By Donna Hoffmeyer
(original post on Medium)
“Your program is nothing more than military welfare.”
Those were the words a Reserve Colonel spat at me in a teleconference about 6 months after our office opened. Over the next 7 years, I found out there were many key people within the Air National Guard and Reserve with this sentiment, and they were impacting the service member’s ability to access necessary medical care.
A few other verbal highlights throughout my last assignment in the military:
“If I listened to every mental health provider, I would be sending everyone to an MEB.” (medical evaluation board) (Comments from a medical provider that worked at the reserve medical headquarters (AFRC/SG), during a discussion regarding a service member with psychosis)
“Every time someone goes to an MEB, there goes my tax dollars.” (AFRC/SG medical provider)
“We cannot help everyone.” (continuous rhetoric from Guard and Reserve medical headquarters)
“They’re just milking the system.” “They are so lazy, they don’t deserve to be on full-time orders.” (People within every level of leadership)
“The condition didn’t show permanent worsening.” (Discussion with a medical evaluation board member regarding a suicide attempt of a service member. Apparently, she had to commit suicide to show permanent worsening of the condition.)
“My wife had cancer when I was deployed, and I was able to keep it together.” (Discussion with a Guard Commander regarding a service member’s mental health decline when he could not go home for his grandfather’s funeral…the grandfather that raised him.)
These comments always confounded me. Is it not our goal to ensure we are doing the best for the service members? Are they not the foundation of the service? If they are all broken, then exactly how do we go about completing the mission? If we gum up the administrative processes with unnecessary red tape, then how are we helping anyone?
So let’s talk about confirmation bias. As defined by dictionary.com, confirmation bias “results from the tendency to process and analyze information in such a way that it supports one’s preexisting ideas and convictions.” Granted, we are all shaped by life experiences, which leads us to beliefs that may or may not work for us. We often, without even realizing it, search for information to support that belief, versus looking at the actual supporting information, research, data, and/or statistics. In many instances, it doesn’t matter…believe in whatever you want. Yet, there are other instances where we need to see the big picture, know the data (with the assumption the data is accurate), and utilize it to make critical decisions. If your beliefs directly impact other people, it is imperative to understand confirmation bias and be aware of your own.
When you are unaware, confirmation bias can creep in and significantly impact outcomes. In the military, decisions, and policy become written for the proverbial 0.1% and the other 99.9% are left dealing with the consequences. I’ve witnessed it too many times to count.
What was completely mind-blowing to me, was the amount of bias coming from very educated people working at a headquarters level. It wasn’t just a few people; it was a large number of people.
I worked for the Medical Continuation Program (MEDCON for short…we’re military, we acronym everything). This program directly reported to a branch of the Secretary of the Air Force (SAF) and was made up of clinical case managers and care coordinators. The goal was to either keep or bring back on orders any Air National Guard or Reserve service member that became injured/ill in a duty status. The object was to allow them time to receive treatment and recover or process through a medical evaluation board if required due to the injury/illness severity. Sounds straightforward, right? Wishful thinking…
The amount of bias we dealt with daily significantly impeded our ability to fully serve our members. We received it from medical units, leadership, and other headquarters. The biggest impediment was the service member’s inability to remain on orders to receive medical care. My perception was the less the service member was liked, the harder it was for us to keep them on orders.
Let me give you an example, a particular Guardsman in the military for 8 years total, incurred a significant back injury during his deployment. He comes home and is trying to figure out how to get medical care. The medical unit is not helping him and, by chance, a friend tells him about MEDCON. The service member enters the program and receives care under military medicine. Part of the “rules” are the service member works at his unit but within the parameters of his medical limitations. In this case, he was a maintenance person but instead could only handle administrative duties. This, in turn, caused the rest of the maintenance crew to pick up the workload. From the leadership’s perspective, morale dropped and it was the service member’s fault.
The injury was legit. The service member required a rod in his back and was going to need to go through a medical evaluation board. Simultaneously, his leadership called me to question his legitimacy. Someone saw him at the golf course…not swinging a club…just there. I told his leadership, the correct process was to do an investigation. (He didn’t do it.) He would have come up short anyway, as his doctor wrote him a prescription to do gentle putting motions to help with mobility.
His leadership called again saying someone saw him come out of the shoppette with a case of drinks in a cart. I asked if he was performing activities outside of his medical limitations. He could not answer my question, as he had no idea of his medical limitations.
A third time his leadership called to tell me he had been on orders long enough, and they were taking him off. I explained they had no authority to make that decision. I continued to explain it was a voluntary program and that they were not footing the bill.
After the third call, I asked the service member if he was having any issues in his unit. Come to find out, he was feeling the tension. His leadership took him behind closed doors and told him that MEDCON was a welfare program and that he was not to tell anybody else about the program. (Can’t make this up if I tried.)
That is one of many stories. Each one seemed as unbelievable as the next.
Leadership at various levels, often indiscriminately, places members into a specific “box” — worthy of care versus not worthy of care; fakers versus the real deal; earned their injury or didn’t earn it…I could go on and on here, but you get the point. I’d love to say it was all subconscious, but I am sure I’d be a fibber. All I can ask is, Why? How about just applying the policy consistently? No matter what you think of them, do they meet the criteria based on the information given and according to the policy written? Yes? Great, here you go. No? Okay, let’s make sure nothing is missing.
How about the Reservist, with tons of mental health documentation stating he is not compatible with military service, due to significant mental health issues, that is returned to duty? Want to know the impact? This individual is unable to continue medical care, unable to have any financial support; unable to be medically boarded….just nothing.
Let’s talk about the “go to” service member; the one everyone respected; and many strived to be. When he became severely injured and the administrative processes (which he had zero control over) bogged down the process of his case, he became the target. The harassment he endured from his leadership became so intense his mental health began to decompensate, and the result was the service member punching and busting a table in half. Now he was seen as a disciplinary problem.
Don’t get me wrong, I know there are slackers out there. But dammit, please do not take the actions of one or a few and assume everyone else falls into the same boat! I get the Pareto Principle that 20% of people will take up 80% of your time…however, do not, for a minute, think that 20% represents the majority (and hell, of the 20%, 19% probably just needed better guidance). Seriously folks, shouldn’t we be fostering an environment that should at least be supportive; leaning in to give the benefit of the doubt to the majority of the service members?
If the policy and guidance are applied consistently, the slackers will shine like glow sticks…easy to pick out and deal with. If we throw in our own confirmation bias, and policy is applied like a drunk dude shooting darts in the dark, those same slackers slide right through, and policy is subsequently written to try to stop them.
The impact? The legit ones are often erroneously denied their entitlements. Pretty much the opposite of the goal.
So exactly how is that helping anyone?
Bottom line…it’s not. Countless hours are wasted in useless meetings trying to solve “problems” that don’t exist; units are left short-staffed; service members are denied legitimate entitlements; care cannot be rendered/is limited/or has to be paid out of pocket; injuries do not get better; unnecessary mental health stress occurs just trying to work through the system.
I try my best to end my articles with potential solutions. For this one, I’m not sure I have one. How do you teach people to see their own confirmation bias? How do you get people to buy into the premise that if you take care of your people it will cost less in the long run? How do you get people out of the mindset of thinking they are the personal gate guards to DoD funding?
The service members are not the enemy. They are the foundation. We have to foster an environment where caring for them is truly the priority…not just the face the services put forth to look like they are doing their part.
As Richard Branson stated, “If you take care of your employees, they’ll take care of your business.” It is about time the services address confirmation bias and cultivate a culture of transparently and fully take care of their people.
