Monday, September 20, 2010

Family Medicine: Learning from the Military

As a cadet at West Point, I recall having to analyze the major military battles in history using the Principles of War, United States Army. Once I became a civilian after five years on active duty and one year of reserve duty, I didn't recall much about the Principles of War until joining the faculty at The Ohio State University College of Medicine. Then I needed to refer to them again as politics heated up at my alma mater. Now , as we enter a challenging era in health care with massive change upon us, I refer back to the Principles of War to analyze and plan responses to our situation. By us, I mean patients and their family doctors.

Business uses of the nine principles were nicely explored in a 1992 book titled Duty, Honor, Company: West Point Fundamentals for Business Success by Gil and John Dorland, brothers who graduated from the US Military Academy at West Point in the Viet Nam era.  Military references to the nine Principles of War include the Combat Leaders Field Guide, Department of the Army FM 22-100 Military Leadership and FM 100-5 Operations.  I'm not aware of any medical works about using the Principles of War.  We're ready for some applications of the Nine Principles of War to health care.

1. Objective:  Direct every military operation toward a clearly defined, decisive , and attainable objective.

2. Offensive:  Seize, retain and exploit the initiative.

3. Mass:   Mass the effects of overwhelming combat power at the decisive place and time.

4. Economy of Force:  Allocate minimum essential combat power to secondary efforts.

5. Maneuver:  Place the enemy in a position of disadvantage through the flexible application of combat power.

6. Unity of command:  For every objective, ensure unity of effort under one responsible commander.

7. Security:  Never permit the enemy to acquire an unexpected advantage.

8. Surprise:  Strike the enemy at a time or place or in a manner for which it is unprepared.

9. Simplicity:  Prepare clear, uncomplicated plans and  concise orders to ensure thorough understanding.

Imagine that the enemy is the H1N1 influenza.  You might be able to recognize how each of the principles might apply.  What if the enemy is biased information from a professional or patient group or the pharmaceutical industry or misdirection of scarce valuable health care resources by overemphasis on technology?  Think of the benefits and detriments of looking at our health care situations with these principles.

We'll discuss these and focus on one or two on my Blogtalk Radio Show 9/21/2010,  including comments from the chat room.  This is a NON-Combat application of the nine Principles of War.  Think peacefully in your heart.  Peace is good.  (The Viet Nam veteran in me knows this up close and personally).  Peace.


  1. Hi Dr Synonymous - Great way to look at it. It does feel like a battle sometimes and docs are on the front lines taking hits from all directions ..yet maintaining an offensive.

    I really like Throckmorton's (surgeon)profile description and think you'll appreciate it.

    A mere footsoldier stuck in the medical-legal battlefield, trying to save the civilians, protect the troops, avoid the mines and identify the saboteurs. "

    Health care sure is getting complicated.

    My PCP is going to start up a concierge practice. Any patient that pays 150.00 for a monthly fee will have unlimited access to him ..with his cell phone number. No visits less than a half hour and longer if necessary. There is more, but didn't pay attention because I can't do that. I can still be his patient though - thank God! It is because of the effect the insurance companies have had on his practice.

    My husband is a Vietnam vet. He rarely talks about it. We don't have any friends that were there and he never joined a VFW and so has just kept it locked in ..with a few exceptions. I never protested the war when my HS classmates had sit ins, etc, but went to class. Even at 14, I thought they were handling the war wrong and all the protesting and wishy washy politicians is what prolonged it.

    And it was horrible that veterans weren't treated with respect. I felt very sad about that for my husband and wondered how he felt when the first Gulf War soldiers were getting recognition. I know he was glad for them. At least they have since said they were wrong and now treat soldiers with respect.

    I wish I knew him then ..I would've sent him cards - mail every day I could. :)

    Sorry off topic a bit.

  2. I didn't realize you have a blogtalk radio show and will check it out when I can. :)

  3. Thanks for your helpful comments, SeaSpray. I reflect on Viet Nam in May 31 blog about "The Wall". Twenty of my West Point classmates died in the Viet Nam Conflict. It is never possible to understand the full meaning of those losses.
    Yes, I have a BTR show and have mentioned your blog. I expanded on the use of the Principles of War on my show 9/21. Peace for you and your husband. Dr S