostly as an army enlisted guy, but when you have a soldier with all above-average fitreps who suddenly gets one sub-par, you tend to look just as closely at his rater as you do the soldier....

    Either way, I agree that the OP's situation sounds a bit like he was letting himself be taken advantage of, but since I'm not in his shoes, I'll allow maybe there's more details we're not getting.
     
  6. pgg

    pgg Laugh at me, will they?
    Moderator Physician Faculty 10+ Year Member

    Joined:
    Dec 14, 2005
    Messages:
    11,610
    Likes Received:
    6,743
    Status:
    Attending Physician
    Well, that's just it. You don't have to burn bridges, be insubordinate, etc in a situation like the OP described.

    "Sir, she missed her appointment. There's no psychiatrist available to see her now. I called the mental health clinic to see if they can squeeze her in, but they can't. I think she can safely wait until January for a rescheduled appointment."

    "No, it would be inappropriate for me to misrepresent her as an emergency in order to get her seen by the on-call psychiatrist."

    I'm not suggesting he say "Piss off, Colonel, you don't know what the hell you're talking about, I'm the doctor here."

    But scrambling around in a near-meltdown state, trying to accomodate unreasonable demands because you're afraid of your CO ... that's a symptom of spinal deficiency, not evidence that GMO life is malignant and unfair. Granted, there might be circumstances or background that are relevant but not described by the OP - so maybe I shouldn't be quite so quick to jump on him. :)
     
  7. GMO2003

    GMO2003 Senior Member
    10+ Year Member

    Joined:
    Dec 27, 2003
    Messages:
    494
    Likes Received:
    13
    Status:
    Attending Physician
    I agree 110% with pgg...I've been confronted numerous times by company, battalion, and even a couple times by brigade level commanders wanting to know what was going on with their soldiers. Sometimes they can be quite confrontational in regards to "insisting" things should be done their way or the highway. The best thing you can do is to talk to them in a very logical and professional manner. I also think its good to speak in layman's terms as to not give the impression that you are patronizing them or trying to hide behind medical jargon. If handled with assertiveness and confidence, I have no doubt they will understand the situation and agree with you course of action....good luck and remember it's almost over :thumbup:
     
  8. Mirror Form

    Mirror Form Thyroid Storm
    10+ Year Member

    Joined:
    May 8, 2003
    Messages:
    7,529
    Likes Received:
    22
    Status:
    Attending Physician
    That is exactly what interns do all day. If you don't accomodate every unreasonable request of your senior residents, the consquences will be very severe. So while I'd like to think that things will change greatly if I become a GMO, I'm not about to fight the system and find out. The OP has a great residency slot lined up for him, why take any chances by trying to fight the power?
     
  9. bogatyr

    bogatyr Senior Member
    10+ Year Member

    Joined:
    Aug 7, 2004
    Messages:
    305
    Likes Received:
    5
    I disagree. When the senior tells me to replace the K because it's 3.7, I just don't do it. If they really want it done they do it themselves. I think the only consequences are that I get 6s on my evals instead of 7s.
     
  10. Mirror Form

    Mirror Form Thyroid Storm
    10+ Year Member

    Joined:
    May 8, 2003
    Messages:
    7,529
    Likes Received:
    22
    Status:
    Attending Physician
    You have nice seniors then.
     
  11. RichL025

    RichL025 Senior Member
    5+ Year Member

    Joined:
    Feb 6, 2005
    Messages:
    422
    Likes Received:
    4
    Status:
    Resident [Any Field]
    Or maybe just bolder interns?
     
  12. Mirror Form

    Mirror Form Thyroid Storm
    10+ Year Member

    Joined:
    May 8, 2003
    Messages:
    7,529
    Likes Received:
    22
    Status:
    Attending Physician
    ah, another med student who thinks he knows everything :rolleyes:

    So when was the last time you told your senior residents that the scut they assinged you was pointless and you wouldn't do it????
     
  13. RichL025

    RichL025 Senior Member
    5+ Year Member

    Joined:
    Feb 6, 2005
    Messages:
    422
    Likes Received:
    4
    Status:
    Resident [Any Field]
    Go back and re-read the posts, O unhappy, bitter, anonymous one....

    It wasn't scut in the example given.

    You've explained your anonymity (refusing to even name this mysterious, malignant program you belong to) by decribing a fear of persecution. Maybe you're simply in a different army than me, I dunno....

    But, to answer your question:

    Actually, never needed to, I was amazed by how little I was "scutted out" in the 2 MEDCENs I worked at. One of my chiefs even explicitly told me that a certain task "wasn't for me" because as a student, my chief job was learning about general surgery, not performing menial low-yield tasks.

    What little tasks there were like that, I did with the rest of the team to help the team out, although to be fair, the bulk of stuff like that fell to the interns. Yeah, that'll be me next year.

    Hopefully I'll remember to not dump on the med students next year.

    Or Lord it over them like I'm so wise in the ways of the world <g>.

    Oh, yeah, and Merry Christmas!
     
  14. GMO2003

    GMO2003 Senior Member
    10+ Year Member

    Joined:
    Dec 27, 2003
    Messages:
    494
    Likes Received:
    13
    Status:
    Attending Physician
    There is no need to be confrontational when being forced to give in to unreasonable demands. As long as you are assertive and professional with your reasoning for not following through with them, no one can touch you.

    If the demand was unreasonable and does not jeopordize or greatly benefit or have any overall effect to the patient's course or hospital stay, what does it matter?

    I cannot tell you how many times as an intern, I was asked to do some ridiculous and inane tasks. I simply worked my way up the chain to either the senior and/or chief resident on service and explained the situation. 100% of the time I was relieved of the task and simply told to disregard the order.

    Of course, if you blatantly disregard an order that does jeopardize the patient and/or has a definite and profound effect on the patient's well being or expedite their disposition/discharge, then there will be definite cause for disciplinary actions to be placed upon you.

    Therefore, I think it is entirely unreasonable and showing an overall lack of character by blindly following all orders without question no matter where you find yourself in the "medical hierarchy." :thumbup:
     
  15. ishii123

    ishii123 Member
    10+ Year Member

    Joined:
    Mar 13, 2005
    Messages:
    78
    Likes Received:
    0
    Status:
    Attending Physician
    I see my thread has gone out of hand. So I feel the need to explain a little more of the situation. I have 6 more months of being a flight surgeon. After my 6 months, I will start a very competitive military residency in July 2006. I will not state which residency for anonymity's sake, but it is in the caliber of Rads, Derm, Ophthal, etc (definitely a specialty that fellow doctors are envious of because it is fun, pays well, and still has enough freetime to spend with family and friends). During my final 6 months, I will play it safe and not do anything that jeopardizes my residency slot. My CO still writes my final FIT REP before residency. An adverse FIT REP can take away my residency slot and there are many salivating "alternates" on the waiting list. Therefore, I'll be following stupid and unreasonable orders (within reason) my final 6 months as a flight surgeon.

    This thread was meant just to be a venting situation. If you aren't in my shoes, then you do not understand, especially if you're a med student who has never been a GMO, deployed multiple times, and worked with line officers. Therefore, do not judge me unless you are in my shoes. Being an operational flight surgeon (aka "glorified GMO") and working with line officers is a totally different world than working within the hospital and clinic heirarachy. Line officers generally have a different logic, have pre-conceived notions in what a doctor is supposed to do, but in reality have little understanding in what a doctor can and cannot do. This can be very frustrating at times. However you learn to deal with it in order to achieve the military mission. Overall, I have done a great job as a flight surgeon and have always received "early promotes" and over 4.0 on my FIT REPS. So I would say I do my job well. Therefore, who are you to say I did a bad job of being a flight surgeon? One thing you learn in life is this: choose your battles wisely (especially if it can jeopardize your residency slot).

    If you are one day in my shoes and have been selected for the residency of your dreams, would you jeopardize it by not following a stupid order? If "yes", then that's your prerogative. But personally, I'm not jeopardizing this for myself and my family. I'm playing it safe because the rest of my life and my family's life is set once I reach residency. :D
     
  16. pgg

    pgg Laugh at me, will they?
    Moderator Physician Faculty 10+ Year Member

    Joined:
    Dec 14, 2005
    Messages:
    11,610
    Likes Received:
    6,743
    Status:
    Attending Physician
    My apologies for derailing your venting session. :)

    Again, no one was suggesting that you disobey orders. Just that it's part of our jobs to persuade our superiors to rescind (or not give in the first place) stupid or unreasonable orders, and that it's almost always possible to do so in a polite, respectful manner, without risking an adverse fitrep.

    Every once in a while I run into an absolutely miserable GMO, who doesn't like working for the line because they're medically clueless meddlers who get in the way. One that leaps to mind immediately arrived with such contempt for Marines ("they were losers in high school, and they're losers now") that I was totally unsurprised to hear the weekly litany of complaints about his stupid command and his dumb patients and the crazy Navy that makes doctors take a break from training to go "babysit high school dropouts." Most of the others just had passive personalities and would vent complaints eerily similar to yours.

    Line officers generally don't know what is or isn't possible, or what is or isn't appropriate, regarding treatment or specialty consults. They want us to tell them what to do with sick/injured/crazy patients, and they'll do what we tell them if we explain our recommendations. I have never, not once, run into that hypothetical situation where my command has discarded my recommendations because the immediate needs of the mission outweighed the health of a Marine. Without exception, the two COs, two XOs, and dozen or so company commanders I've worked with the last couple years have been intelligent, reasonable people who've deferred to my judgment on all things medical. Maybe I've just been lucky to not have any malignant superiors ... but I don't think mine were atypical.

    Well, I've been a GMO for the last 2.5 years, am midway through my 2nd deployment with the Marines, and was just selected for the residency of my dreams too. (Congratulations to both of us. :)) Truthfully, a GMO getting an EP isn't all that big a deal, since we're usually either the only, or one of two, people in our summary group.

    And once again I'll admit that there may be other factors in play in your situation, such as a truly awful CO who always treats his medical officers like crap ... though I do feel at least minimally qualified to comment on the information you did provide.

    And all I can say is that if either of the Colonels I've worked for had told me that he wanted that psych patient seen right-this-very-minute, I would have told him that he missed her appointment, that psych didn't have anyone available to see her, and that it would be unwise to 'cry wolf' and pretend the patient was an emergency just to get her seen by the on-call shrink. And that would have been the end of it. At worst, I would have spent a few minutes calling the mental health clinic to ask the on-call guy for a favor out of the goodness of his heart, but I wouldn't have been emotionally invested in the outcome. And regardless of that outcome, I wouldn't have made the conceptual leap to conclude that the day's petty annoyances were an indictment of GMO life in general.

    I didn't post in this thread just to criticize you - not really, anyway :) - my basic intent was that future GMOs who read this forum would have another perspective. I think your claim that GMO life universally sucks, even for "glorified GMOs" like flight surgeons (not sure where that's coming from?), is inaccurate. The truth is that the overwhelming majority of former GMOs I met as a medical student and intern had basically positive things to say about their GMO tours, and many looked back on it as a fantastic experience that they'll probably never match.

    The biggest factor adversely affecting current GMO happiness, as far as I can tell, is the deployments and op tempo - not command climate. I personally have loved my GMO tour, and have enjoyed the respect, confidence, and support of the line the entire time. Although I wouldn't want to make a career out of it, and I'm very much looking forward to getting back to a hospital next year ... spending time with the infantry has been a great experience and I'm glad I had the opportunity.

    Anyway, congrats on your residency selection, and sorry to hear your GMO experience wasn't more positive. :)
     
  17. GMO2003

    GMO2003 Senior Member
    10+ Year Member

    Joined:
    Dec 27, 2003
    Messages:
    494
    Likes Received:
    13
    Status:
    Attending Physician
    I think there are pros and cons to every situation you find yourself in life. Overall, I'd say my time as a GMO has been a positive experience. It has allowed me to work independently to a certain degree on my own license and learn how to interact with other physicians on a professional level. I've also had the opportunity to participate in certain military unique medical educational experiences that I would not otherwise have the opportunity to do. Nonetheless, I am thankful knowing that I am leaving the military soon and starting a civilian residency. :thumbup:
     
  18. Mirror Form

    Mirror Form Thyroid Storm
    10+ Year Member

    Joined:
    May 8, 2003
    Messages:
    7,529
    Likes Received:
    22
    Status:
    Attending Physician
    I'm sure you'll be a bundle of joy when you're an intern . . . :rolleyes:

    So I'll take that as a "no" then.
     
  19. Mirror Form

    Mirror Form Thyroid Storm
    10+ Year Member

    Joined:
    May 8, 2003
    Messages:
    7,529
    Likes Received:
    22
    Status:
    Attending Physician
    My experience has been that doctors, even residents and interns, have large ego's. If an intern (or especially med student) ever tries to disagree with the resident's plan, some residents don't take it so well. If you disagree more then once with the wrong resident . . . you going to get hosed, and thats the way it is.

    B/c the residents don't like to be told they're wrong by an intern.

    I find this a bit hard to believe! If you go over your resident's head to the chief resident or attending, then you're just asking for it.
     
  20. Homunculus

    Homunculus SDN Caveman Administrator
    Moderator Physician 10+ Year Member

    Joined:
    Jul 24, 2000
    Messages:
    3,529
    Likes Received:
    297
    Status:
    Attending Physician
    sorry to hear you're at such a malignant program, sledge. the program i'm at is pretty resident friendly, and we get along well. disagreeing with management plans and putting forth your own is part of the learning process :)

    --your friendly neighborhood tries to avoid assigning scut PGY2 caveman
     
  21. island doc

    island doc Senior Member
    5+ Year Member

    Joined:
    Jul 24, 2005
    Messages:
    494
    Likes Received:
    4
    NO ONE had a worse GMO experience than I did. NO ONE.
     
  22. delicatefade

    delicatefade ASA Member
    10+ Year Member

    Joined:
    Jun 13, 2004
    Messages:
    846
    Likes Received:
    2
    Status:
    Attending Physician
  23. GMO2003

    GMO2003 Senior Member
    10+ Year Member

    Joined:
    Dec 27, 2003
    Messages:
    494
    Likes Received:
    13
    Status:
    Attending Physician

    As an intern, I did it all the time if I felt I was being bullied into doing something that had absolutely no net negative or beneficial effect on the patient. I simply asked the resident for clarification and/or justification. If a logical and reasonable explanation was not forthcoming, I would then ask for further clarification from the senior or chief resident. 9/10 times it woud be dismissed altogether. It is ultimately the attending who is responsible for the patients. In turn, it is the chief who is in charge of the team, not the junior resident(s). Overall it is a team effort and communication must work both ways to make sure there is no confusion existing from the top to bottom or bottom to top.

    It sounds like you're in a pretty malignant program. So if you've got a lot at stake in terms of residency selection or future assignments, I'd ride things out and look to greener pastures in the future. The bottom line is to pick you battles carefully and always make the right decision that you can live with. Good luck, Sledge
     
  24. usnavdoc

    usnavdoc Senior Member
    10+ Year Member

    Joined:
    Apr 5, 2005
    Messages:
    919
    Likes Received:
    2
    Status:
    Attending Physician

    I bet my last command would give you a run for your money if not outright beat you.
     
  25. r90t

    r90t Senior Member
    10+ Year Member

    Joined:
    Mar 2, 2004
    Messages:
    352
    Likes Received:
    1
    Status:
    Attending Physician
    This was a few years ago, but one of my friend's had a suicide 1 week into deployment, a guy died while heading into the gulf from an MI, then a SEAL want-to-be died while deciding to take a run in 120 degree heat. His body had to be retrieved in the middle of the night fromt he foreign country's morgue. This GMO was relieved for a couple of weeks mid-cruise to compose herself. After this tour she matched into a great residency.
     
  26. usnavdoc

    usnavdoc Senior Member
    10+ Year Member

    Joined:
    Apr 5, 2005
    Messages:
    919
    Likes Received:
    2
    Status:
    Attending Physician
    OK....I was more talking about non-medical aspects of the GMO tour.

    Like the CO who is verbally and physically abusive to his staff and in combat places the medical officer in mortal jeopardy by having him do things outside the scope of his job. you know like searching caves and wells. Didnt they go over that in medical school? ETC.....

    I could go on and on...

    BTW how do you get relieved mid cruise to "compose yourself". Is that like free leave???? Sign me up anytime lol
     
  27. island doc

    island doc Senior Member
    5+ Year Member

    Joined:
    Jul 24, 2005
    Messages:
    494
    Likes Received:
    4
    I take it she was not an emergency medicine GMO as I was, or this would have been all in a day's work. Let's see what I can remember from back then:

    Being the base "go to" man for all codes because the ambulance crews were all basic EMT's and did not know ACLS. Yes, it was the 21st Century and there were NO paramedics.

    How about a high BSA burn victim who had slipped off a roof into a vat of hot tar, failed resuscitation of an 11 y.o. drowning victim submerged for 30 min in warm water, successful resuscitation of a child in acute respiratory failure at the very moment the JCAHO inspectors arrived in the ED, etc. Was any of this ever appreciated and rewarded?? NO!!

    Being a GMO sucks and that is all there is to it. No ifs ands or buts.
     
  28. pgg

    pgg Laugh at me, will they?
    Moderator Physician Faculty 10+ Year Member

    Joined:
    Dec 14, 2005
    Messages:
    11,610
    Likes Received:
    6,743
    Status:
    Attending Physician
    Gee, I wonder if that great residency program will give her a couple weeks off to compose herself the next time someone dies in her general vicinity.
     
  29. orbitsurgMD

    orbitsurgMD Senior Member
    10+ Year Member

    Joined:
    Dec 27, 2005
    Messages:
    1,920
    Likes Received:
    52
    Status:
    Attending Physician
    I think I was det'ed shoreside at the super-busy Bahrain Navy clinic when that ship pulled in. That was in my final 6 months of active duty. I heard the ship had to have the mobilized psych team flown aboard while en route to its operational station, the crew was so rattled. The topper was the death ashore in Jebel Ali. Not a fun float, I'm sure.
     

Share This Page