Originally Broadcast April 8, 2013
Michael Keegan: Welcome to The Business of Government Hour. I’m Michael Keegan, your host and managing editor of The Business of Government Magazine.
The provision of health services is a critical and significant mission within each branch of the US military. The US Department of Navy’s, Bureau of Medicine and Surgery has a long and cherished tradition of serving and safeguarding the health of its service members and their families. In fact, the Foundation of Navy Medicine is force health protection and that is ensuring the availability of a medically ready, healthy, and fit force. It is what it does. It is why it exists.
Whether at sea or on the battlefield or at home, Navy Medicine also plays a central role in the most effective joint casualty care and management system in military history, a system that has saved thousands of lives that otherwise would have been lost on the battlefield.
What are Navy Medicine’s strategic priorities? What is force health protection? How is the continual care for military personnel being enhanced and strengthened and how is medical research and development helping Navy Medicine? We will explore these questions and so much more with our very special guest, Vice Admiral Matthew Nathan, Surgeon General of the US Navy.
So Admiral Nathan, thank you for joining us today. It’s great to have you.
Matthew Nathan: Thank you, Michael. It’s a pleasure to be here with both you and Gio.
Michael Keegan: Also joining our conversation from IBM is Gio Patterson. Gio, welcome as always.
Gio Patterson: Thank you.
Michael Keegan: So Admiral, many are familiar with the US Navy but may not be as familiar with the US Navy Bureau of Medicine and Surgery also known as Navy Medicine. Would you share some of the history with us and when was it established and how does it support DOD’s overall mission?
Matthew Nathan: Well, Navy Medicine formally came into line in the 1840’s as the Bureau of Medicine and Surgery to support the navy from a seagoing aspect and from those land elements. Some people aren’t aware that we also are responsible for the care of the marine corps. So the marines and the navy are under our charge for healthcare as well as their families. We were designed at first to basically coordinate the activities of healthcare at sea and throughout the century have migrated to being in care of the sailors, the marines, their families, those who have retired and left a legacy for us to follow, and now we are very much diversified into significant research areas.
And as I like to tell people, I’m a little parochial, I admit, but I like to tell people our medical service is really responsible for providing care above the ocean and aviation, on the ocean and our surface navy, below the ocean and our submarine force, and then on land as we support the marines and the special operators such as seal groups and EOD groups. So we have a pretty wide portfolio that has developed throughout the years and our job is really one of two missions and it is one to be ready.
And when people ask me what business I am in, I like to tell them I am in the readiness business. My job is to be ready for the next improvised explosive device that goes off in Afghanistan. My job is to be ready for the next mom who has gone into labor and needs her delivery at the threshold of one of our hospitals. I consider both to be paramount in readiness and so there is an expectation on the Navy Medical Department, both from my bosses, the Chief of Naval Operations and the Commandant of the Marine Corps to be there when they need us and to absolutely bring the best we have.
Michael Keegan: Admiral, with such a broad and critical mission, would you give us a sense of the scale of operation for Navy Medicine? How is your office organized? What is the size of your staff, and perhaps gives us a sense of the geographical disbursement of Navy Medicine?
Matthew Nathan: Sure, so we have a motto, Michael, in Navy Medicine, which says world-class care, anytime, anywhere. And because we are a maritime centric force and we support a maritime centric force, the navy and marine corps, we basically call ourselves the away team. Our job is to be away from home. Unlike, perhaps, the army and the air force which are more garrison based services, and when needed deploy en masse to a foreign shore or to a foreign area of conflict. The navy’s job is to be out and about most of the time, controlling the water ways and notarial (ph) areas and to be engaged in trying to put out small fires before they become big ones, be it somewhere in the Persian Gulf or the South China Sea or the Atlantic or the Pacific.
So Navy Medicine must be agile to be with them. So if somebody said to me where do you like to sort of stay in one place, our answer is we don’t like to stay in one place. We like to have bases from which we work but our job is to be out and about and be very responsive for any need that may come up. That said, we’re organized with regions at home. We have the Navy Medicine East Region headquartered out of Portsmouth, Virginia, a personal care facility there. Navy Medicine West Region out of San Diego, Navy Medical Center San Diego, and the National Capital Authority Region out of the Bethesda area. Those are our three regions that support and headquarter all of our military treatment facilities which include tertiary hospitals, family practice teaching hospitals, and smaller hospitals scattered throughout the world.
And then we are task organized through our support to the warfighter as we provide Navy Medicine, what we call surgeons, to the various fleets. So the fleet forces command and the pacific command have surgeons that represent their medical needs to them and we have surgeons for all of our numbered fleets; the fourth fleet, the fifth fleet, the sixth fleet, the seventh fleet. I had a job once as the seventh fleet surgeon.
We have a public health system which is headquartered in Virginia and that is responsible in large part for the preventive medicine efforts that go on to maintain a war fighting capability and it varies from protection for insect and infectious disease vectors to keep troops from becoming ill or injured, all the way to public safety, looking at vehicle mishaps, looking at any sort of foodborne type issues, and then we have our research units.
I think many people are surprised to see in Navy Medicine that we have had research units in Cairo for over sixty years with uninterrupted service there. They have a robust research department down in Lima, Peru. These facilities do amazing engagement with the local countries, the host nations, neighboring countries. Really, I think, as much as they find new science and team up with host nations to find new ways to combat illness and injury, they also, I think, show other nations American compassion and desire to participate and be a team. And so that is in large part how we are organized.
Gio Patterson: Admiral, now that you have given us a view of the global operation, maybe you could tell us more about your specific responsibilities as a US Navy Surgeon General and the Chief of the Navy BUMED? What are your specific responsibilities and duties?
Matthew Nathan: Well, my job is to be responsible to the Chief of Naval Operations and the Commandant of the Marine Corps and informally I would say that my job is to make sure that we have the best medical team available to both prepare the warfighter in the event that they need to go into harm’s way, to protect the warfighter in the event that they have something occur while in harm’s way or while in deployment, and then to maintain a confidence in the navy and marine corps that their families will be taken care of.
I think both Michael and Gio, you would agree that it’s very hard for you to keep your mind on the job if you were here or anywhere else, if you have a loved one who is suffering, who is ill, and you can’t be there. You would be very preoccupied by that. So we do everything we can to instill confidence in our troops and our crews that while they’re away from home or even at home, that we’re going to be there for their families. We’re going to be there to take care of them and they can concentrate on other things because the medical care is not going to be an issue.
Formally, my task is really to provide the manning and training and equipping of medical forces that lie resident in the United States Navy.
Michael Keegan: So Admiral, regarding your role and responsibility, what are your top challenges? What are the three top challenges you face and how have you sought to address them?
Matthew Nathan: Well, so Michael, that’s a great question because we’re coming now off of over ten years of war. This is unheralded. We have not seen this in our country’s history and it has done a couple things. One, it has lead us to some tremendous innovations in combat casualty care and deployment medicine but it has also been very taxing and it has created a cadre of service men and service women who have challenges that we hadn’t seen or hadn’t seen to this degree in such protracted warfare.
There is an expectation and I believe it is quite legitimate on me and on my Navy Medical Department that we be a marquee organization when it comes to peacetime healthcare. And what do I mean by that? If somebody walks into Bethesda Naval Hospital or into San Diego or Jacksonville, they should expect to have the kind of compassion, care, and professionalism that they would expect at any marquee organization, be it Georgetown, be it Hopkins, be it Stanford.
On the other hand, those organizations don’t go to war and we do, and so my other challenge is I have to maintain a vibrant readiness force that can deploy at a moment’s notice and that can be ready to operate in what could be an unfamiliar environment. So my challenge is to maintain the quality care that somebody seeks in one of our medical facilities and at the same time be able to deploy and maintain first class combat support care in a hostile or even simply an austere environment.
Like everything else, in healthcare, we’re not immune from the American healthcare system, it’s expensive, and the cost of healthcare to the Department of Defense among all of the services has been escalating at unprecedented rates. And so the Secretary of Defense and the secretaries of the services as well as the executive branch is depending on us to look for new and innovative ways to reduce the cost of healthcare in the Department of Defense.
Just as the leadership of this nation is looking for some sort of game changer to try to bring down the cost to the average American for healthcare and to increase access, we’re looking for innovative ways that we can give some resources back to the Department of Defense and without sacrificing any of the quality that people have become accustomed to in military healthcare.
Gio Patterson: Admiral, along with the challenges you have encountered leading Navy Medicine, can you also discuss your unanticipated or unexpected surprises? To that end, what has surprised you the most since taking over this role?
Matthew Nathan: Well Gio, it’s a great question because if you had asked me three years ago would I be looking at the normal budget challenges that occur in healthcare, I would say absolutely. If you’d say are we going to season that gingerly with sequestration and continuing resolutions and try to figure out what won’t be involved in those, we hadn’t really expected that.
When I used to speak to civic organizations over a year ago and they would say what do you think the impacts of sequestration are going to be, I ,like many leaders throughout the government, would say well, hopefully it won’t come to that. We think that maybe sequestration won’t be a big issue. But it has come to that and I will say that my leaders have been very supportive in trying to minimize the effects of sequestration when it comes to the provision of medical care and the ability to protect our fighting forces. We’re moving resources around and we’re shifting assets so that nobody who is deployed or nobody who is in an austere environment will feel any effect of this.
But none the less, depending on how long and how significant the budget situation goes on, my job is to work through that. My job is to give a coherent plan to my boss on how I am going to meet their mission and yet be faithful to some of the budget challenges that we have.
Michael Keegan: Well this environment, Admiral, requires a real sense of leadership and given your experience as a physician and a commander, what are the characteristics of an effective leader in your mind and has the model of leadership changed because of the complex challenges being faced today?
Matthew Nathan: There is no question that I think leaders are faced with a dynamic that goes up and down. In our case, we have an organization that has both been at war for ten years and in Navy Medicine, I use the term we’ve been all in. What do I mean by that? We’ve been one of the most heavily deployed aspects of the United States Navy in the war. For one reason, when you’re at war for that long, you’re going to have to cycle people back into theater (ph) and back into other deployed units fairly often.
The largest toll is taken on our surgical specialists and our combat trauma specialists and our mental health specialists. Most people don’t realize that of all of the navy forces that have been deployed in the last ten years to Iraq and Afghanistan, all navy, all navy ranks and rates and types, that over fifty percent of those wounded in action have been from Navy Medicine and over one third of those killed in action have been from Navy Medicine.
Now, most of those are a footprint with the marine corps who are side-by-side, organically assigned to the marine corps. But it speaks, I think, to the dedication and to the heroism and the commitment that the United States Navy corpsmen and the doctors and the nurses and the dentists and the medical service corps officers have accrued throughout history. The United States Navy corpsman is the most decorate rating in the military and it is simply because their job is when everything breaks loose and everybody is trying to either sort of hunker down or get back, their job is to run in. And so they are an amazing group of individuals.
One of the challenges I have as a leader now is maintaining buoyancy and maintaining optimism and encouragement for a force that sometimes can be fatigued, compassion fatigue. One of the interesting things about Navy Medicine is I may have a doctor, a nurse, or a corpsman who is assigned for months and months and months in Afghanistan or Iraq, taking care of some of the most critically injured people in history. And we can talk about some of the advances that have been made there but none the less, they’ll see things that maybe trauma surgeons or trauma teams or other hospital facilities won’t see in a lifetime. They’ll see that in the time they’re over there.
Then they come back, we give them a break, but then they come back and they work in a hospital and they’re taking care of these folks who have now been evacuated back to these hospitals. So some of them don’t really get a respite. So it’s up to me as a leader to make sure I create a culture that monitors and provides adequate relief and visibility for the caregiver. We call it care for the caregiver because it’s bad enough if somebody is injured. It’s compounded if the people who are supposed to take care of the injured are failing themselves. So we work very hard as leaders to make sure that we monitor our troops, monitor the health of them.
As you know, in this war, because of the advances in body armor, because of the tremendous advances in resuscitative care that really have changed the game completely compared to the first World War, second, Korea, Vietnam, your chance of surviving heinous wounds now is just incrementally so much bigger and so much better than it was in the past. Now that’s created a population of people now who have more amputations and do have more traumatic brain injury and, to some extent, more post-traumatic stress.
So my job is to figure out how to best approach those signature injuries, make sure that we create the best care in the world for the people who are afflicted by those, and at the same time monitor my own personnel and make sure that they’re not going to be consumed by this to the point of exhaustion or the point – because I will tell you Michael and I’ll tell you Gio that in one of my previous jobs I was the commander at Walter Reid Bethesda. I was on deck when the National Naval Medical Center, the navy’s medical center, merged with Walter Reid to create one large, happy family. Not always happy but getting happier every day as you can imagine any cultural merger that occurs in the country.
And the good news was that they both have one thing very much in common and that is the un-abiding desire to see the best care for anybody of any service. But that said, I would walk around and I would see nurses that looked tired taking care of wounded warriors and I would say why don’t you take a break. Let me send you to another hospital for a while just to take care of more traditional kinds of illnesses and they would refuse. They would absolutely refuse because they felt like this was their family they were taking care of. And we learned the hard way that if we didn’t force them to leave, they would sometimes break on us and so that is the dedication and the compassion. These people won’t raise their hands themselves to take a time out. So we have learned to do that.
So I instill that premise and that is a little bit different than, let’s say, to the CEO of another civilian medical facility or system because although I’m very proud and respectful of the dedication of our civilian medical systems and the doctors and the nurses and the roles they
play – oh, by the way, they don’t go to war at the same time. So I have to figure that into my dynamic of my leadership.
Michael Keegan: What are Navy Medicine’s strategic priorities? We will ask Vice Admiral Matthew Nathan, Surgeon General of the US Navy, when our conversation continues on The Business of Government Hour.
Welcome back to The Business of Government Hour. I’m Michael Keegan, your host, and our guest today is Vice Admiral Matthew Nathan, Surgeon General of the US Navy. Also joining our conversation from IBM is Gio Patterson.
So Admiral Nathan, you had mentioned that Navy Medicine must perform from the sea to the land the toughest environments and across the spectrum of the military mission but to do it successfully requires a strategic vision and for you to chart a course for your folks, for the folks that support you. Would you outline the strategic vision and briefly describe your core priorities?
Matthew Nathan: Sure, so I think that we’ve tried to be as concise and succinct as possible with our strategic vision. I always worry about somebody who outlines a strategic vision of ten or twelve things and then people say well where do I start? And I wanted to keep it simple in the sense that if I could walk around any of my battalions, my hospitals, my ships and talk to my medical personnel, they could tell me what the three things were.
And it starts with readiness. Readiness is job one for us. As we have talked about before, that is the business I am in. I am expected to be able to answer the bell anywhere, anytime around the world. I like to think of us as part of the navy Marine Corps team as sort of the world’s 911. If there is a foreign land or an environment somewhere that gets into trouble either through a manmade disaster or through a natural disaster, we would like to believe that we can be on scene very soon.
Second is value. Value comes back to the point where we have to constantly be analyzing what we do, how we do it, and how much bang for the buck. I tell my people it’s really sort of a fraction described as quality times capability divided by cost and so what does that mean? That means if I am doing a certain procedure in a certain hospital and I do it fairly rarely but it costs me a pretty penny to do it, as much as I might like being able to have that procedure in my portfolio, does it make more sense to export that to a local hospital nearby? Or do I need that procedure to maintain a skills preservation for my doctors when they go overseas?
I have to constantly be analyzing that because in the past I would tell you when cost was not on the forefront of the military medical leaders, we simply put safety and we put readiness as job one and we didn’t worry too much about the cost. Now we have to evaluate everything we do and look at it from the standpoint of is it worth it. And whatever we do, we’re going to do first class and safely but let’s make sure our portfolio includes only those things that really bring value to our system.
Then the third is joint. I need my people to start thinking more and more joint. I am a believer because of my experience at Walter Reid Bethesda where we sort of built this, I call it a Reese’s peanut butter cup where one hospital brought the chocolate, the other brought the peanut butter. We put them together and we have this synergy of best practices that occurred. I have seen the utility and the value of doing things jointly.
In addition, it doesn’t make good business sense for the army, the air force, and the navy to have three different medical systems that use three different types of, for instance, MIT technologies, pharmaceutical systems, education training systems. Why not figure out a way to standardize those, create best practices, share those among the services, reduce redundancies, and create more jointness? Not going as far as the purple suit that some people talk about which is everybody will just simply wear one uniform and we’ll sort of homogenize the army and the navy and the air force.
I think it is critically important that we preserve the traditions and the cultural ethos of the services but we can certainly do that while creating much more alignment and much more joint care. When I run into resistant audiences at times, I remind them that the person who has been critically injured on the battlefield, neither that soldier or airman or marine or their family is worried one bit about what uniform the person is wearing who is going to save their life. And we’re operating jointly in the war where if are injured, you may be treated on the field by a navy corpsman. You may be medevac’d by an army helicopter. You may be medevac’d to an air force hospital, and then you may be shipped back to an army, navy medical center. So it just follows that we need to look at that more.
So when I go to my hospitals, my commanders already know if they want to get brownie points, they have prepped their crew so that when I walk up to the youngest most junior civilian or enlisted member there and say what is Navy Medicine’s strategic value? They better pop off readiness, value, joint sir. And then the commander of course is hoping that I won’t try to ask them questions about each one. But that is our vision.
Michael Keegan: So Admiral, what are the guiding principles that frame your command philosophy?
Matthew Nathan: Well I think throughout time what served me well is in addition to the – to the what I consider to be the mission and business metrics and the readiness and the value joint which I think gives people the priorities of what we need to be doing, as far as working together and as being a successful unit, be it a small unit or a large medical system, I tell my people I believe in ship, shipmate, and self.
And in the navy we say you’ve got to take care of the ship because if you don’t and you lose the ship, nothing else matters. You yourself are now lost and the mission is lost. Shipmate; we’ve got to look after each other. I think one of the reasons I have stayed in the military for a career, and I trained in an academic residency, a non-military residency, so I have maintained great friendships with people I trained with, you know, over thirty years ago. But one of the things I have enjoyed is the covenant relationship that we have with our people. The fact that our job is to monitor their health, monitor their welfare and to, and some would say intrude when necessary to help people through situations and take care of them when they’re not doing well. And that’s a shipmate taking care of a shipmate.
And then self, taking care of yourself, raising your hand when you need help, letting people know if you’re not doing well, letting people know if you need help either because of a personal issue or a professional one. You can’t handle what you have been asked to do and raise your hand and do it. So I have tried very hard to create non-stigma, guilt-free environment where somebody can raise their hand and say I need help, where somebody can be constantly vigilant about the people they work around and notice subtle or dramatic changes, and recognize that they have to take care of the mission around them, in this case the ship or that may be the marine unit you’re assigned to, or it might be the naval hospital you work for.
Gio Patterson: Admiral, Navy Medicine is in the business of force health protection. Would you elaborate on the key components of force health protection and how it relates to force readiness, ensuring your service stays sharp, lean, and ready anytime, anywhere?
Matthew Nathan: That’s a great question, Gio. If I were to ask you during, say, in the African conflicts in the desert, in North Africa, and in parts of the war in the Pacific and some of the jungles, what a commander feared the most that would impact the mission the most and would possibly cause them to lose capability to fight; the enemy would be high on the list but it wouldn’t be top. The top thing would be illness, dysentery, malaria, infectious disease, what is called jungle rot by allowing moisture and fungus and not being able to clean the feet and that sort of thing.
Those would bring a unit to its knees much faster than the enemy could and so our job is to make sure that when somebody goes into an austere environment, a hostile environment, all the way from a humanitarian disaster which may be an earthquake or a tsunami or a hurricane, to kinetic war, that they go in as protected as possible so that they can be at their peak, they can be on their game, they can concentrate all of their facilities on the job at hand. They will have the best equipment to protect the eyes, to protect the ears. They will have the best immunizations to ward off infections. They will have the best ready medical supplies near them to take care of small injuries before they worsen, and they will have the best major resuscitative equipment to take care of catastrophic injuries and catastrophic illness.
One of the great changes that has occurred in combat casualty care is that over the years, if you looked at World War I, II, Korea, Vietnam, if you were catastrophically injured in the field, from the time you were injured to the time you eventually made it back to the states to a tertiary care facility like Bethesda or a veteran’s hospital was forty-five to sixty days. So we provided care in theater and we believed in sort of stabilizing in theater before getting back to the states, so forty-five to sixty days.
In this war, from the time you are catastrophically injured until the time you arrive at the bed here at Bethesda is three to five days and that has mostly been facilitated by the on scene resuscitative care and by the great air force medical evacuation system which has these flying ICUs which can fly the most significantly injured and out people in the world safely across the ocean.
Gio Patterson: That’s great. Admiral, we heard you say one of the greatest honors of being in the Navy Medicine is the mission of supporting the marines on the battlefield. The continuum of care for combat wounded is unprecedented as you just shared with us. the survivability rate of nearly ninety-seven percent. Would you elaborate on your efforts to enhance and strengthen the continuum of care for military personnel from point of accession, through active service, to rehabilitation and transition?
Matthew Nathan: The continuum of care really encompasses what I guess could be described ironically as sort of a ballet or an orchestra of care that is facilitated across the join spectrum. So you are a warrior and you are significantly injured by an explosive device, by a gunshot wound, by a burn, and we’re seeing, you know, most of the changes now because we had a lot of vehicular accidents or injures and wounds in Iraq and we’re having mostly people on foot in Afghanistan because of the terrain differences.
And so you’re injured. Well, here is what has changed. So the corpsman or the medic who is here on scene now has updated tourniquet therapy, they have quit clotting substances they can give. They have body armor which protects. We have a medical evacuation system which is highly responsive and we’re very good at getting people within that first fifteen minutes to seventy-five minutes of what we call a platinum/golden hour of care to a resuscitative station where they can be resuscitated, reverse the shock.
That is a ballet of joint forces. For instance, if you look at Bastion in Afghanistan, that is some air force, navy, army, and British working that facility and then we have some joint forces in Bagram, and in Kandahar and other places. Then once you are stabilized, we get you out of there. The idea is not to hold onto you there. It’s not to do definitive care. It’s to package you up, get you stabilized, get you to Landstuhl Regional Army Medical Center where further stabilization is done, a little more sophisticated, but again not definitive therapy, just enough to get you stable for the flight back home.
Then the air force picks you up and flies you and gets you back to San Diego or Brooke Army Hospital or Walter Reid Bethesda and that is where really, I think the military excels from that point, and now we get you to a place where you need rehabilitation, prosthetic rehabilitation and also emotional rehabilitation. If you suffered TBI or post-traumatic stress, you know, how will we approach those injuries?
We work in concert with the VA because some of these injuries are going to be lifelong and they are going to require the VA to take off where the military left off. So we work with the VA poly trauma unit and the VA has some magnificent poly trauma units in Tampa, Florida and Richmond, Virginia, in Minneapolis, in Paulo Alto where they take some of the more devastating injuries that are going to require long-term therapy in those places.
But we work on the rehabilitation there and then we start to partner with our academic and private partners. One of those that was created through the Armed Forces Foundation was the NICoE on the campus at Bethesda, the National Intrepid Center of Excellence for Traumatic Brain Injury. It’s a very vexing injury.
We have had a number of amputations through this war. Sometimes people ask me why there are more amputations in this war than there were in others. There aren’t necessarily more but people are surviving them more and so you see more people come back rehabilitating from an amputation. But that number pales in comparison to the number of people who suffer traumatic brain injury and/or post-traumatic stress so we really also have to figure out how we’re going to create a collective across the country, partnering with civic organizations, with academic centers of excellence, the private sector, and the military and the VA sector to provide a soft landing for these folks all the way along.
One of the great lessons learned from Vietnam was that we just didn’t really recognize the role of post-traumatic stress and traumatic brain injury and how it could rob somebody if not aggressively treated and monitored. It could rob somebody of their ability to be productive and functional and have a goal oriented life, and a lot of these people ended up sort of driftless and that is morally wrong but it also, if you’re a civic organization or a city, you worry about the impact of that on your city.
So I go to civic organizations and I tell them let’s work together to figure out how to engage these folks, these veterans as they come back, and make sure that they don’t fall through the cracks and that we partner and learn things. And the good news is I think the country is turning too. The country gets this and we like to say if we can sort of steal the phrase, it takes a village to care for someone with traumatic brain injury and post-traumatic stress because it can’t be just one particular organization by themselves.
Michael Keegan: Well I’d like to go back, Admiral. You had mentioned earlier that the survivability rate, I think we said it was an upwards of ninety-seven percent and it takes folks three to five days to get to the states for care. But the greater rates are sort of a double-edged sword because it’s a positive but you’re also dealing with folks who, as you said, have severe injuries; amputations and what have you. These create new challenges and you touched on them but I would like for you to elaborate a little bit. What are you doing to address these challenges and what programs are available?
Matthew Nathan: There has been a tremendous impetus to try to address what I call a sort of good news problem, the good news meaning that, you know, we’ve had people return from the war. We’ve had a few soldiers and marines who have returned from the war who have been quadruple amputees. Now, you know, some people have said to me gosh, you’ve lost all of your limbs, is that, you know, is that worth it?
And my answer is these people – these heroes, they engage with their families. There are new technologies occurring. You may have seen recently there was a double arm transplant at Hopkins, so every day we’re learning something new about some of the physically devastating injuries with magnificent prosthetics and with regenerative medicine and with transplant medicine that I think is going to give people their lives back. But that is something that we hadn’t seen before because most times those kinds of injuries wouldn’t have survived.
Then you get into the traumatic brain injury which can vary from mild, just concussion, to the major, then open head injury, to the post-traumatic stress, and how do we approach that? And we’re looking very hard at innovative sciences. We have found now that complementary alternative medicine which, when I was in medical school if somebody had said we have an acupuncturist here and they want to put some needles in for your headache, I would say get out of here, you know. And now when I get a bad headache, where is that needle?
We’re finding that these kinds of things, bio-feedback mechanisms, hypnosis – I’m not saying that’s where the center of gravity of the care is, but I am just saying that we’ve opened the aperture to any and all possibilities now to find a way ahead for some of these folks.
The number one thing we have found, Michael, which has made a difference in our moderate to severe TBI patients and our post-traumatic stress patients, is a comprehensive multi-disciplinary approach to them, bringing them in at the same time, not only engaging them but engaging their families as well.
Here is what I like to say. If I could, I’ll illustrate by example. When I was the commander at Walter Reid Bethesda, I was seeing the new casualties that came in and we had a young marine who came in who had lost his leg pretty high up in the leg and part of his hand and his family had arrived. Because one of the things we do now in combat casualty care is we bring the families in right away. We fly them in the next day. Now that is good in that they can be there right away and it is bad because they haven’t really had time to adjust to what they have heard.
Remember in World War II, you had forty-five to sixty days to sort of adjust to the serious injuries that you heard about in your loved one. Now you may have two days to adjust and so you walk in the room and you see this catastrophically injured person and it takes a while to adjust. But none the less, the best chicken soup in the world for somebody who has been severely injured is to have their family or their loved ones or their friends nearby. It really makes a difference so we bring the family in.
So I walk in and this marine was fine. He had lost a leg and he was newly arrived and he was excited about going to the operating room and getting the touch-up changes and getting into the prosthetic rehabilitation. He had his young son with him. It looked like he was five or six and he had his wife with him and his son was saying in the course of the conversation, he was a little bit bewildered by all of this. I guess they had planned to go to Disney World at the end of the tour when he was coming home, but he came home early of course and now with an amputation. And his son said daddy, are we still going to Disney World?
And so the marine sort of saddened up and teared up a little bit and his wife teared up a little bit because they didn’t know what to say to the little boy looking at this missing leg and everything. I said well when are you going? He said well, we were supposed to go when I got back. That was about eight months from now. I said you’re going to go. I said eight or nine months? We’ll have you up, we’ll have you walking. Not only will your dad take you to Disney World, he’ll take you on every ride.
The little boy brightened up. The wife brightened up and the marine sort of beckoned me to him and I bent down. I said you know, I’m not making this up. He said, it’s not that sir. I didn’t like those rides to begin with.
So my point is that he will engage with his family again and I am not trivializing his injury, but he will be able to play catch with his son and laugh with his son and roll around on the floor with his son and carry his son on his back in a piggyback ride. If he had moderate to severe traumatic brain injury or post-traumatic stress, I couldn’t make that promise to him because that can take the whole family with it. The whole family can be consumed by the altered affect and personality and challenges of that and so we are really looking at ways to engage the family and the wounded warrior at the same time or the injured person at the same time through a lot of modalities; using more sophisticated sensors, more sophisticated therapies, using much more alternative therapies.
We used to reach for the prescription pad all of the time and we’re trying to do that as little as possible now. We’re trying to find finds to obviate pain using other systems, ways to obviate depression using other systems, using medication when we need to, absolutely, but trying to look for alternative methods that can be more holistic in approach the patient.
Michael Keegan: How is the continuum of care for military personnel being enhanced and strengthened? We will ask Vice Admiral Matthew Nathan, Surgeon General of the US Navy, when our conversation continues on The Business of Government Hour.
Welcome back to The Business of Government Hour. I’m Michael Keegan, your host, and our guest today is Vice Admiral Matthew Nathan, Surgeon General of the US Navy. Also joining our conversation from IBM is Gio Patterson.
So, Admiral Nathan, Navy Medicine would not accomplish much of its mission without a robust research and development portfolio. Would you tell us a little bit about the research priorities for Navy Medicine and how it has impacted the delivery of care?
Matthew Nathan: Some of the most significant advances, I think, in peacetime care have come through the exploration and the research of issues, illnesses, and injuries that affect us in a wartime environment. We may be, in the near term, looking at a vaccine for malaria. Now malaria is the number one infectious disease killer in the world. We don’t think of it that much in the United States but it ravages other populations. Dengue fever, dysentery, certain encephalitis that are carried, west Nile, and others that are carried through mosquitos and through flies.
The origins of our research started in trying to protect our troops but this bleeds over into eventually protecting our peacetime. The model for trauma care in this country was based on our experiences in Vietnam. That’s where we learned about the golden hour and we learned about having an actual trauma support center such as shock trauma at Baltimore and other places.
We’re learning things now in this conflict through research and development of trauma care, be it clotting agents, be it artificial blood, body armor, tourniquet therapy, that will be on an ambulance today in a motor vehicle – a critical motor vehicle accident somewhere in the beltway. So we’re going to change lives just as a result of that research.
Most of our research is done, of course, to try to figure out how to be better force protectors and/or care responders for our troops and our crews, be they submarines and the environment of working in the submarine and the atmospheric and the pressure. When people go scuba diving for recreation in the Caribbean, the reason they know how far they can go and how much air they can breathe is because the US navy developed those tables years ago in trying to protect its divers from decompression illness. So these things carry over.
I think we get a two-for in our research, especially in our research overseas where we have places where we embed in overseas countries. First of all, the countries may be an environment where these illnesses are prevalent so we can really study them and secondly the engagement we get, the cooperation we get among the host nations is nothing but good. The partnerships that we have, sometimes in environments where they can be a little bit dicey and where the politics may be somewhat fragile, our relationships and the fact that our only agenda for being there is research and the advancement of science and the advancement of betterment of all people, including the host nation, really carries the day in many of these cases. So I am very proud of that part of it.
But we have researchers just down the road at Walter Reid Bethesda who are looking at new and innovative ways to treat cancer, all the way to somebody who is looking at a mosquito in Lima, Peru and determining how to create some sort of genetic variation so that the mosquito can no longer carry a certain disease. Yes, that is going to make a difference in the lives of our troops, but there is also going to be a young child born in the near future somewhere in the world who is not going to suffer something because of the navy research.
Michael Keegan: I hadn’t realized the R&D portfolio was another element of soft power. It’s interesting.
Matthew Nathan: Absolutely and again, and I think it’s because military medicine itself has always been a great soft power, you know, tool in the toolkit because the agenda is health and wellness and so often we can be a great ice breaker.
Michael Keegan: Admiral, Navy Medicine has a significant track record of engaging in humanitarian missions and responding to disasters. Could you elaborate for a moment on Navy Medicine’s involvement in some of the most recent relief efforts and to what extent does such engagements represent an extension of US soft power?
Matthew Nathan: When you look at Indonesia and how at one time that country had a pretty strong anti-American sentiment, they suffer a calamitous tsunami and we send the Lincoln battle group there, we send the hospital ship Mercy there. They see American troops helping rebuild, you know, infrastructure, schools. They see American troops taking care of children, looking at disease and injury, and the sentiment changes because of good will. The navy’s motto is not navy’s medicine’s motto. It’s the navy motto. It is a global force for good.
I think that appeals to young people. I think a young person today, in the generation today watching the ads on the TV or looking in a magazine or whatever, they’re patriotic and they want to be part of the national defense and they are willing to be part of the national security and they are certainly willing and able to step up and fight when they have to in a hostile environment to protect, you know, our nation’s interests. But they also like being part of something that leaves the world a little better place and they like being part of something where we have ships that can bring war power when necessary and we have ships that can bring tremendous compassion and healing if necessary. So I think that is one of our selling points.
But, yes, the research allows us to retain some very, very world-class scientists in the navy because we have some very, very world class and unique research environments.
Gio Patterson: Admiral, with the rising healthcare costs, the increased number of beneficiaries, and maintaining this long-term care responsibility for our medically retired warriors, your focus on the value is key in your decision making. To that end, would you tell us more about your efforts to realize sustained value and elaborate on your concept of value being quality multiplied by capability, all divided by cost?
Matthew Nathan: Great question and I think this is what keeps CEOs of any major healthcare system awake right now. Whether you are talking to the CEO at, you know, Hopkins or Geisinger or Cleveland Clinic, you know, how are we going to figure out how to improve access, improve health, and reduce costs? From the president on down, everybody is looking hard at how we can change the game, not only in military medicine but in our private sectors and academic sectors as well.
I believe that the answer lies in truly harnessing technology and creating more virtual care. What do I mean by that? If you look at history and you look at some of the things that really changed the way the masses either survived or got their care, we might start with the infectious theory of germs and antibiotics. All of the sudden, people who are dying of simple things stop dying. It changed the game.
The next might be anesthesia, the ability to operate on somebody at leisure so you could do intricate operations while they were asleep. That changed the game. Then I consider imaging, the ability to see into the body now, into the tiniest recesses, and actually even pinpoint radiation into the tiniest recesses using imaging has changed the game.
And I think we’re in the current great tectonic change in medicine which is genomics, diagnosing and treating illnesses using gene theory and gene manipulation, targeting tumors, the drama of a woman maybe deciding to have a mastectomy based on a blood test. These are dramatic things that are happening in medicine and I think we are heading to the next great change, the next great sea change we would say in the navy which would be virtual medicine, the ability to get more and more of your care done in a location away from a hospital, only going to the hospital for when you really need or have an illness or an injury that requires that.
Virtual medicine allows more health. What do I mean by that? We’ve become a nation that sort of has rewarded healthcare in the way we pay our system more than rewarding health. Most of our providers in this country get rewarded or paid by doing sort of more to a patient than less. It’s not bad; it’s just a system that’s not predicated on really keeping the patient healthy. I like to tease and say we should be more like the fifteenth century Chinese who used to pay their physicians while they were healthy and when they got sick, they stopped paying their doctors. So their doctors were vitally concerned with making sure they didn’t get ill.
We’re trying to harness that in our organization and trying to look at new and innovative ways to reward and recognize our providers based on how healthy they keep their populations. It’s not a novel concept because other organizations have been doing it where they have a capitated system where they say to a company give me this much money; I’ll take care of your people. And then the risk is really on the healthcare organization to keep those people healthy because if they don’t, they’re going to lose more money than make it.
So how can you do this? You need a few ingredients. One is you need an electronic medical record. We have that in the military. Two, you need a population that is insured and can come to your hospitals and get your healthcare when they need it. We have that in the military. Three, you need providers that are rewarded for health and not necessarily that interested in patients becoming ill. We have that in our system and I think all physicians, all providers want their patient to be as healthy as possible, but we’re trying to put the emphasis on health instead of healthcare.
If we are not able to push illnesses such as diabetes, certain cancers, heart disease, stroke, lung disease, pulmonary diseases, vascular complications; if we can’t push those out of people’s fifties and sixties, into their seventies, eighties, and nineties, we’re going to be in real trouble. We’re on a non-sustainable path in this country.
So I am an internist by training. I am an internal medicine specialist so I have two great reasons I worry about the trajectory of health in this country. Reason number one is as an internist, people are getting too much overweight, too diabetic, too much heart disease, the smoking, all of those things. So as an internist that bothers me because I know the complications. I am worried as a military leader because I want to have a reservoir of people in this country that can join the military that are not affected by these issues.
We have less people in our country now than we ever have who are able to join the military. We have many who are willing but less who are able simply because of health issues at young ages or fitness issues at young ages, a variety of other reasons as well. But the bottom line is strategically and medically, I need to alter people’s healthcare choices.
Michael Keegan: So, Admiral, the patient centered medical home represents a shift toward a more holistic approach to healthcare delivery and with virtual healthcare it’s a nice segway. Would you tell us more about your efforts to implement this kind of healthcare model in Navy Medicine? I believe it’s called the Medical Home Port Program; how is it revitalizing your primary care system?
Matthew Nathan: This is basically an environment where you can increase the continuity of care of a patient. What I mean by medical home, you feel like you’re at home when you’re there. They know you. If you were to talk to many of our beneficiaries in the military and in medicine over the last several years, many of them would say once I get in to see you, the care is great, but sometimes it’s hard to get in to see you. And secondly, sometimes when I get in to see you, there is a different person there and I have to start all over from square one. And I really would love to have my good old doc or that nurse who knows me since, you know, for four years, and we do too. We want that as well.
Now, we’re a rotational organization. Our people move and rotate and so how do we combat that? So we created patient center medical home which is a pod of providers centered around physician and a nurse practitioner, a physician’s assistant, perhaps an advanced duty corpsman. All of them who know you. One of them is available to you. Where this is working, and we don’t have it everywhere yet but it’s growing. But where it is working, you can reach one of them at all times. In addition, you communicate to them a majority of the time, through either a web-based secure web-based system or through email or through an iPhone or whatever. You don’t have to come in for everything.
One of my favorite things to do as a Surgeon General is to walk around my hospitals around the world and go into a clinic, a primary care clinic, and count the number of patients who are being seen across the desk from each other and then tell the clinic how many of those were unnecessary. There was no reason that that patient had to come in for that visit.
The older patients are comfortable doing that. They like coming in. The older doctors like that, the system we grew up with. The younger patient would just as soon get over their diagnosis and everything else over their iPhone, the same way my daughter can text and talk to me and listen to music and watch TV at the same time. So this is how we have to skate to where the puck is going to be.
Here is where the puck is right now; big institutions, lots of brick and mortar, lots of offices, all of the x-ray equipment, the lab equipment, and everything else in a big building, parking decks, congestion getting in, walking in, waiting in line to be seen. That is where the puck is.
This is where the puck is going to be; it’s going to be where you can use your iPhone to make appointments, to converse with your doctor. You can go down to the local kiosk or store or satellite military clinic that will have lab equipment and maybe rudimentary x-ray equipment near you where you don’t have to drive to a big parking deck, and you’ll be able to take care of ninety percent of what you do.
When you get ill and you need an emergency department, you need a surgeon, you need sophisticated medical care, we’re there for you but on a more concise, smaller, less expensive, less overhead facility. Just as radiology now. You know, there are organizations, there are hospitals that have given up their radiology and do digital radiography and it is read somewhere overseas. In other words, at two in the morning, the radiologists read your film – this doesn’t happen in the navy yet – but the radiologist who reads your film isn’t in the hospital with you. They’re in Australia or Japan because for them, it’s two o’ clock in the afternoon.
Harnessing the power of digital and tele-medicine is critical and I would add pivotal to the United States navy because I need that more than any place else because I have so many medical facilities displaced all over the world. They’re called ships and if I have a doctor on a ship that is in the South China Sea and he has a patient who comes to him and he thinks they’re having a heart attack or a stroke or maybe some debilitating abdominal problem, I want to equip him with things where he can transmit the information back to a place like Bethesda or Portsmouth and I can have a myriad of cardiologists, surgeons, OB/GYN doctors, neurologists, standing around, looking at the images he’s transmitting, looking at the electrocardiogram he’s transmitting, even looking at pictures he’s transmitting of the patient, and calling in information. That way I can provide the firepower, the medical firepower of a tertiary care hospital to a small little ship that is out in the middle of the ocean.
We’ve already experimented with putting CAT scanners on some of our larger ships, small CAT scanners that can do the head so that if someone has a severe concussion at sea, we can tell this captain of the ship right then and there, you know what, you don’t have to turn the ship around. He’s fine. Or captain, you better turn the ship around. This looks a little worrisome. So already we’re leveraging what I would call virtual medicine, tele-medicine. And I believe that a, that’s good for people in austere environments and b, that is going to be the game changer for cost.
Gio Patterson: Making headways on the cost or access to healthcare requires continued leveraging of information management or IT at all levels of care. Would you tell us more about how you are enhancing your use of healthcare informatics and also sharing electronic health data across DOD and VA?
Matthew Nathan: Thanks, Gio. It’s a great and very timely question. As we talked a little bit about before, we’ve had some separate stovepipes in the way each service runs its IMIT departments, both those that communicate the electronic medical record and those that also use digital systems for patient care, pharmacy dispensation systems, those kinds of things.
We’re going to create a defense health agency that will allow us to share all of those services in one place. I have told people before; I don’t really want to be in the IMIT business and have to own that in Navy Medicine. I need it as a service and I need it to be expeditious and available but I am happy to outsource that if I can have it reliably provided to me. The army and the air force feel the same way.
So we’re looking at how we can create one sort of system that integrates all of our care systems together to make one large system and then once we do that, the next question you may want to ask is how do you put that together with the next continuum in military care which is the VA, the VA system? So we’re working very hard with the VA to try to find integrated electronic health records, an IEHR is what it’s called.
So we’re working very hard with that because right now one of the laments of some of our service members is when I go to the VA, they are compassionate, they’re great, the care is great, but they can’t see what happened to me when I was on active duty. I have to bring my paper record with me and they have to flip through a paper record.
Well, I have to tell you, the paper records should be like the dinosaur. It should become extinct at some point and the fact that anybody has to carry around a paper record, I think, is an indictment on the system and of course that is still commonly the way care is given in this country, but I think the VA and the Department of Defense are looking very closely at integrating a health record electronically.
Again, we’re looking at anything that can be done to capture what I believe is the desire of the upcoming generations, to be connected more electronically. I am generalizing a little bit here but my eighty-year-old patient wants to drive forty miles and park in the parking deck and go to the pharmacy and actually see the pharmacist hand them the pills. My twenty-year-old patient would just as soon have it delivered on their door because they hit something on their iPhone. So we’re developing an iPhone app that allows you to fill your pharmacy.
So here you are. You’re somewhere, you’re stuck in traffic. You know your medicine is running out. You go on the iPhone app. It is secure and you all of a sudden punch in something. You get your pharmacy prescription number. It asks you refill? Yes? Where do you want it sent? Home? Yes? You’re done. And that saves money. It removes the middle man. It makes it expeditious and it is one less car that has to be in the parking lot.
Michael Keegan: What does the future hold for Navy Medicine? We will ask Vice Admiral Matthew Nathan, Surgeon General of the US navy, when our conversation continues on The Business of Government Hour.
Welcome back to The Business of Government Hour. I’m Michael Keegan, your host, and our guest today is Vice Admiral Matthew Nathan, Surgeon General of the US navy. Also joining our conversation from IBM is Gio Patterson.
I talk to many of my guests about the use of collaboration and partnerships among agencies, branches of the government, and with the private sector to achieve mission results. How are you at Navy Medicine using partnerships and collaborating, and I think this dovetails with jointness as well, to improve operations and program outcomes?
Matthew Nathan: Clearly the more you can learn from, share, partner, team up, become joint with other marquee organizations, the more you’re going to accelerate the ability to provide care in a professional and in a cost effective way.
We want to leverage this country’s great patriotic desires. We want to leverage this, the academic institutions, the private sector who I have to say everywhere I go, be it any organization I talk to in the private or academic sector, all they want to know is how they can help. They really do. And many of these in the past have sort of been parochial and very protective of their research or protective of their grant money or protective of what they are doing because they don’t want somebody to steal their thunder. But when I come in, they say you know what, for you we want to be totally transparent. If there is something we’re doing which you think can help, please let us know.
They also enjoy the give and the take from the military because we have so many experiences that we can bring to them. It will probably be military based providers along with private sector, but it will probably be a center of gravity of military based providers who will discover the vaccine for malaria. And so again, I think that this kind of rising tide lifts everybody’s boats. We’re very interested in partner, in what we were talking about before, in traumatic brain injury and post-traumatic stress
There are some places who have been doing this in the private and academic sectors for years and years and years and are just outstanding at it. What they haven’t had is exposure to the kinds of injuries that we’re seeing in the military. So they’re desperately interested in getting engaged with us. What kind of injuries do they see? Motor vehicle accidents, gunshot wounds, somebody falling off of a ladder. They have not seen people standing twenty feet away from a massive explosion and receiving that kind of concussive blast.
So that is a whole new kind of head injury that we don’t get in America, we don’t get in the world because people are succumbing to motor vehicle injuries and gunshots and hitting their head at a fraternity party, but they are not being blown up, and so these organizations are vitally interested in seeing our results, our scans, partnering with us, sending some of their people to work in our hospitals and inviting some of our people to work in their hospitals so we can do this.
I am encouraged by the collaboration that is going on. I am not yet satisfied by it. It is still, in my opinion, still in its infancy and it can be much more robust but we are getting there. The fly wheel is starting to turn and I think that those kinds of cooperative agreements along with the jointness where the army and the air force and the navy all throw in together with the VA. Federal medicine, I think, is becoming more joint, more altruistic, and the cooperation we’re seeing with the private sector is significantly better than it’s ever been but it’s not where we need it yet.
Gio Patterson: Admiral, I’d like to transition now to the future. What are some of the major opportunities and challenges that Navy Medicine will encounter in the future and how do you envision your office will need to evolve over the next couple of years to meet those challenges?
Matthew Nathan: Thanks, Gio. It’s a question that I and my team wrestle with every day. Again, getting back to where do we think the puck is going to be so we can skate to it. There is more and more of an expectation because of our track record so far that Mr. and Mrs. America who has a son or a daughter or a brother or a sister or a husband or a wife who is somewhere in the armed services, there is more and more of an expectation that if something happens to them any place in the world, they’ll get the kind of care that if they had had that same thing happen on the steps at Hopkins or the steps at Bethesda. So I am vitally interested in figuring out how to translocate care and using virtual care, using technology, using tele-medicine to bring that expectation to truth.
I think that the other great challenge for us is the socioeconomic challenge of the cost of healthcare and how do we get that under control and at the same time not sacrifice some of the gains we’ve made. And so what I have told my people for the future is we need to do a complete sort of soup to nuts look at all of our infrastructure in Navy Medicine because it is built on – and antiquated is too strong a word – but it’s built on a premise, an existing premise that lots of buildings and brick and mortar is good and I’m not so sure it is anymore. And I think if you look at other marquee private sector healthcare systems, you’ll see more of them and more of them going to really concentrating the gravitas on ambulatory care facilities and virtual medicine, and we need to at least be even with that, if not, I think beyond.
So I have asked my folks to take a hard look at what is tomorrow’s sailor? What is tomorrow’s marine? What is their family going to need? And that is the other big issue; family care. World War I and II, most service members didn’t have families. These days most do. The family is a critical part of the care, not just for taking care of the family but for making sure that the service member feels comfortable and can do their job. So we’re looking at family programs.
I am often asked about – you have pediatricians and OB/GYN doctors in the navy or in the armed services. Do you really need them? I mean, would we lose a war if we didn’t have military pediatricians? Yes, we probably wouldn’t lose a war but my military staff brings something to the game, an understanding of the military family, of the ethos, of the challenges of the military and deployment, as well as, when necessary, we’re doing more and more humanitarian assistance and disaster relief.
And I don’t fault it but I recognize the fact that I can’t grab a civilian pediatrician who is in the middle of a practice and say I need you to be in Haiti in forty-eight hours because the country has just destroyed itself through an earthquake. They’ll say I’ll get there when I can but it may be weeks, whereas my people can be there. When the Haitian earthquake went down, we had the hospital ship Comfort underway within seventy-two hours with a crew that went down there and performed miraculous, miraculous resuscitative and crushing injury surgeries to sort of get things going.
So that is what I am looking at is how can I meet the head-on challenge of virtual care, access, and reward health more than trying to reward the healthcare. Provide the healthcare when necessary, but the goal should be let’s keep our patients healthy.
Michael Keegan: So, Admiral Nathan, what advice would you give someone who is thinking about a career in public service, whether it is military service or medicine?
Matthew Nathan: Well I think anybody who wants to go into medicine or the healthcare professions, be it dentistry or nursing or a corpsman or a medic, you know, already has sort of defined themselves as somebody who wants to make a difference.
When I talk to young people today, and I talk to large groups, they’re, as you can imagine, they’re a little mystified by the military. They think of us in terms of okay, you’re out there with the marines in the deserts, slugging it out in the combat zone or I heard you have a military hospital or maybe you’re on a submarine. Isn’t that kind of weird? And I was that kid years ago. I was on a military scholarship to pay for medical school. I had no plans what so ever to stay in the military one day longer than my obligation, to repay my school loans.
I got in and I realized that the people I was serving with, the people I was working with, were dedicated, altruistic, and I enjoyed the different venues of federal medicine. I enjoyed being sent occasionally to a place like Guam or Japan or Cuba or Europe. I enjoyed the aspect of, you know, when I first had to go with the marines, I didn’t know what to think. I didn’t know anything about the marines except I had watched Jack Web movies. I went there with great trepidation and it was a tour of a lifetime. I learned a respect for a unit of dedication and a group of men and women who personified professionalism and the unit above themselves. And then when I went to sea, great trepidation about that. Then I went to sea and realized what an amazing environment to practice in. What a challenging environment to try to bring great care in and what changes we can make.
And so I would tell any young person today, first of all I think the health professions are a noble occupation and profession because you’re putting service above self. And secondly, if you want to do it in the venue of the federal healthcare system, in my case the military healthcare system, I think you’d be very surprised at the numbers of opportunities and the dynamic range that you can practice in.
As I said, I often talk to my friends who I trained with in the civilian sector many, many years ago who are wonderful family citizens and physicians and have wonderful practices, but I noticed at the end of it Michael, when I talk to them, all they want to do is talk about me. It doesn’t take me long to catch up with what they’ve been doing and I am interested in what they are doing. But what I do has so much variety to it that they know there is a whole thing that has occurred in the year since we’ve talked and so I enjoy that aspect of it.
And so I would commend that to anybody, recognizing that for some people you may come in and do this for a little while and for others you may do it for quite a while. But I think it’s a way to give back. I think it’s a way to put service above self. I think it’s a way to feel, as you could in any profession, I don’t care what it is as long as you have given your all to and done it altruistically, that at the end of the day you have made a difference. That is what I tell young people.
Michael Keegan: Well, sir, I want to thank you for joining us today but more importantly, Gio and I would like to thank you for your dedicated service to the country.
Matthew Nathan: Thank you. Thank you very much, and Michael and Gio, it’s been a pleasure meeting with you.
Gio Patterson: Thank you.
Michael Keegan: This has been The Business of Government Hour, featuring a conversation with Vice Admiral Matthew Nathan, Surgeon General of the US Navy. My co-host from IBM has been Gio Patterson. Be sure to join us next week for another informative, insightful, and in-depth conversation on improving government effectiveness. For The Business of Government Hour, I’m Michael Keegan and thanks for joining us.
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