Cite this post as:
Scott Weingart, MD FCCM. A Comment on the Toughness Episode. EMCrit Blog. Published on March 9, 2015. Accessed on December 7th 2021. Available at [https://emcrit.org/emcrit/toughness-comment/ ].
Financial Disclosures
Unless otherwise noted at the top of the post, the speaker(s) and related parties have no relevant financial disclosures.
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A wonderful comment. Lots of personnel coming out of military service recently with experience and attributes that will make them excellent Drs/practitioners. Exactly the approach to practice that I hope to achieve, however I have no military background so would not fit into Norm’s criteria for recognition.
thanks to Francisco Norman for this considered comment. I think he and I agree to disagree on some points, which is fine. Does medicine need tough people? Do we need to be all warrior mind set? Does the resuscitationist need to be like a Navy Seal or Pararescue operator? Maybe..maybe this is all opinion. we dont really know if it will help. it makes sense but then again last night on Australian TV, there was a documentary on the rates of psychiatric casualties in Australian soldiers returning from Afghanistan. PTSD does and will happen to anyone subjected to trauma. Intriguingly… Read more »
Minh, Not sure of the brush you are painting these guys with. i might have a non-representative sample, but all of the special ops military i have associated with have been nuanced and delicate folks who just happen to have an extreme degree of mental resilience and a plasticity of thought that seems ideal for critical care. I would not eant to fill my residency or fellowship with solely these folks, but to have 1 per class, I can only see as a huge boon. Now as to the ptsd comments, i need to have a long think on that… Read more »
this is the article that is making me think:
http://www.ncbi.nlm.nih.gov/pubmed/15656996
so the ? is would a change in training minimize of increase this already present issue.
good question. we dont know, is the true answer for now. and I would caution using military analogies and research to extrapolate to medicine, even resuscitation medicine. everything requires context. certainly the OZ psychiatrist on the TV documentary proposed that training to deliberately create the warrior mindset may predispose to PTSD. becoming emotionless, robotic in action, is great to get things done in crisis, but not so great when you return to non crisis, civilian mode of living. One ex Commando interviewed said on return from Afghanistan he was utterly unable to emotionally connect with his children and personally I… Read more »
Minh, As always, I appreciate the comments. I am humbled by your words of support as well. I think, however, there is a fundamental difference between developing skills to cope with stress, and elevate performance, perposefully programming emotional indifference to enable taking life. These are very different concepts. Although a somewhat necessary union exists between areas to prepare one for combat, I agree, it would certainly inappropriate (and likely detrimental) include this in any sort of medical training. In my modest opinion, it should be quite to the contrary: enable emotion and compassion that would drive a provider to work… Read more »
Great post
Great comment Minh! We should also not forget that every team needs different members. 10 warriors does not make a good team. You need people that are complementing each other, with different qualities
Before an operator can get into the ED or ICU, he or she must first make it through academia which is often antithetical to pretty much everything the operator has stood for in their first career. If they can succeed in an operational environment, and then succeed academically, they will be able to fit into any team. Dr. Minh – there is a big difference between being tough minded, and being the tough/rough guy in the room. Furthermore, while PTSD is currently a hot-button topic for veterans and therefore the subject of numerous studies, I would suggest many (non-military veteran)… Read more »
While I agree that approaches from the military might be applied to evaluate and develop mental/emotional resilience, I am concerned that this paradigm of the “tough” resuscitationist leaves women behind.
Is a more collaborative leadership approach less valued? Is the softer spoken but no less capable physician less valued? Stereotypes of “strong” leaders are frequently gendered and an avenue for perpetuating gender inequity in medicine.
All- I’m a prior service enlisted Army Ranger Medic and am currently about to complete my first year as an EM resident. Part of my residency requires me to lecture and work with medical students (which I love) and as an avid reader of emcrit I had to comment. As a Ranger, I was also a senior medic and trained new Ranger Medics as part of my job description which I again loved doing. The difference in my experience is that the Ranger Medics were held to a significantly higher standard than med students and even residents. Yes, we were… Read more »
This whole Comment stream has provoked some interesting thoughts. Having never been in the military I can not comment on or begin to understand the training. I kinda agree with the original comment posted regarding the benefits of military training in respect to overcoming the task at hand. I also share Minh’s comments regarding the necessity of this kind of training. I think PTSD is PTSD regardless of cause. The sexually assaulted are equally prone to PTSD as my grandfather who watched his friends split in half by heavy rounds from Mitsubishi A6M zeros at Pearl Harbor. The military is… Read more »
Craig,
If you ever get a chance to visit the Shock Trauma Center in Baltimore, you will find what you are looking for in any of the trauma critical care units. It is a center entirely devoted to only one thing: what is the best move for the patient. I never found a single instance in 2 years where this was not the case.
Thanks For the response…
Sometimes I feel like I am that lone little voice advocating from my ICU. Every now and then the stars line up and care goes in the direction of optimal….I need to get up there and check it out….
Dr. Rosebrock, For “most” people with military experience your concerns with them requiring a high level of top-down direction/leadership/management is valid. But operators, especially those who are more specialized, are used to functioning in environments with little to no direct supervision. A spec ops team may be told that their target is supposed to arrive in this town sometime tomorrow…go get him. A SAR team will launch on a mission and receive no further direction from above. Furthermore, while the rank structure still exists in such teams, there is more credence given to situational leadership rather than positional leadership, and… Read more »
Boatswain2pa, Sorry man, I should have been more clear. I understand that the spec ops guys when deployed are given more operational latitude. My point, which I didn’t really make well, is that to get to that position they have first move though the basic and then more advanced training. Boot camp, BUDs, and then the more special weapons, demolition, halo training etc is done before they can have the ability to think more freely…. make their improvised tactical plan after their strategic plan has been made for them. In order to be that special operator though there has been… Read more »
Thanks for the clarification. I think today’s MD/DO education process is so academically focused that many of those who make it through it do so to the detriment of some other developmental processes. Not many pre-med students on college varsity teams. Your comment about the mil-ops guys spending years following more senior guys who have BTDT (been there done that) is true. I’m not a MD/DO (went to PA school after 20 years of operations), but isn’t that analogous to a residency? I guess the obvious difference is the team-based focus with military training/operations vice the individual (and potentially competitive)… Read more »
what a remarkable thread of commentary! brilliant stuff from Craig and Boatswain Medicine is like the Hunger games but more ruthless. we are indoctrinated to be lone wolves, top of the game. Graduating from medicine, gives you the sense of entitlement. as Craig points out, its great until you actually have to work as a team! but I still maintain medicine does not and should not turn into a military hierachical warrior culture. Medicine is far more holistic than that. The psychiatrist who is called in to consult on ICU case is a classic example. ICU patient on ECMO for… Read more »
Great discussion guys as said above… When I got into medical school I was so excited. I was a biology major, and a duel minor in chemistry and ancient history…..stuck around five years in college. Worked as a synthetic organic chemist for two years and then squeaked into medical school. I thought I was going to meet folks interested in deep discussion and play chess till three am in between our studies. Oh boy what a shock….I felt like I was in a class where everybody was striving for A’s so they had choices ….. Not entirely because they wanted… Read more »