The Gap between Medicine, Leadership and Statecraft: The Unexpected Way this Surgeon’s War College Experience Helped Close that Wound

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I entered school expecting to figure out how military medicine fit within national security and left with a deeper understanding of how health diplomacy, in part through military medicine, is an important and perhaps underutilized part of statecraft.

By  Cmdr. David Gwinn, MC, Chief of Department of Orthopaedics and Chairman of Orthopaedic Surgery, Walter Reed National Military Medical Center Associate Professor Uniformed Services University of the Health Sciences

 I departed for War College anticipating broad and deep exposure to the U.S. foreign policy and national security strategy process.

I hoped to learn the intricacies of the national security apparatus, determine how the medical corps fits within that system, and identify ways of using my new found understanding to affect positive change for military medicine.

 For the most part, I did learn these things. Exposure to the workings of the interagency, frameworks for thinking about international relations, and the art of statecraft will all help me in my federal service career, but surprisingly, they were a minor portion of the education I received.

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I can only hope that more physicians and surgeons decide to experience War College for themselves. It was the most enjoyable, interesting and possibly the most valuable year of my military career.

More important were the lessons I learned from my classmates, faculty, and guest lecturers about leadership, the insights I gained from significant and methodical self-reflection, and the relationships that I fostered throughout the experience.

 As physicians, we are often immersed in a decade long culture of education, subservience, and intense mental and physical trials as we work our way to independent practice. Medical school, internship, residency and fellowship leave little time for self-reflection, family or even engagement in current events. Our exposure to leadership is largely limited to the interaction we have with a few staff members during our training rotations. There are few opportunities for leadership experience that allow the trial and error cycle of developing one’s own leadership abilities.

War College was analogous to a medical student’s dream of the perfect set of notes for leadership. Every member in my class had significantly more leadership experience than me, many of them having commanded Marine battalions, air wings and armored divisions in combat. After the initial ice was broken, most were more than willing to share both their successes and failures.

The constant stream of high-level U.S. policy shapers that interacted with our class offered insight into the thought that went in to major strategic decisions.

 The constant stream of high-level U.S. policy shapers that interacted with our class offered insight into the thought that went in to major strategic decisions. The non-attribution policy during these sessions allowed discussion of some of their mistakes in both strategic thought and leadership. It didn’t hurt that some of the venues for these interactions included Wall Street, Miami, Beijing and Hanoi.

Perhaps more than anything, the pure analysis of leadership, through the relationships, the lectures, and the required reading–and discussion with experienced leaders in class–was most eye-opening. It made me feel as though I had slept through a very important semester of classes at medical school and was now getting the opportunity to catch up. I certainly feel more prepared to take on future leadership responsibilities because of the experience.

 There are many important aspects of leadership that I learned, but ironically none was more important than the critical role of self-reflection. With my head firmly explanted from a medical book or patient chart I was actually able to partake in this important process. I have become a more thoughtful and less self-serving person because of it. Identifying and confronting my weaknesses and emotions has made me a stronger and more emotionally stable person. This was a common realization in many of my classmates, and I now recognize that the stoic armor we wear as doctors is endemic in the national defense industry because of the lives depending on our decisions.

I can only hope that more physicians and surgeons decide to experience War College for themselves. It was the most enjoyable, interesting and possibly the most valuable year of my military career.

 Most importantly, self-reflection has taught me the important leadership art of listening to and considering the opinions and perspective of other people even if initially turned off by them. I’ve been more open to considering the thoughts of both colleagues and trainees and willing to reflect upon the utility of their points of view because I’m more willing to question my own. My interactions with patients have improved for the same reason and I’ve become a more empathetic physician.

 Certainly, the scope of my experiences at War College was more expansive than these “soft” lessons that I took with me. Paradoxically, I entered school expecting to figure out how military medicine fit within national security and left with a deeper understanding of how health diplomacy, in part through military medicine, is an important and perhaps underutilized part of statecraft. It stands to reason that the capability and willingness to save life may be more internationally influential and enduring than the threat of violence.

 I saw many raised eyebrows from my orthopaedic surgery colleagues as I embarked on War College. Many wondered out loud that I was wasting a year of valuable medical experience in an endeavor that could not be applicable to my practice as a doctor. They were wrong in so many ways. I can only hope that more physicians and surgeons decide to experience War College for themselves. It was the most enjoyable, interesting and possibly the most valuable year of my military career. Military medicine and many physicians would benefit from the broader perspective gained and the opportunity for self-improvement.