The Medical Community Should Learn Something From the Military Community

Posted on July 20, 2012


In her opinion piece in The New York Times, “Don’t Get Sick in July,” Theresa Brown writes of the relationship between nurses and brand-new, wet-behind-the-ears doctors.  The thrust of the article is that July can be a dangerous time for patients, as the latest batch of new M.D. graduates begins making real decisions with real patients.  In the case she writes about, she judged that a new doctor’s decision concerning a particular patient was the wrong call, and went over his head.  Later, she and the doctor had a friendly exchange in which she started to apologize for going over his head, but he – surprisingly to her – apologized to her, and thanked her for getting the patient what he needed.

What bugs me about this is that this sort of conversation should not be unusual or surprising, but it is.  “Such an exchange is rare,” writes Brown.  “A nurse who goes over a doctor’s head because she finds his care decisions inappropriate risks a charge of insubordination… Nurses aren’t typically consulted about care decisions….”

Insubordination.  As if this were a military organization.  All right then, let’s compare the medical training culture to the military one.  A brand-new lieutenant with five minutes under his belt outranks the Sergeant Major of the Army with all his decades of experience.  The Sergeant Major is required to render all military courtesy and obey all lawful orders of the greenest lieutenant.  But you can bet that no green lieutenant would get away unscathed from making a boneheaded decision against the advice of his own sergeants who work for him.  Every lieutenant I know got “the talk” from a senior officer before taking over any position of responsibility:  “Listen to your sergeants.  They have a lot of experience.”  Even more specifically, the lieutenants often get advice on which sergeants are the sharpest, and – when there is the flexibility to do so – the senior officers assign those sergeants to positions where they will best serve as the young lieutenants’ “right hands.” This is not to say that the lieutenants “obey” the sergeants; the lieutenant is the one who makes a command decision and is responsible for the result, right or wrong. But it is considered sheer idiocy, and hubris, to think that a college degree and a few basic military courses are sufficient preparation.  Good decision-making needs experience, and officers continue to consult their sergeants’ experience throughout their careers.  It’s not mentoring, exactly; more an unequal, but highly effective, partnership.

Well, what a contrast with the medical community, where every decision can be life-or-death, can cripple, can lead to unnecessary suffering of patients.  Nurses – even those with decades of experience – are too often ignored, expected to remain silent and do whatever the all-powerful doctor says, and God help them if they dare to do otherwise.  It is a waste of an enormous amount of experience and knowledge that could be put to use to the great benefit of the patients for whom the system exists.  And it is – I think – a holdover from past generations where nursing was one of the few career options open to women, and women were most decidedly second-class citizens.  Well, it’s time for that whole culture to end, and to be replaced by one similar to the military relationship between officers and sergeants.  As Brown concludes, “…admitting that new residents need help, and that nurses can and do help them, is the beginning of owning up to our shared responsibilities in providing care.  For the good of our patients, nurses and doctors need to collaborate.”  A partnership, even if necessarily unequal.

Originally published at The Color of Lila.