A young doctor's plan to streamline US federal medical care
by Gentry Yeatman

Part 1. Of Coughing Kids and Axle Grease

It was the mid 1970's. I was in charge of the Pediatrics Department at a hospital providing care for a large Georgia military base. It was during the Vietnam War and the draft was still in effect. My department staff was made up doctors whose MD training took place in civilian facilities. The Uniformed Services Medical School had not been established, so there was no such thing as a military medical degree. Several of my doctors had voluntarily come into the military service to serve for two years. This way they could plan their career rather than risk being drafted just as they were beginning to set up practice or to continue schooling to become highly trained child specialists in various areas.

I had just come from a large military teaching hospital at Denver with strong ties with the University of Colorado Medical Center. It is there that I had received my pediatric training and would later return to specialize in adolescent medicine. It had an aging facility but was staffed with pediatricians all of specialties, heart, kidney, cancer and blood diseases, lung, neonatal, teen and so on. Our newborn doctor would soon become the preeminent author of an important textbook still in use. Our teen doctor was to become the executive director of the American Academy of Pediatrics. If our teaching center couldn't produce a certain expertise we could always “borrow” from the U. of Colorado. For instance the team who had discovered “The Battered Baby Syndrome.” (No one 'prior to their publication in the 1960's believed that a parent could possibly hurt a child). Fitzsimons Army Medical Center, in my estimation, ran like a finely tuned machine caring for the ill and training young doctors to head up clinical departments in community hospitals such as Martin Army Hospital, Ft. Benning, GA.

So there I was, a young whippersnapper determined to whip a community hospital's childcare into a well oiled machine. Luckily they threw me into a rusty pit of coughing kids that needed thick axle grease! Just my kind of challenge in those days, and I was arrogant enough to set out to do just that. By golly I was there to impose my military values on civilian doctors. Together we set out to wipe noses! But we would first need to retrain an entire military post population from the lowest E-1 to the commanding general. All we needed was a plan.

Hundred of kids poured into our clinic on a daily basis. It seems that all children became ill at night and at times every night. Most parents were young and inexperienced. Let's put it this way, many of the mothers were just out of their own childhood. Their husbands were trained to stick bayonets into Viet Cong, but they would faint at the sign of baby poop. They did, however, know their way to the pediatric clinic. They thought by being there at the crack of dawn they may make it home before dark.

Such was my inheritance. And to think I actually asked to be sent to this place!

One “special”morning we arrived at our usual wall-to-wall flu factory. Six pediatricians, a nurse, an LPN and a two receptionists manned their battle stations. The RN made her usual rounds through the waiting room to attempt to triage the thirty-five sick children away from the thirty-five well ones. This potentially disastrous day revealed a child who should have been in an emergency room. The one of a hundred who was dying before our eyes. She grabbed his flaccid little body and headed straight to the treatment room! He lived. By the skin of his teeth or the seat of his pants or the grace of God or something. But in spite of having been far too long in the wrong place two of our best doctors stabilized him and admitted him to the hospital.

Let's see now, if my math serves me correctly we now have four doctors for a 99 patients and our nurse is tied up for a while.

A few months later our typical clinic scenario looked something like this. Two receptionists opened the clinic, all ten patients were checked in. Five pediatricians went to their office and began to see five patients. Two of the five doctors confirmed or corrected tentatively assigned diagnoses,treated their patients and called two more patients from the waiting area. A third doctor quickly diagnosed a classic rash. The fourth doctor began a thirty-minute examination of a child with a complex medical problem. The fifth doctor examined a child's ears, wrote a prescription, and sent the child on his way home. A sixth doctor answered the phone.

“Hello this is Dr. Alford, may I help you.”

There was short pause on the other end of the line.

“Am I really talking to a doctor?”

They talked for a short while and he asked, “How soon can you be here?”

I walked into the waiting room. There were now about seven patients and four of them knew exactly which doctor they would see and why they needed to see her.

And on this “special” day I have time to invite a gentleman into my office. He is with the local newspaper. He wants to know how we turned a infamous factory into a children's medical clinic?

And I hope by now that you would like to know as well.

Stay tuned to Part 2- The Plan

Rather than attempt to write our methods and results in story form, I decided to post a reference for the article we published.  http://www.ncbi.nlm.nih.gov/pubmed/6784020