PHYSICIANS ON THE FRONT LINE
to teach the art and science of medicine, and most importantly, how
to be a clinician. My time was mostly spent in the hospital or clinic.
Very little time was spent participating in military exercises, and
medical residents were not considered deployable. However, the
faculty did an outstanding job of integrating the nuances of military
medicine into my residency education, which sufficiently prepared
my classmates and I for life as military physicians.
Reflecting on my service as an active duty physician, I have come
to realize that military medicine is a specialty unto itself. There
are military-specific issues that require consideration that most
civilian clinicians wouldn’t need to think about. These include how
a diagnoses or treatment might affect a troop’s ability to perform
their job, deploy or even remain in the military. Let’s consider the
diagnosis of asthma through the lens of military medicine. Not
only does the military physician need to be familiar with how to
diagnose and manage asthma, they must also consider how asthma
control could be affected by military life. Can a patient diagnosed
with asthma perform their physical fitness test without triggering an
asthma attack? How will the various global climates affect asthma
control? How does asthma affect a trooper’s ability to carry out the
mission? Having an asthma attack mid-flight would not be ideal,
especially if the attack occurred in a pilot who was flying a single
seat fighter jet. Military physicians must consider how a diagnosis,
or treatment, will affect the patient’s ability to deploy. Often times we
are deployed to locations that have limited medical resources. Such
locations are not equipped to treat asthma attacks and a higher level
of care could be hundreds of miles away. Lastly, military physicians
must consider the well-being of the trooper’s family. How will a
family member’s diagnoses or treatments affect where they can be
stationed? How will the family cope when they are separated from
their active duty loved one? Caring for the family allows the active
duty member to focus on completing their mission without the
added worry of their loved ones’ well-being.
The military physician does have extra “layers” to consider
when caring for their patients. However, every physician has more
to consider than just the science of medicine when caring for their
patients. Those considerations vary from specialty to specialty. I
would say military medicine offers its physicians experiences that
most in civilian practice would never have. The Air Force wants its
physicians to have a working knowledge of how an Airman’s work
environment affects their health and performance. Experiences vary,
but as a flight surgeon I learned how to use night vision goggles,
had the opportunity to fly in various aircraft and took a spin in a
centrifuge. I learned how to conduct public health food inspections,
occupational health worksite assessments and I received training
on how to conduct investigations into air and ground mishaps.
I completed hypoxia training in a hypobaric chamber, donned
chemical gear and gas masks, learned how to survive in the open
ocean, and how to safely land under a parachute. All of this provided
me with a deeper understanding of what other Airmen experience
on a day-to-day basis.
of their comfort zones by sending them to isolated and sometimes
austere environments. When I was deployed, I responded to an in-
flight emergency at four in the morning wearing what equated to my
pajamas. When I arrived on scene, I needed to assess the casualties,
but the fire chief said I need better protection from the chemicals
that had spilled. Another firefighter handed me his firefighting boots
and magically I was “protected.” So, there I am in shorts, a t-shirt
and firefighting boots walking out to the accident scene alongside
a firefighter who is wearing his full gear (including his respirator).
I don’t know if it was the chemicals or the fact that I was still half
asleep, but I remember thinking the firefighting foam on the ground
was snow (mind you I was in the middle of a desert in September).
In the end everything turned out okay, and I was able to focus on
the job at hand. However, I believe this experience highlights how
military physicians must be able to perform in various situations
and locations.
My family and I moved six times in the past 12 years and each
move took us farther away from our families and friends. By the time
we moved to our last duty station we had become pretty homesick,
and I was beginning to consider a career transition into palliative
care. My wife and I began exploring palliative care fellowships close
to home and I was able to match into the University of Louisville’s
Palliative Care program. Six months later, my family and I separated
from active duty, moved back to Louisville and I began my fellowship
in July 2019. Shortly after our return to Louisville, I was also able
to join the Kentucky Air National Guard which has allowed me
to continue my military service while simultaneously pursing my
personal career goals.
None of my career milestones would have been possible without
the love and support of my family, and I cannot thank them enough
for everything! Additionally, I am grateful to the Kentucky Air
National Guard and the Palliative Care Fellowship at the University
of Louisville for accepting me into their respective organizations.
My hope for the future is not only to establish myself as a palliative
care physician here in Louisville, but to also explore if palliative
care can be integrated into military medicine. Specifically, can the
provision of palliative care be pushed closer to the battlefield (i.e. in
the deployed setting and/or on Med-Evac flights)? Would doing so
be beneficial, sustainable, and cost effective? If not, what are some
methods that could be leveraged to optimize the delivery of palliative
care in the deployed setting? Ultimately, I am envisioning a system
that affords maximum comfort for military casualties throughout
the Med-Evac process.
The opinions and assertions contained herein are the private
views of the author and are not to be construed as official or as
reflecting the views of the US Air Force Medical Department, the
National Guard Bureau, or the US Air Force at large.
Dr. Daniel Dierfeldt is a Palliative Care Fellow at the University of Louisville School of
Medicine and Flight Surgeon for the 123rd Medical Group, Kentucky Air National Guard.
The military is also very good at placing its physicians outside
NOVEMBER 2019
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