How can you improve your chances for good care by military doctors?

In the light of the case of Dr. Donal M. Billig -- a surgeon who operated despite many accusations of incompetence -- and many other recent problems, this question affects more than 10 million military personnel, retirees and their families.

The answers here are distilled from the strong suggestions of present and former military doctors, servicemen and servicewomen, and those of a Washington Post reporter, Chris Spolar, who has spent more than a year studying and writing about military medicine.

Those who criticize military medicine and those who defend it make much the same suggestions.

First, be wary. This is a good rule inside and outside military medicine. At some point, we all must trust some doctor or doctors to care for us. But don't invest that trust blindly. I can assure you that doctors who become patients do not.

Ask about the doctor who is supposed to be caring for you. Ask about his or her credentials. Is he or she board-certified? A fully qualified physician or an intern or resident (a doctor in training)? Experienced in the disease or procedure involved? And, if experienced, with what success rate?

Ask questions like these not only of the physician assigned to you -- and they can be asked courteously and tactfully -- but of other doctors in the same hospital or facility. Ask: "Is this doctor best for me? And if not, who is?" Ask medics or corpsmen, and ask other patients on the same floor or ward or in the same clinic. Ask recently discharged or treated patients, "How did you feel about your doctor?"

If you're in doubt about a diagnosis, ask: "How do you know?" Ask, as a physician would, for some confirmation. Ask to see the X-rays or lab test results and have them explained. Even if you don't understand the explanation, you should get some sense of whether or not you're getting an off-hand opinion or a thoughtful diagnosis.

If you're in doubt about a diagnosis or suggested treatment or operation, ask to see another doctor. If the suggestion comes from a surgeon or specialist you've been referred to, try to go back to your primary care doctor, the one who made the referral, and discuss it. If you don't know who "your doctor" is -- if no one seems to be -- say, "I want to see a primary care doctor usually a family practitioner or internist who can advise me."

If you're not satisfied at your facility, ask to be referred to a specialist at some other nearby military facility. No matter what service you're in, you can be referred to an Army, Navy or Air Force medical center, if the best person to see is located there. In Washington, referrals may be made between the Naval Medical Center and Walter Reed Army Hospital. Or ask to be referred to a nearby civilian specialist, which is also possible.

If you're about to be sent to another physician or another city or facility, ask for a personal copy of your records, one you can keep and show to a doctor anyplace. Also, says one person familiar with the military: "Volunteer to carry your original records from place to place, even though the rules say otherwise. Records are often misfiled or lost, whether or not someone's being transferred. And sometimes they can take weeks to get from place to place."

*Any of these may prove very easy or abominably difficult. If all else fails, go to a civilian doctor on your own. If you can't afford any substantial fee, try calling that doctor's office or the local medical society to say: "I'm in the service and I can't afford to pay much, but I need help." There are doctors who will willingly see you. Be sure to bring along your records to avoid expensive retesting.

*In all these cases, the polite request, always the thing to try first, may not do the job. In that case, insist. Keep insisting. In reporter Spolar's opinion: "The people who get the best care in the military are the aggressive people." This may not be easy if you're a dependent or low-ranking. But remember: just because medical officers outrank you does not mean they can give you orders about medical treatment. They should have nothing to do with your status or promotions in your own unit.

*If surgery or some other invasive procedure is involved, you will be asked to sign a consent form. If you haven't received reasonable answers to your questions -- or your requests for consultation or other opinions -- you don't have to sign it or consent to any form of treatment. This is obviously not a step to be taken lightly. You may be in acute need of the treatment. But if all else has failed, such a refusal may get you the answers or consultations you want.

*There are other people, too, you can ask to see if dissatisfied. You can ask to see the chief of service (the doctor in charge of that kind of care). Or, every service person's right, you can ask to see the hospital's or clinic's commanding officer.

*If refused, write the C.O. a letter. I am told that good medical commanders pay attention to such complaints. In the light of today's events, any officer who denies your request to see a higher-up may himself or herself get into trouble. Some commanding officers designate their second in command or executive officer to handle patients' problems. One former Navy second-in-command told me that "at our hospital I personally went around and touched and talked to every patient three times a week, and in intensive care, every day." I would suspect care was good at that hospital.

*Ask the commanding officer of your own, non-medical unit to help you. Good commanding officers look after their people, and are just as likely as you to be concerned about the medical system.

*Finally, some military hospital commanders have named well-qualified, well-backed patient representatives to hear complaints or problems and try to solve them. Such a person can be either highly effective or powerless depending on the person and the authority he or she is given.

Obviously, the patient representative, if one exists, is the person to see before bugging a hospital's C.O.

Next Week: A doctor whose patients set his salary and fees.