There is no higher religion than human service. To work for the common good is the greatest creed. — Woodrow Wilson (1856-1924)

Editor-In-Chief, Chester "Trip" Buckenmaier III, MD,  COL (ret.), MC, USA

Chester “Trip” Buckenmaier III, MD,
COL (ret.), MC, USA

Government service can be extremely trying at times. Last month, I touched on the difficulties of surviving the bureaucracy to which we submit ourselves each week in the care of our servicemembers and their families. As I have been challenged recently with seemingly nonsensical decisions on critical projects for patient care that my organization is working on, I feel further comment on this topic is warranted. The organizational consultant and author Warren Bennis (1925-2014) stated, “Leaders are people who do the right thing; managers are people who do things right.” Think about that for a moment.

Previously, as an active-duty medical officer and now as a federal employee, I have and continue to fancy myself as a leader. I have tried to do the right thing, as best as I could determine what that “right thing” was — for my patients, my command and for federal medicine (in that order). In fact, since its inception, the unofficial “golden rule” question guiding the decision-making process of the organization I direct has been, “What’s good for soldiers?” I am Army, but, of course when I say “soldiers” I also am referring to airmen, coastguardsmen, marines, and sailors.

I admit that, as a young second lieutenant in medical school and newly-minted physician captain, the understanding of what was right was pretty easy; my responsibilities did not range beyond the patient immediately in front of me. Caring for my patients appropriately, passing the occasional physical fitness test, showing up on time and staying off the naughty-physician lists by wading through mind-numbing computer training were, to a large extent, my only tasks. As both my career and I matured into ever-greater positions of responsibility for other employees and programs, the true meaning of frustration in working within the federal system became more apparent. I wear the marks of this sage education in my graying hair and deepening facial wrinkles (and sadly rotund center of mass). I, like so many other like-minded individuals in federal medicine who have had the audacity and pluck to not only point out that the king lacks clothes but then go on to try and do something about it, likely can commiserate with the age-inducing frustration I am describing. It can be exceedingly difficult to lead others to do what is the “right thing” when the prevailing attitude of the organizational machine is to stick to the safer, less work-inducing path following worn, dated and tired policies — the proverbial “right way.”

As I have noted many times in this column, working for federal medicine and within the juggernaut bureaucracy — which fuels this massive system to perform a worldwide mission in some of the most difficult environments — takes a special dedication and devotion to service. It requires leaders at every level and every category of profession and task to be focused on what is right or perhaps better said, “What is good for soldiers?”

When I say every profession, I am referring not only to doctors, nurses and other allied health professionals; I mean everyone — politicians, lawyers, financial officers, administrative officials, information technology personnel, office assistants and everyone else who keeps the lights on, the health facility clean, grounds secure and performs any other vital task I have missed. For the system to work, everyone must recognize that his or her contribution is vital to the success of everyone else and the system in general. In short, no matter what the task is, if it occurs within the federal medicine bureaucracy, it is contributing (or at least should be) to successful care of the soldier.

Of course, so many of these vital federal medicine activities do not involve physical contact with an actual patient. Many of the jobs within a health system may not, on the surface, appear to have anything to do with patient care, but the fact is they do. My concern is that many individuals who are not directly involved in patient care may lose sight of their connection and their contribution to quality patient care and all that entails. When we lose sight of our place in the overall mission of patient care, I believe it becomes very easy within any particular work “silo” to become good at doing things right within the parameters and rules of the particular job but far more difficult to do what is the right thing ultimately for the patients, despite those regulations.

We must remember, it is the patients that are the center of purpose, not successful execution of the bureaucracy. Success with one is not necessarily compatible with success in the other.

Regrettably, this editorial likely has become confusing for many. The point I am trying to make is that, no matter what activity occupies your work-life, if it is not contributing to the common good, as Woodrow Wilson points out, perhaps some adjustments should be made in how the job is being accomplished. As a simple corollary for everyone within the federal medicine system, please pose yourself this question, “Do my work activities contribute to the common good of soldiers, or am I just doing what has been determined, possibly erroneously, to be right by the local bureaucracy?” I admit that it is far easier and safer to simply accept rules as they have been established and not worry about unintended consequences of doing things by the long-established regulations. If these regulations are not in the ultimate best interests of the soldier or patient, then who or what are we really serving?

This “always follow the rules” approach might be good for the bureaucracy and the individual employee’s career, but does it serve the soldier? To channel some Henry David Thoreau, “Any fool can make a rule, and any fool will mind it.” I suggest everyone in the federal medicine system has the responsibility to concern themself with understanding how their approach to their job is (or more importantly is not) serving soldiers. In situations where we are following rules to serve the system rather than the soldier, it is appropriate to question the rule, possibly adjust it, or even throw it out all together.

I am convinced that if everyone would approach his or her particular job within our great system with an eye toward the soldier’s common good in all activities and decisions, everyone’s job would be that much easier and far more fulfilling. Imagine what could be accomplished with this approach.