Scapegoating Doctors

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Madigan medical chief Colonel Dallas Homas

This is a hard post to write. It is with deep sadness and conflicted feelings that I have learned about the controversy on PTSD (post-traumatic stress disorder) diagnoses at Madigan Army Medical Center. I want to defend my former colleagues, but, like you, do not have all the facts. There is an ongoing investigation.

Instead I would like to add context in several areas: 1) the perpetual controversy about PTSD and disability; and 2) the recurring scandals which blame the doctors taking care of patients. Unfortunately this has led to a corrosive and demoralizing atmosphere for those serving in Army medicine.

PTSD has always been a controversial diagnosis. Not labeled as such until well after the Vietnam War, the relationship to disability has always been especially contested.

There is no blood or X-ray test for PTSD.  The diagnosis is usually based on self-report of a history of major trauma and collateral information, gathered from unit members, families and others.

Therefore great and good minds can argue whether a patient has PTSD or related diagnoses, such as depression, anxiety and adjustment disorders.  The diagnosis is complicated by the relationship to disability. Currently all Soldiers with PTSD receive a 50% disability rating from the Army.

Secondly, I am dismayed  by how “scandals “have rocked Army medicine over the last five years, destroying careers of physicians who have devoted their lives to taking care of Soldiers.  For example, between 2001 and 2007, the patient population at Walter Reed went from 100 to 1,000. There was simply not enough housing at Walter Reed, so patients were put in nearby hotels and other facilities.  LTG Kevin Kiley and MG George Weightman were fired over these poor living conditions, even though both had worked tirelessly to improve them.

Another major tragic event was the Fort Hood shooting by an Army psychiatrist. Again there is an ongoing trial so I cannot comment specifically, except to state, in my opinion, Army psychiatrists were not to blame. They had done a tremendous amount to both enlarge the small pool of applicants to Army psychiatry and to remediate the poor performance of the psychiatrist when he was a resident and fellow.

Many of my Army medical colleagues were investigated; some had careers ended, promotions delayed or retired early.  Fortunately the stellar Army psychiatrists investigated were eventually exonerated, but it took way too much time.

The ripple effects of those investigations continue to reverberate, through military medical education and clinical practice, leading many physicians to decide to leave the Army as soon as their obligation is done.

Now, another investigation at Madigan, which may end the careers of several more physicians who have given all they have to care for American Soldiers.  I know all the persons described in the news reports. They are fine Soldiers and dedicated doctors, who have devoted their lives to treating patients, both in the United States and in Iraq and Afghanistan.

COL Dallas Homas, for example, is an exceptional leader, a graduate of West Point, and a combat veteran, who has spent his career taking care of Soldiers.

One lesson Army medicine should learn is that doctors should not sit in our hospitals and try to figure it out ourselves, with our screenings and checklist of symptoms.  What should the standards be for diagnosing and compensating PTSD? Like so many other debates, this should be transparent and national one.

The big story here for the press should be how these kinds of investigations, often carried out and tried in public, result in demoralization and problems retaining the best and brightest in Army. On these complicated and highly charged issues, we need to avoid to crucifying those in the trenches.

I would urge all who rush to judgment to step back, and let the investigation unfold.  I suspect that it will find good men and women doing everything they could to take care of Soldier in uncertain circumstances—not exactly the fog of war—but the smog of the fallout, the psychological effects of combat.

As one of my colleagues said, “Stop destroying the very people who are leading the fight.”