Military Medicine: It's Not Terminal

As the surgeon general of the Army, I feel obligated to set the record straight on several bogus arguments posed in Lawrence H. Fink's article critical of Army medicine ("Military Medicine Is a Terminal Case; It's Time to Pull the Plug," Outlook, Nov. 24).

Let me first acknowledge the shortcomings that exist in the military's capability to provide patient services during peacetime and during armed conflict; however, these ailments are being treated and the prognosis is excellent. These ailments took root in a system that did not grow simultaneously with the demand.

The purpose of military medicine is a multifaceted one. The military medical system provides crucial quality care to our soldiers during combat and ensures their health and their families' health during peacetime; it conducts extensive research to protect lives of soldiers who are deployed worldwide; and it provides training and knowledge to our international allies.

The physicians who serve the military have chosen to practice medicine often in lieu of greater personal financial profit in the civilian community. To conclude that our physicians are incompetent because they receive lower salaries is a disservice to the Hippocratic oath to which all doctors aspire. There are tangible and intangible benefits of being a military doctor that must not go unsaid. First and foremost is the pride of serving our nation while practicing medical skills; second, the encumbrances of private practice, which can detract from the pure practice of healing, are nonexistent.

The military has medical standards that equal or exceed those in civilian practice. There are the internal rigors of inspections as well as the solicited external civilian reviews to ensure that military standards are equal to or better than the civilian standards. The fact is that more military physicians are board-certified than their civilian counterparts. All of the military hospitals inspected by the Joint Commission of Accreditation of Hospitals have their accreditation.

Let us clarify the debate regarding the separation of peacetime care and combat medical readiness. The active duty military personnel have never held the entire mission of peacetime care or combat medical care. Our combat readiness relies greatly on the support of the Reserve component, and the delivery of health care for our beneficiaries relies heavily on the civilian health care sector. There is not a line of demarcation between the two missions. It is not that simple. Our medical readiness results from the practicing of varying skills on the wide spectrum of patients seen through the peacetime care mission.

I do not believe that a totally Reserve medical force can meet the demand for care that will exist during the first days of armed conflict. The active-duty medical force must be capable of making a smooth transition to war and providing medical support until reserve units can be mobilized and deployed. I do have initiatives under way to gain additional medical treatment capability for host nations. The interlocking of these roles is complex and should not be oversimplified by sweeping statements or generalizations.

I am cognizant of areas in which the military system is simply overburdened, and alternate sources of health care for our military beneficiaries are being studied to improve access. Let not this high demand erase or obscure the significant reasons for the establishment of the military medical system.

Military medicine is not terminally ill. To "pull the plug" on it would be the equivalent of "pulling the plug" on a patient who is responding well to treatment. Military medicine is vital to this nation's defense and is manned by extremely high-quality, proud professionals.

-- Quinn H. Becker

Lt. Gen. Becker is surgeon general of the Army. LETTERS

Lawrence Fink's call to pull the plug on military medicine is truly a case of sending the baby down the drain with the bath water.

As an informed observer of civilian and military health care for about 50 years, I find almost all of the shortcomings of military medical care present to an equal or greater degree in civilian office and institutional practice. The deficiencies in civilian care are compounded by the elaborate billing and collection procedures that seem to take precedence over the professional services. I attribute many of the problems in both areas to the evolution of the health care "industry" following the infusion of tens of billions of dollars from Medicare and Medicaid since the 1960s.

The solution is not to eliminate these civilian programs and military medical care but to use the latter (along with the VA system) as the nucleus for a national health service.

-- Edward Weiss LETTERS

In response to the scathing opinion of Lawrence H. Fink, I must say that during my many years' association with military hospitals, I cannot complain about the care I received from doctors, nurses or other personnel. I have been in civilian as well as military hospitals and, honestly, I prefer the military hospitals.

Military doctors do work extremely hard and long hours and are short of help, but despite this, quality care is forthcoming, outstanding and professional.

Fink spoke of the poor attitude, lack of courtesy and unresponsiveness to the concerns of patients. Many of us have experienced civilian doctors who have been most offensive in their bedside manners. I've sat with loved ones in civilian hospitals and have seen patients neglected. Just last week, a nearby civilian hospital lost X-rays for days and accused the patient of having mistaken the hospital at which he had the X-rays taken.

Military doctors are subject to military justice and can be disciplined by court martial. The only way to discipline a civilian doctor is to take him to court and sue for malpractice, and that cost is passed on to the patients.

-- Eileen Matthews LETTERS

It was all news to me to read about the poor quality of military medicine. Having been on the receiving end of extensive military medicine since 1940, during periods of warfare, peacetime active duty and retirement, I give military medicine high marks.

-- Nicholas Dunlap