Medical Science Publication No. 4, Volume II
THE ROLE OF THE PROFESSIONAL CONSULTANT*
COLONEL FRANK E. HAGMAN,MC
This discussion will consider the role of military and civilian consultants,primarily from the surgical point of view, from the outbreak of the KoreanCampaign until February 1952.
Military Surgical Consultant
The surgical consultant was one of several professional advisors onthe staff of the Chief Surgeon, Far East and United Nations Command. Duringthis period successful medical support of the United Nations military missionwas the pre-eminent responsibility of the Chief Surgeon. At the same timemedical care had to be provided for dependents of military and for numerouscivilian personnel.
When hostilities in Korea began and our Armed Forces were committed,there were scarcely enough medical officers in the Far East to providenecessary medical support for our far-flung occupational forces. Fortunately,there were a number of medical officers who had previous experience inwar surgery. There was also a group of young Regular Army officers temporarilyassigned to the Far East Command from military and civilian residency trainingprograms of the military establishment. These formed the nucleus for themanagement of battle casualties in the early days of the Korean conflict.
World War II had produced priceless information and experience in thecare of the wounded that were applied as quickly as possible. It was aresponsibility of the surgical consultant to disseminate by all possiblemeans to all actually engaged in the medical support of our forces theselessons learned from previous experience.
In order for the surgical consultant to be of greater value as advisor,he had to become familiar with the functions of many units throughout thecommand. This required an inordinate amount of traveling by almost everymode of transportation. Freedom of movement by the consultant throughoutthe theater is extremely important. He can be of little help if he is anchoredto a swivel chair. If his movements are restricted for one reason or another,much of his value is lost. If restrictions are imposed by his superiorsbecause of lack of confidence in him, he should be replaced forthwith.
*Presented 26 April 1954, to the course on Recent Advances in Medicine and Surgery, Army Medical Service Graduate School, Walter Reed Army Medical Center, Washington, D. C.
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The surgical consultant had the opportunity of visiting almost everymedical unit as often as physical endurance permitted. From these visitshe learned much of considerable benefit toward the aim of maintaining andimproving a high standard for surgical practice. Not only could suggestionsbe made on the spot, but also to others in various echelons along the chainof medical units from the most forward to the rearward fixed hospitals.
The consultant frequently became familiar with many of the problemsof commanding officers and surgical staffs concerning such matters as adequacyor inadequacy of personnel, both quantitatively and qualitatively. Muchwas learned about deficiencies of supplies and equipment. Information wasgleaned concerning triage and transportation problems.
During these visits professional rounds were made during which qualityof surgical care was noted. This provided opportunity to judge the caliberof medical officers and their background of training and experience. Leadershipand teamwork within the organization commonly became manifest. The consultantlearned for himself from the staff and from the patients seen by him whereinsurgical care, given at another echelon, could be improved. At the earliestopportunity suggestions for improvement were made, in a friendly, not hypercriticalmanner. Almost invariably doctors were appreciative, accepted the suggestionskindly and altered the management of battle casualties accordingly.
One of the unfortunate facts about military surgery in combat is lackof or inadequacy of follow-up information concerning patients treated byone unit and subsequently transferred elsewhere. In a small measure theconsultant provided some of the desired data. Hospitals in Japan were requestedto send a copy of the final summary to the hospital which had administeredinitial surgical care, upon completion of treatment or transfer to theZone of Interior.
On the basis of these observations, the consultant was in a better positionto make recommendations. By various means and through channels open tohim, he frequently was able to get supplies and equipment on the way expeditiously.Recommendations were made for augmentation or depletion of staffs and changesin assignment on the basis of these surveys.
Another function of the surgical, as well as of other consultants, wasto meet with newly arrived medical officers sent to the Far East Command.Many of these officers were recently commissioned doctors, still somewhatstunned by the quirk of fate which had brought them from their careersin civilian life to a strange land, on orders to participate in a militaryoperation for which they had neither taste nor experience. An attempt wasmade to greet these men collectively
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and individually with friendliness and interest. Exhausted from a longtransoceanic crossing, subjected to the impersonal hoppers of the militarymill and almost ground to a pulp, some of these men appeared to appreciatethe interest of the consultants. For subsequently when these doctors wereseen again in their duty assignments, the consultants were rewarded bya word or two of gratitude from them.
During this first contact the consultants endeavored to brief the newlyarrived officers about the Far East and the medical experience prevailingtherein. Each doctor with special qualifications in surgery and ancillaryspecialties was seen by the surgical consultant when possible. Informationas to his background and training was obtained and used for recommendingassignments. A sincere and realistic attempt was made to place each doctorin an assignment commensurate with his qualifications and in accordancewith pressing needs of medical units.
Attention was directed to current concepts in the management of battlecasualties and certain recurring errors were emphasized. When possible,medical officers destined for assignment in the combat zone were sent fora short time to hospitals in Japan prior to their departure to Korea. Thisafforded an opportunity for the doctors to see for themselves the resultsof managing battle casualties. This firsthand knowledge of what constitutedgood, bad or indifferent initial treatment gave the doctors a frame ofreference, in a relatively short space of time, more effective for theirarduous tasks in Korea than mere words. Unfortunately, demands for immediateservices of medical officers elsewhere often precluded carrying out thisplan. Personnel officers, charged with getting medical officers to fillrequisitions and constantly harassed by demands from all echelons, hadvery little sympathy with this idea of a period of orientation. Sometimeswhen the consultant thought he had accomplished what he had set out todo, others totally disregarded his recommendations, acted without his knowledgeand completely contrary to what was proposed.
To be truly effective in his role of military surgical consultant, especiallyin a theater of operations, he should possess many qualities difficultto find in a single individual. From brief experience with such a rolein the Korean Campaign the author believes the surgical consultant wouldbe fortunate if blessed with these attributes. Professional competencyin general surgery is essential. His experience should be broad and heshould have more than a passing interest in all of the related surgicalspecialities. In his role of professional advisor certain aspects of surgerymay suffer if he is preoccupied with one narrow field.
Practical knowledge of the Military, including organization, militarymission and medico-military relationship, is important. During
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a period of combat he must have had experience with managing battlecasualties at all levels, else he is severely handicapped. Since he dealswith many people of great intellectual and professional accomplishments,he must possess tact and ability to get along with them to obtain the mosteffective results. The chronic fault finder would be a miserable candidatefor this position. A sympathetic understanding of the problems of the commanders,surgeons and others at all levels for accomplishing the military missionis most desirable.
To be effective the surgical consultant must enjoy the respect and confidenceof all concerned or else his recommendations are worthless. He should bea good judge of professional men and their capabilities. Not infrequently,a medical officer appears to be a failure, when part of a staff havingpersonality problems, but does exceedingly well in a different environment.Much can be done by willingness on the part of the consultant to guideand encourage his colleagues. Many have personal problems related to separationfrom families and difficulties in adjustment to military life. Occasionallysomething can be done to help, if nothing more than to assume the roleof a Father Figure to whom these people can ventilate their troubles.
The surgical consultant must be willing to travel a great deal. Thereis no substitute for frequent visits to his colleagues. An old-fashioned"bull session" with them is of inestimable value. If a situationis bad he should possess the courage to try to do something constructiveabout it.
Fortunate is he who can speak and write well. Opportunities for communicatinghis ideas to others are unlimited and necessary for effective action. Analysisof results obtained, means for improvement and correction of mistakes canbe imparted to those usually eager to do their utmost in supporting themilitary mission.
Civilian Surgical Consultant
The role of the civilian surgical consultant in an overseas theateris somewhat different from that of the military surgical consultant althoughsome overlapping occurs. The civilian surgical consultant has the distinctionof being a prominent representative of civilian surgery as well as an emissaryof The Surgeon General. His is the role of liaison between civilian andmilitary surgery, a breath of fresh air from home to those serving in farawayplaces. His reports of new developments are received eagerly.
A surgical consultant visiting a theater of active combat is distinctlyhandicapped if he has had no prior experience with military surgery. Appraisingthe results of efforts of those actually engaged in managing battle casualtiesis more difficult for him. Furthermore, specific
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advice for problems associated with combat casualties can be embarrassing.
The civilian consultant finds his days busily occupied. In the Far EastCommand there were numerous organizations desirous of benefiting from hisvisit. In the time allotted for his tour it was impossible to see all medicalorganizations. The particular interest of the consultant may guide theplanning of his itinerary so that installations caring for patients ofhis field or interest may have more time allotted to them. However, doctorsare assigned to units in the field who also are interested in what theconsultant has to offer and these men must not be neglected.
The civilian surgical consultant meets with military and professionalpeople of all echelons. His main function is that of teacher. This is accomplishedduring informal and formal conferences, professional hospital rounds, consultations,etc. In Korea many medical officers were reached through the medical societiesin divisions, such as the X corps Medical and Dental Society, the 38thParallel Medical Society, whose meetings were attended by physicians fromall United Nations in the field. The consultant received a warm welcomeby an appreciative audience as a respite from the ugly realities of a combatzone. At these as well as other conferences, the consultant finds visualaids, slides, motion pictures or charts valuable in presenting his material.
The consultant is in a position to boost morale of all professionalmen within the theater. All are interested in seeing him. Professionalrounds of patients at any level are always welcome. During these the consultanthas the opportunity for bedside teaching and will find patients with medicalproblems which will tax his ingenuity. The small informal conference or"bull session" in the evening with interested doctors togetherwith the consultant is a very effective and stimulating experience.
After the tour, the consultant makes a report to The Surgeon Generalconcerning his findings, his criticisms and suggestions for change or improvement.It is wise, and a matter appreciated by those closely concerned, that thesesuggestions or criticisms be made to the responsible individuals on thespot and within the theater. It is disconcerting and unfair to these physiciansto have such criticisms come back to the theater via The Surgeon Generalwithout anything having been said about them by the consultant while makinghis tour.
The consultant has the opportunity of teaching doctors native to thecountry he visits. Japanese and Korean physicians are avid for anythingpertaining to current medical practice in the United States. Usually aconference must be arranged sometime in advance of the date set. Languagedifficulties can be overcome by obtaining a com-
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petent interpreter. At least twice the length of time usually utilizedby the consultant for a lecture in English will be necessary because oftime consumed in translating. Suitable pauses after a few sentences willbe required for translation and may be somewhat frustrating but are verymuch worth-while.
A tour as civilian consultant is an interesting and stimulating experienceand, according to many who have enjoyed the trip, the consultant also learnsa great deal.
The surgical consultants we have had the privilege of knowing in theFEC have been prominent in their profession. It was very helpful for themto know something about and to have a sympathetic interest in the militaryestablishment and military medicine. Furthermore, those who contributedthe most were interested in teaching and endeavored to encourage militarymedical effort. While it was expected that they would enjoy photography,sightseeing, collecting curios and art objects, for which ample time usuallywas provided, these latter should not be their primary interest.
The most successful consultants were helpful and not carping critics.They were willing to spend time with the young medical officers, perhapsof an evening, and discuss medical subjects.
Every attempt was made to minimize discomfort during travel and in thefield. The consultant expected some preferential treatment, but the redcarpet was not always before him. He was entertained freely and cheerfully,usually by those with a sense of gratitude for his contribution.
Auxiliary Surgical Teams
Auxiliarly surgical teams were first used by the American Army in WorldWar II. Organized, trained and equipped in the United States, they becamereserve units overseas. The teams provided a high level of surgical competencyand economy and could be sent where they were needed quickly since mobilitywas one of their chief virtues. Comprising the teams were personnel ofhigh caliber and exceptional qualifications who worked together well, whowere adaptable to theater policies and who became integral parts of thestaffs of hospitals to which they were temporarily assigned.
There were, of course, no auxiliary surgical teams available when hostilitiesbegan in Korea nor were any furnished (as such) for the Army later in thecampaign. The U. S. Navy from time to time sent surgical teams from Japanto augment the medical units of the First Marine Division, and eventuallytwo neurosurgical teams could be provided by the Army in support of medicalunits in Korea. Various groups of medical professional personnel were sentto the Far East Command for specific purposes but not as auxiliary teamsas
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we know them. They were sent to perform certain missions such as investigationof problems arising from the management of casualties, study of dysenteryamong prisoners of war, investigation of cold injuries, study of infectioushepatitis, and the like. But these groups in no way could be consideredauxiliary surgical teams. The nearest approach to these teams, developedby the Army, was limited employment of teams from relatively quiet hospitalssent to augment staffs of other units more actively engaged in caring forcasualties.
