Walter Reed: lets clear up some of this BS

[deuist]

A nurse as the surgeon general? What will the army think of next?

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[AF M4]

Enh, screw it, why not? What's the worst that could happen - wounded veterans left in mold-infested rooms and brain-damaged heroes wandering the grounds aimlessly? I say they could put a voodoo shaman in there if that person (a) cared more about the vets instead of scoring career points; (b) stream-lined the bureaucracy while installing more caseworkers; (c) knew what they didn't know and listened to the advice of the physicians and nurses providing care.

 

[USAFdoc]

It makes me think that the skills required of a surgeon general are distinct from the skills required of a physician.

they are different. it all depends on what is their priorities; what is their agenda. Saving $$$ and getting promted are fine so long as they do not trump the real reason we are here.

it is possible to have a doc as SG and they could suck (proven over and over again).

now you might see if it is possible to have a nurse as SG and see what happens......

 

[Gastrapathy]

now you might see if it is possible to have a nurse as SG and see what happens......

The nurse corps clipboard commandos have won the game. Overwhelm a system with paperwork bull****, cause total failure and...get put in charge. For anyone who thinks this is a simple dr vs nurse rivalry, you are sorely mistaken. This is all about how the military trains its nurses and fails to reward them for clinical excellence. Our midlevel and senior nurses are rewarded for being administrators, they learn to reward others for the same. Yet another step backward for clinical medicine.

BTW, I have time to write this because I can't get ahlta working to do any clinic notes today.

 

[Gastrapathy]

now you might see if it is possible to have a nurse as SG and see what happens......

The nurse corps clipboard commandos have won the game. Overwhelm a system with paperwork bull****, cause total failure and...get put in charge. For anyone who thinks this is a simple dr vs nurse rivalry, you are sorely mistaken. This is all about how the military trains its nurses and fails to reward them for clinical excellence. Our midlevel and senior nurses are rewarded for being administrators, they learn to reward others for the same. Yet another step backward for clinical medicine.

BTW, I have time to write this because I can't get ahlta working to do any clinic notes today.

 

[mitchconnie]

A nurse as the surgeon general? What will the army think of next?

I’ve recently changed my mind about the wisdom of having nurses as hospital commanders and/or SG. I’ll grant that it is not optimal, but the two alternatives are.

1. A physician who has remained in the military only because of clinical incompetence, lack of ambition, or prolonged indentured servitude, and is skilled only at glad-handing his superiors.

2. A nurse who has presumably distinguished herself by some degree of management skill, and has some competition from peers who also want to remain in the military as a career.

In other words, a shameless suck-up vs. a go-getter.

I have rarely encountered a physician at the O-6 or O-7 level who had a strong leadership presence, was respected by his subordinates, or was competent in anything other than making Powerpoint slides and sending out e-mail. Most don’t even seem to have basic management skills. In contrast, there are occasional MSC officers who are aggressive and able to get things done.

MSC and NC officers may be know-nothing buffoons when it comes to directly supervising MD’s in a clinic, but at higher levels of administration I’m not so sure they are any worse than the current crop of physician-administrators.

 

[The White Coat Investor]

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[Galo]

I’ve recently changed my mind about the wisdom of having nurses as hospital commanders and/or SG. I’ll grant that it is not optimal, but the two alternatives are.

1. A physician who has remained in the military only because of clinical incompetence, lack of ambition, or prolonged indentured servitude, and is skilled only at glad-handing his superiors.

2. A nurse who has presumably distinguished herself by some degree of management skill, and has some competition from peers who also want to remain in the military as a career.

In other words, a shameless suck-up vs. a go-getter.

I have rarely encountered a physician at the O-6 or O-7 level who had a strong leadership presence, was respected by his subordinates, or was competent in anything other than making Powerpoint slides and sending out e-mail. Most don’t even seem to have basic management skills. In contrast, there are occasional MSC officers who are aggressive and able to get things done.

MSC and NC officers may be know-nothing buffoons when it comes to directly supervising MD’s in a clinic, but at higher levels of administration I’m not so sure they are any worse than the current crop of physician-administrators.

While I agree somewhat with this assesment, I have found that these go-getter nurses can also just cruise along with minimal management skills, but some real hard on's or in's to screw with physicians and make management decisions that are not based on patients best interests.

Hopefully there are some go-getters out there who truly want to do their job, but invariably they will come up against lack of money, support, and ability to do their jobs.

I have seen myself over the two years that I've been out, as getting more and more cynical. With the additional multiple voices I have gotten to know here with stories to top mine, and things like this Walter Reed crap, I just cannot see medicine surviving or existing in any decent manner in the military mentality. For physicians, (and any job in the military), as you gain more and more experience at your job, you are herded more and more out of it into a managerial position. In the civilian world, a physician, (surgeon) would not dream of giving up surgery for a desk at an early time in a career.

I just cannot see the survival of military medicine. Nurse, MSC, or MC, they will either be totally incompetent, or made that way by a system that cannot support what they need to implement to make a paradigm shift in the care of our soldiers.

 

[mitchconnie]

Most of the O-6, O-7s I've met are great people, competent leaders, and occasionally, good clinicians too

Wow, Desperado, I am so surprised to hear you say that. Our experiences in the AF must be VERY different. My observation is that hard-charging, no-nonsense decision makers who can cut fast and straight never rise to the top of Air Force surgical departments. It's more the go-along, get-along guy who doesn't make any waves that ends up in charge. Sort of 'leadership by default.' I imagine my current commander saying, "Well ****, I'm the only O-6 surgeon who's still in the USAF, so I guess I'm in charge."

And Galo...I've got two words for you: Wright-Pat...Dr. P.M. Could any nurse be worse?

 

[Galo]

Wow, Desperado, I am so surprised to hear you say that. Our experiences in the AF must be VERY different. My observation is that hard-charging, no-nonsense decision makers who can cut fast and straight never rise to the top of Air Force surgical departments. It's more the go-along, get-along guy who doesn't make any waves that ends up in charge. Sort of 'leadership by default.' I imagine my current commander saying, "Well ****, I'm the only O-6 surgeon who's still in the USAF, so I guess I'm in charge."

And Galo...I've got two words for you: Wright-Pat...Dr. P.M. Could any nurse be worse?

If I ever see that POS on the street, I would evicerate him with my bare hands. Never have I know an individual to so malevolently treated patients and subordinates. You know my story oviously. But the nurse that I dealt with before him gave me a letter of reprimand for crossing the street. All in all, no comparison, p.m. is the devil incarnate. I still wish him ill.

 

[alpha62]

The now ex-CO of WRAMC did make one valid point I think.

He thought the current MEB/PEB system is a left-over from the draft era. What we've got is an all volunteer army and every guy that is on medical hold is fighting a medboard every inch of the way.

the GIs have to shoulder a little bit of responsablity themselves for this mess.

 

[Mirror Form]

Did anyone read the article in Newsweek about Walter Reed? I understand the idea of inaccurate reporting and media misrepresentation, but it seemed that there are a good deal of unhappy soldiers/veterans who are receiving poor care and being put on waiting lists to get an appointment. So for the people defending Walter Reed, are the interviewed soldiers lying?

Thank you for posting this, b/c it's proof that the media is displaying BS.

1. The media only takes stories from the small minority that want to publicly complain, and don't report on the majority that are happy with their care.

2. I know that at least several of the people on "waiting lists" were on those lists for reasons other there simply being a long line (can't go into specifics b/c of hippa). It's great having patients go on TV with BS and not be able to defend yourself. But why should the media bother fact checking? One of the guys I've personally seen was complaining about all sorts of stuff, especially the meb process. Only one media source of many mentioned that he WASN'T EVEN GETTING MED BOARDED! And he did in one off second mention while getting interviewed that his doctors and the care he got from them were great. That phrase wasn't in any of the papers that quoted him though.

3. What are your examples of "poor care" again? The media are basically acting like Michael Moore in a documentary. They make these associations and lead people to a conclusions. What soldiers haven't gotten the healthcare they need? And once again, we've already established that barracks and med eval boards were fubar'd. As is most of the rest of the admin. However, the healthcare for soldiers is fine.

 

[Mirror Form]

Congratulations you Army guys, you've got a new temporary surgeon general. A nurse! Guess it's back to the civil war days when the only qualification to be a battlefield doc was you were good with a hacksaw.

You don't have to rub it in. BTW, it's only temporary until the board convenes to officially select the next surgeon general.

 

[Mirror Form]

Those who are doing their best to provide care are not going to suffer for this. It's those that have prevented the provision of that care or failed to support it that will be eviscerated--and rightfully so.

You have no idea. The staff and residents at WR are suffereing greatly. Not directly b/c of the media, but indirectly b/c of the army's typical idiotic responses. I don't have several hours to write all of them down. But one of the major new issues is that we have to admit every patient from OIF/OEF, regardless of whether their were air evac'd out b/c of a sprained ankle from a football game. Then it's impossible to discharge anybody b/c there is a ton of additional paperwork and signatures that have to be completed. So it's turning WR into a hotel. The medicine/ortho/surg/etc residents are being completely screwed b/c instead of seeing cases that are actually educational, they're just baby sitting a bunch of perfectly healthy people who don't even need qshift vitals. The consult services are being screwed b/c they don't have the man power to suddenly be dealing with a large in-patient service (even if the patients are healthy, pages still come 9 times per day). of course the nurses are lovin it b/c they're socializing with all the patients and just having a blast all day long.

 

[mitchconnie]

You have no idea. The staff and residents at WR are suffereing greatly

.

One of the first moves to "fix" the problems was a five-page sheaf of additional paperwork for the residents to fill out on every discharge. Still more paperwork for the people who are already drowning in it. Less medical care and more filling out forms--nice educational experience. I feel so sorry for the residents, who are defenseless against this sort of abuse. But it's the classic military response to a problem--create a new set of forms.

 

[USAFdoc]

You have no idea. The staff and residents at WR are suffereing greatly. Not directly b/c of the media, but indirectly b/c of the army's typical idiotic responses. I don't have several hours to write all of them down. But one of the major new issues is that we have to admit every patient from OIF/OEF, regardless of whether their were air evac'd out b/c of a sprained ankle from a football game. Then it's impossible to discharge anybody b/c there is a ton of additional paperwork and signatures that have to be completed. So it's turning WR into a hotel. The medicine/ortho/surg/etc residents are being completely screwed b/c instead of seeing cases that are actually educational, they're just baby sitting a bunch of perfectly healthy people who don't even need qshift vitals. The consult services are being screwed b/c they don't have the man power to suddenly be dealing with a large in-patient service (even if the patients are healthy, pages still come 9 times per day). of course the nurses are lovin it b/c they're socializing with all the patients and just having a blast all day long.

nothing, should ever, ever suprise anyone about milmed....ever.

 

[Ex-44E3A]

They're making everyone an inpatient? And they added an additional sheaf of papers for the already-stretched providers to fill out? No ****? That's their X$@#! solution?

*Deep Breath*

Nooooooooooooo! You fools! Ahhhhhhhhgggghhh!

If everyone will excuse me, I'm going to go beat my head against the wall in solidarity with all the WRAMC residents who are no doubt doing the same.

 

[resxn]

They're making everyone an inpatient? And they added an additional sheaf of papers for the already-stretched providers to fill out? No ****? That's their X$@#! solution?

*Deep Breath*

Nooooooooooooo! You fools! Ahhhhhhhhgggghhh!

If everyone will excuse me, I'm going to go beat my head against the wall in solidarity with all the WRAMC residents who are no doubt doing the same.

If there's one thing my time in the military has taught me, it's to over-react to everything inappropriately.

For example,

If a 19yo E-1 gets caught with meth, you bring the entire squadron in to pee in a cup at 5AM, including the O-5's with 3 kids and doesn't have time to even get med head on Sudafed, much less concoct meth with it.

If there's a base anywhere in the world with a fire, you need to run 3 fire drills in a month even during buisness hours while patients are being seen to make sure everyone knows that the stupid parking lot didn't change positions suddenly.

If there's a 20yo who wrecks on a motorcycle after breaking up with his girlfriend, everyone in the med group needs updated suicide prevention briefings.

If tornado season is still 3 months away, you've got to have a tornado drill NOW.

If someone is dumb enough to put a battery powered cautery instrument in the sharps container where it proceeds to start a fire, every clinic needs to write a new OI on how to properly dispose of said cautery units.

If you work in the hospital and there is so much of a chance that you might glance at a patient under 18yrs old, you will need to complete Pediatric Advanced Life Support.

If someone gets a paper cut, you need to do a computer-based training module on the appropriate handling of paper.



Ok, so the last one wasn't real, but every single one of the above is a true reaction to a true event.

And in the vein of truth:

If there is so much of a whiff of poor care for an active duty troop, a sprained-ankle will need to be life-flighted to the nearest MTF for immediate MRI's and inpatient RICE care.

 

[USAFdoc]

If there's one thing my time in the military has taught me, it's to over-react to everything inappropriately.

If there's a base anywhere in the world with a fire, you need to run 3 fire drills in a month even during buisness hours while patients are being seen to make sure everyone knows that the stupid parking lot didn't change positions suddenly.

.

the fire drill scenario brought back painful flashbacks of my previous base. At timeswe would be running weekly fire drills (evacuating the clinic, one time just before I started a vasectomy) just to see if they (the alarms) work, again right in the middle of pt hous. When I presented the problem to the Commander....no action. When I went after the problem myself; neither the firecheif or bldg maintenance could give me an answer as to why so often d why at the "worst time of the day" they had to test the alarm.