Military Medicine- A medical student's elective with the Defence Forces

St.Bricin's Hospital (formerly King George V Hospital)

My name is Michael Devine and I am a medical student in UCC going into final year this coming autumn of 2015. I have recently undertaken an attachment with the Medical Corps in St Bricin's Military Hospital in Dublin. I undertook this experience as I wished to gain an insight into the responsibilities of an army doctor, and also from having a personal interest in this area. The army personnel who organised my elective were very friendly and completed the setting up of same in a comprehensive manner on my behalf so that I had no difficulty or work in securing the placement.

From shadowing the staff in St Bricin's I became aware that a doctor serving with the Defence forces has three main roles. The first is fulfilling the role of a GP, providing a service to Defence Force personnel in the form of sick parade. These are daily clinics which usually run in the morning and are used to treat patients and monitor any chronic illness. One piece of knowledge I had not learned previous to this attachment is that primary care is provided to Defence Forces personnel free of charge. The second role takes place mostly in the afternoon. This consists of conducting medicals, which can be further subdivided. Medicals are supposed to be carried out yearly on every member of the Defence Forces, however due to a shortage of doctors this is unable to be achieved. The number of doctors needed to carry out this task is 37; further to this number, more would be required to provide sick parade services and those who would be placed on overseas deployment. Medicals also take the guise of renewal of contract medicals. These are conducted as service personnel approach the end of their current contract; which would occur at the end of their first five years of service, the next four after this, the end of the following three years, and the culmination of the next nine years. After twenty one years of service personnel have their contracts renewed circa every two years. An overseas medical is done when personnel wish to be deployed on foreign peace keeping and peace enforcing missions. Medicals are also conducted on recruits and stringent regulations govern the acceptability of applicants. Finally, the third aspect of responsibility to provide care during service as an Irish military doctor is on overseas deployment, where one would be sent out foreign in a capacity so as to treat not only one's own troops, but also the indigenous population as needed and resources allowed. Obviously this is a pivotal and dangerous role, unique to the setting of military medicine and requires a great deal of commitment.

The largest proportion of sick parade was, as one would expect, muscular and orthopaedic problems ranging from strains and sprains to fractures. In regards to a case mix for these, in my limited time I saw many scaphoid fractures, a gastrocnemius tear, a number of sprains, and also a high incidence of sciatica. The scaphoid fractures were interesting from the aspect that one saw the progression of pathology from the acute stage, to those which resolve, and those who don't in the form of chronic debilitating necrotizing fractures. Infectious diseases were also a common presenting complaint with cellulitis and RTIs being common among these. Psychiatric illness was also a topic which featured, from my experience, as a heavy burden on the military doctors; in that due to the sensitive nature of the topic and its associated stigma, the consults themselves would take a far longer duration than a relatively less complex RTI. The psychiatric cases presented in a range from depression and suicidality to addiction. In general, the presenting complaints were wide and varied with one getting exposure to a wide range of general medicine from bursitis to right bundle branch block, hypertension and Crohns' disease. What is interesting from the aspect of military medicine is one has a duty of care to both the patient and to the Defence Forces, as opposed to being entirely an advocate for the patient. This is true for both the sick parade and if pathology happens to comes up during the medicals, then one has a duty to also be an advocate for the Defence Forces in one's reporting and grading of the individual.

There are many regulations governing the fitness of personnel as I have already alluded to, and in correlation with each person's medical outcome a grading is awarded. This results in the determination of eligibility for promotions, renewal of contracts, and the ability of the soldier to go on overseas missions. What amazed me was the tightness with which these gradings are issued, and how such pathology as hypertension or obesity could potentially deem one ineligible for overseas deployment due to the possible outcomes of the illness.

The officers and staff of St Bricin's accommodated me with the utmost hospitality and afforded me lodgings within the officers' barracks. Anyone I met there were sincerely helpful and friendly, in addition to providing an excellent teaching experience.

I would heartily recommend any student thinking of conducting a medical placement with the Medical Corps to act on their interest as you will be undertaking a worthwhile placement that will broaden your horizons and confer great tuition to you. You can also avail of Phoenix Park right next to the hospital or the city centre is only a few minutes away, so you will never be short of things to do in your down time!