I wouldn't let it go

When I began my stint as a primary care physician at Robins Air Force Base in Georgia in 2002, I was new to military medicine but not to the military. From 1983 to 1989, I'd served in the Navy's nuclear power program, but, midway through my Navy service, I decided that I wanted to be a doctor. For me, that meant getting my undergraduate degree, before completing medical school and residency.

What I'd hoped would be a long and rewarding career in military medicine lasted only three years. But that experience taught me a lesson that I've taken into civilian practice.

I began to learn this lesson several months after I started at Robins. One day, I was examining a patient who was complaining of routine cold symptoms. She mentioned, almost casually, that she'd been feeling fatigued for the past several months. I pulled up her lab results stored in the computer and discovered, to her surprise and mine, that, two months earlier, she'd had a hemoglobin of 9.0.

There were other problems that concerned me during my time at Robins-physician staff shortages; pokey responses to imaging tests and referrals; treadmill medicine; and, above all, a breakdown in continuity of care. Patients routinely complained about the revolving door of new providers, physician or PA, that were assigned to them. Complicating matters was the fact that because we had no on-base ED or hospital, we had to rely on a local nonmilitary hospital to provide inpatient care. The civilian doctors rarely communicated with us, which often left us guessing what kind of treatment they'd provided to our patients.

I began documenting our problems and took my concerns-as well as some proposed solutions-up the military chain of command. When nothing happened, I reluctantly told my story to the JCAHO field reps when they surveyed us in July 2004. The interview lasted for nearly an hour, but, in the end, we passed our inspection and nothing changed. For my efforts, I received a tongue-lashing from the chief of staff of the clinic.

In a way, I couldn't blame him, since his agenda was different from mine and he hadn't seen what I had. But his response taught me something valuable: As physicians, whether military or civilian, we can't limit ourselves to the four walls of our exam rooms. When we do, someone with a different agenda, who hasn't seen what we have, makes the decisions-and those decisions end up affecting our patients as much as anything we do for them.

To be true patient advocates, we must stand up and speak out.