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Chapter 1, Part 2

Medical Science Publication No. 4, Volume II

THE ROLE OF THE PROFESSIONAL CONSULTANT*

COLONEL FRANK E. HAGMAN, MC

This discussion will consider the role of military and civilian consultants, primarily from the surgical point of view, from the outbreak of the Korean Campaign until February 1952.

Military Surgical Consultant

The surgical consultant was one of several professional advisors on the staff of the Chief Surgeon, Far East and United Nations Command. During this period successful medical support of the United Nations military mission was the pre-eminent responsibility of the Chief Surgeon. At the same time medical care had to be provided for dependents of military and for numerous civilian personnel.

When hostilities in Korea began and our Armed Forces were committed, there were scarcely enough medical officers in the Far East to provide necessary medical support for our far-flung occupational forces. Fortunately, there were a number of medical officers who had previous experience in war surgery. There was also a group of young Regular Army officers temporarily assigned to the Far East Command from military and civilian residency training programs of the military establishment. These formed the nucleus for the management of battle casualties in the early days of the Korean conflict.

World War II had produced priceless information and experience in the care of the wounded that were applied as quickly as possible. It was a responsibility of the surgical consultant to disseminate by all possible means to all actually engaged in the medical support of our forces these lessons learned from previous experience.

In order for the surgical consultant to be of greater value as advisor, he had to become familiar with the functions of many units throughout the command. This required an inordinate amount of traveling by almost every mode of transportation. Freedom of movement by the consultant throughout the theater is extremely important. He can be of little help if he is anchored to a swivel chair. If his movements are restricted for one reason or another, much of his value is lost. If restrictions are imposed by his superiors because of lack of confidence in him, he should be replaced forthwith.


*Presented 26 April 1954, to the course on Recent Advances in Medicine and Surgery, Army Medical Service Graduate School, Walter Reed Army Medical Center, Washington, D. C.


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The surgical consultant had the opportunity of visiting almost every medical unit as often as physical endurance permitted. From these visits he learned much of considerable benefit toward the aim of maintaining and improving a high standard for surgical practice. Not only could suggestions be made on the spot, but also to others in various echelons along the chain of medical units from the most forward to the rearward fixed hospitals.

The consultant frequently became familiar with many of the problems of commanding officers and surgical staffs concerning such matters as adequacy or inadequacy of personnel, both quantitatively and qualitatively. Much was learned about deficiencies of supplies and equipment. Information was gleaned concerning triage and transportation problems.

During these visits professional rounds were made during which quality of surgical care was noted. This provided opportunity to judge the caliber of medical officers and their background of training and experience. Leadership and teamwork within the organization commonly became manifest. The consultant learned for himself from the staff and from the patients seen by him wherein surgical care, given at another echelon, could be improved. At the earliest opportunity suggestions for improvement were made, in a friendly, not hypercritical manner. Almost invariably doctors were appreciative, accepted the suggestions kindly and altered the management of battle casualties accordingly.

One of the unfortunate facts about military surgery in combat is lack of or inadequacy of follow-up information concerning patients treated by one unit and subsequently transferred elsewhere. In a small measure the consultant provided some of the desired data. Hospitals in Japan were requested to send a copy of the final summary to the hospital which had administered initial surgical care, upon completion of treatment or transfer to the Zone of Interior.

On the basis of these observations, the consultant was in a better position to make recommendations. By various means and through channels open to him, he frequently was able to get supplies and equipment on the way expeditiously. Recommendations were made for augmentation or depletion of staffs and changes in assignment on the basis of these surveys.

Another function of the surgical, as well as of other consultants, was to meet with newly arrived medical officers sent to the Far East Command. Many of these officers were recently commissioned doctors, still somewhat stunned by the quirk of fate which had brought them from their careers in civilian life to a strange land, on orders to participate in a military operation for which they had neither taste nor experience. An attempt was made to greet these men collectively


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and individually with friendliness and interest. Exhausted from a long transoceanic crossing, subjected to the impersonal hoppers of the military mill and almost ground to a pulp, some of these men appeared to appreciate the interest of the consultants. For subsequently when these doctors were seen again in their duty assignments, the consultants were rewarded by a word or two of gratitude from them.

During this first contact the consultants endeavored to brief the newly arrived officers about the Far East and the medical experience prevailing therein. Each doctor with special qualifications in surgery and ancillary specialties was seen by the surgical consultant when possible. Information as to his background and training was obtained and used for recommending assignments. A sincere and realistic attempt was made to place each doctor in an assignment commensurate with his qualifications and in accordance with pressing needs of medical units.

Attention was directed to current concepts in the management of battle casualties and certain recurring errors were emphasized. When possible, medical officers destined for assignment in the combat zone were sent for a short time to hospitals in Japan prior to their departure to Korea. This afforded an opportunity for the doctors to see for themselves the results of managing battle casualties. This firsthand knowledge of what constituted good, bad or indifferent initial treatment gave the doctors a frame of reference, in a relatively short space of time, more effective for their arduous tasks in Korea than mere words. Unfortunately, demands for immediate services of medical officers elsewhere often precluded carrying out this plan. Personnel officers, charged with getting medical officers to fill requisitions and constantly harassed by demands from all echelons, had very little sympathy with this idea of a period of orientation. Sometimes when the consultant thought he had accomplished what he had set out to do, others totally disregarded his recommendations, acted without his knowledge and completely contrary to what was proposed.

To be truly effective in his role of military surgical consultant, especially in a theater of operations, he should possess many qualities difficult to find in a single individual. From brief experience with such a role in the Korean Campaign the author believes the surgical consultant would be fortunate if blessed with these attributes. Professional competency in general surgery is essential. His experience should be broad and he should have more than a passing interest in all of the related surgical specialities. In his role of professional advisor certain aspects of surgery may suffer if he is preoccupied with one narrow field.

Practical knowledge of the Military, including organization, military mission and medico-military relationship, is important. During


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a period of combat he must have had experience with managing battle casualties at all levels, else he is severely handicapped. Since he deals with many people of great intellectual and professional accomplishments, he must possess tact and ability to get along with them to obtain the most effective results. The chronic fault finder would be a miserable candidate for this position. A sympathetic understanding of the problems of the commanders, surgeons and others at all levels for accomplishing the military mission is most desirable.

To be effective the surgical consultant must enjoy the respect and confidence of all concerned or else his recommendations are worthless. He should be a good judge of professional men and their capabilities. Not infrequently, a medical officer appears to be a failure, when part of a staff having personality problems, but does exceedingly well in a different environment. Much can be done by willingness on the part of the consultant to guide and encourage his colleagues. Many have personal problems related to separation from families and difficulties in adjustment to military life. Occasionally something can be done to help, if nothing more than to assume the role of a Father Figure to whom these people can ventilate their troubles.

The surgical consultant must be willing to travel a great deal. There is no substitute for frequent visits to his colleagues. An old-fashioned "bull session" with them is of inestimable value. If a situation is bad he should possess the courage to try to do something constructive about it.

Fortunate is he who can speak and write well. Opportunities for communicating his ideas to others are unlimited and necessary for effective action. Analysis of results obtained, means for improvement and correction of mistakes can be imparted to those usually eager to do their utmost in supporting the military mission.

Civilian Surgical Consultant

The role of the civilian surgical consultant in an overseas theater is somewhat different from that of the military surgical consultant although some overlapping occurs. The civilian surgical consultant has the distinction of being a prominent representative of civilian surgery as well as an emissary of The Surgeon General. His is the role of liaison between civilian and military surgery, a breath of fresh air from home to those serving in faraway places. His reports of new developments are received eagerly.

A surgical consultant visiting a theater of active combat is distinctly handicapped if he has had no prior experience with military surgery. Appraising the results of efforts of those actually engaged in managing battle casualties is more difficult for him. Furthermore, specific


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advice for problems associated with combat casualties can be embarrassing.

The civilian consultant finds his days busily occupied. In the Far East Command there were numerous organizations desirous of benefiting from his visit. In the time allotted for his tour it was impossible to see all medical organizations. The particular interest of the consultant may guide the planning of his itinerary so that installations caring for patients of his field or interest may have more time allotted to them. However, doctors are assigned to units in the field who also are interested in what the consultant has to offer and these men must not be neglected.

The civilian surgical consultant meets with military and professional people of all echelons. His main function is that of teacher. This is accomplished during informal and formal conferences, professional hospital rounds, consultations, etc. In Korea many medical officers were reached through the medical societies in divisions, such as the X corps Medical and Dental Society, the 38th Parallel Medical Society, whose meetings were attended by physicians from all United Nations in the field. The consultant received a warm welcome by an appreciative audience as a respite from the ugly realities of a combat zone. At these as well as other conferences, the consultant finds visual aids, slides, motion pictures or charts valuable in presenting his material.

The consultant is in a position to boost morale of all professional men within the theater. All are interested in seeing him. Professional rounds of patients at any level are always welcome. During these the consultant has the opportunity for bedside teaching and will find patients with medical problems which will tax his ingenuity. The small informal conference or "bull session" in the evening with interested doctors together with the consultant is a very effective and stimulating experience.

After the tour, the consultant makes a report to The Surgeon General concerning his findings, his criticisms and suggestions for change or improvement. It is wise, and a matter appreciated by those closely concerned, that these suggestions or criticisms be made to the responsible individuals on the spot and within the theater. It is disconcerting and unfair to these physicians to have such criticisms come back to the theater via The Surgeon General without anything having been said about them by the consultant while making his tour.

The consultant has the opportunity of teaching doctors native to the country he visits. Japanese and Korean physicians are avid for anything pertaining to current medical practice in the United States. Usually a conference must be arranged sometime in advance of the date set. Language difficulties can be overcome by obtaining a com-


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petent interpreter. At least twice the length of time usually utilized by the consultant for a lecture in English will be necessary because of time consumed in translating. Suitable pauses after a few sentences will be required for translation and may be somewhat frustrating but are very much worth-while.

A tour as civilian consultant is an interesting and stimulating experience and, according to many who have enjoyed the trip, the consultant also learns a great deal.

The surgical consultants we have had the privilege of knowing in the FEC have been prominent in their profession. It was very helpful for them to know something about and to have a sympathetic interest in the military establishment and military medicine. Furthermore, those who contributed the most were interested in teaching and endeavored to encourage military medical effort. While it was expected that they would enjoy photography, sightseeing, collecting curios and art objects, for which ample time usually was provided, these latter should not be their primary interest.

The most successful consultants were helpful and not carping critics. They were willing to spend time with the young medical officers, perhaps of an evening, and discuss medical subjects.

Every attempt was made to minimize discomfort during travel and in the field. The consultant expected some preferential treatment, but the red carpet was not always before him. He was entertained freely and cheerfully, usually by those with a sense of gratitude for his contribution.

Auxiliary Surgical Teams

Auxiliarly surgical teams were first used by the American Army in World War II. Organized, trained and equipped in the United States, they became reserve units overseas. The teams provided a high level of surgical competency and economy and could be sent where they were needed quickly since mobility was one of their chief virtues. Comprising the teams were personnel of high caliber and exceptional qualifications who worked together well, who were adaptable to theater policies and who became integral parts of the staffs of hospitals to which they were temporarily assigned.

There were, of course, no auxiliary surgical teams available when hostilities began in Korea nor were any furnished (as such) for the Army later in the campaign. The U. S. Navy from time to time sent surgical teams from Japan to augment the medical units of the First Marine Division, and eventually two neurosurgical teams could be provided by the Army in support of medical units in Korea. Various groups of medical professional personnel were sent to the Far East Command for specific purposes but not as auxiliary teams as


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we know them. They were sent to perform certain missions such as investigation of problems arising from the management of casualties, study of dysentery among prisoners of war, investigation of cold injuries, study of infectious hepatitis, and the like. But these groups in no way could be considered auxiliary surgical teams. The nearest approach to these teams, developed by the Army, was limited employment of teams from relatively quiet hospitals sent to augment staffs of other units more actively engaged in caring for casualties.