As I noted in my Semper Fi post of a week or so back, I am working for a while in a military town. I haven't been here long enough to really comment on the Tricare plan (the military's HMO) except to say that many of the little and not-so-little patients I see are on it.
Most of their parents don't want a lot to do with the military hospital. I've heard a lot of very negative things that I don't feel inclined to repeat here. I can't really comment on the hospital because I have no association with it.
I therefore found Brenda's post today and her perspective (as a military wife) very enlightening.
Joe's perspective as a physician who spent some of his training years at VA hospitals was very much in line with what I have heard from my friends who worked the VA's during medical school and residency. He confirms Brenda's observation that VA's are often staffed with civilian doctors in training. Again, as a Pediatrician, I have no first-hand experience.
The Walter Reed fiasco has my attention for a different reason than most people. My main question is, as the system fell into disrepair, where were the doctors?
Unlike Brenda, I don't think that the military's physicians (or their system of policing physicians) is any better than that in civilian service. In fact, from what I know of it (via my loose association with the "federal contingent" of the Semmelweis Society), the system is often driven by the pursuit of rank (much like the pursuit of money on the civilian side) and political influence/power. The professional back-stabbing can be just as vicious as that I encountered in Asheboro (as a lowly National Health Service Corps provider), and have seen in my years on the road. Those on top of the food chain can crush those on the bottom . . . and when your career is destroyed in the military, it is destroyed.
You are destroyed.
Brenda's right. Military doctors get paid (reasonably well, but not as they would in civilian private practice - but I'm told retirement can be early and sweet) no matter what they do or how good they are. Everyone remembers M*A*S*H. Rank was not indicative of medical skill or dedication to patients. Frank Burns was an selfish moron.
I've known some real pieces of sick work who are (by now) fairly highly ranked in the military.
I also know some outstanding people who serve with distinction and honor.
I digress. Semmelweis now boasts members of all of the service branches . . . as well as public service docs (like me) . . . who can testify to the brutal tactics employed against medical whistle-blowers in the US military. It's not really something to boast about.
As someone who more-than-honorably completed an NHSC service obligation . . . only to be thrown out on the street within weeks of completing it (canned for performing duties that are not protected or defended by anyone) . . . I was "lucky". I "just" got fired and have "only" spent ten years bouncing around a corrupt legal system . . . where perjury and fraud do not matter.
I can still work.
Some of these doctors in the military have lost everything for standing their ground and speaking up for their patients . . . victimized by bad-faith-medical-peer-review and the most brutal kind of character assassination (particularly the kind that alleges someone is "crazy"), they've been buried by persons of rank (some of them now in the headlines) . . . black-balled and lost in a bureaucracy that shows no mercy.
They've lost everything. Humiliated and discredited, often bogusly reported to the data bank (a professional kiss-of-death), they cannot find work.
It has been the subject of some conversation in the last few weeks, that changes that first happen in the military can serve a catalyst for, or agents of social change. It was so for racial desegregation. One can hope it may be so for medicine. But I doubt it.
For despite all the noise being made by politicians in Washington, the reality is that federal whistle-blower protection is a joke.
So a sad joke, I expect, will be the end result of any bipartisan commissions.
But the joke isn't funny.
The truth is that, in the military and public service, doctors are devalued, powerless serfs. And this I believe, is the real reason Walter Reed happened.
So what does that make their patients?
There is so much dirt under the spit-shined surface.
This is the kind of system the Ed Cones of the world would foist upon all of us.
3/21/07 Update.
A physician friend of mine noted (rather sarcastically) today that the Feds are all over the case when lawyers are treated badly.
Notsomuch with doctors.
For the Ed Cones of this world, if you're unhappy with the medical system we have in this country, yet you stand by, do/say nothing, and allow the kinds of things that have been done to me . . . and to many other doctors . . . for trying to stand up for patients just like you . . .
. . . then you have the medical system you deserve.
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4 comments:
Mary. I agree with you about the old boy networking that goes on in the military and the very real fact that RANK HATH PRIVILEGES. This is not only with the medical field but with all the areas. And it is true that there is really not a great deal that can be done if an officer or enlisted person above you in rank has it out for you. My husband claims the only recourse is to keep your head down because you know that in no more than two years one of you will be gone since military personnel are shifted around so much. There is also some much needed improvements in the gaining rank area that depends more on testing of knowledge in ones field than in personal recommendations as it had always been before. And yes, rank means money, not only while on active duty but after retirement.
As far as peer review as I mentioned in my post, an intoxicated doctor would NEVER see a patient. One phone call from anyone would bring the military police to escort him/her off the premises. He/she may very well get sent back to the hospital but base gossip would have done a good job of destroying reputations and it is possible to ask not to see a certain doctor. Whereas with a civilian doctor I have unfortunately met a few in my time and all I could do was pay my bill and never go back. There was and is no one to complain to. The medical board is certainly not going to listen to a patient unless some prevailed harm has been done.
My daughter at age 9 developed a wandering eye. Her left eye began moving towards the outside. I took her to doctor after doctor. Even to the one doctor who was considered the best eye surgeon on the East coast. Several thousand dollars was spent taking her from doctor to doctor ion several states. This was in the early ‘70’s. They ALL told me that nothing could be done. This lovely little girl’s life would be damaged by a crooked eye. I was heart sick. Then I met Lew and he told me that we could take her to see Dr. Murphy who was considered the best eye surgeon in the Air Force and just happened to be stationed at MacDill. Elaine and I walked into his office, she got in the exam chair and I handed him a three inch thick medical record of all the doctors who had said nothing could be done. He glanced at Elaine and laughed shaking his head. And told me that of course something could be done. The muscles holding her eye in place were out of balance and just had to be adjusted. He explained that since it would be like working with a piece of elastic he might not get it perfect on the first try but there would be improvement and he could operate as many as three times if necessary. It took two operations.
My family and I may have just been extremely lucky but I wish I could continue with military doctors the way it was when we were in the service. But the recruitment of doctors has been down and with the cut backs the only services offered now in most military clinics are the basic exams, paps, mammograms, x-rays, etc. and referrals more and more to civilian doctors.
But as you know the same good old boy club operates on the outside. My experience was different but essentially the same. The universities are the most chauvinistic places on earth. At staff meetings women listened no matter what their degree. And the person under whom you worked could actually use your material to get in his publishing requirements. I was published under Dr. Delito’s name for several years until I left for another position.
"The medical board is certainly not going to listen to a patient unless some prevailed harm has been done."
They don't listen to doctors either . . . even the ones who kept the patient from harm.
I know that all too well.
Thanks for dropping by.
I have a question. My 27 year old son has been sick for the past 6 weeks. He has severe headaches, chest pain and sleeps a lot. He is in the military and quite frankly I am not happy with the haphazard way the doctors on the base have taken his symptoms for granted. My question is what can I do to help?
If you are unhappy with the medical care your son is getting in the military, I honestly think that it helps for families to RAISE HELL . . . in other words, CALL you Congresspeople/Senators (better yet, VISIT their offices unannounced and demand to be seen). It would help not to go alone.
If you feel time of the essence do not waste your energy on letters or e-mails.
In short, be an in-your-face advocate for your loved one in the service.
I do not/cannot offer medical opinions on this blog.
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