Podpułkownik doktor medycyny Konstanty Świder (1908–1965), zasłużony psychiatra Polskich Sił Zbrojnych na Zachodzie

This is the first of three papers published in this issue of the Lekarz Wojskowy (Military Physician) magazine dedicated to an outstanding military physician, Lt. Col. Konstanty Świder MD, PhD, forgotten in Poland. The paper presents his lineage, school years and studies, at the Physician Department of the Warsaw University and at the Medical Cadets School in Warsaw. The beginning of Świder’s career as a professional military physician in Poland, his fate after the outbreak of the WWII in September 1939 – time he spent in Soviet captivity, his military service in the Anders’ Army in the Soviet Union, in the Middle East, and during the Italian Campaign, and his contribution to building a psychiatric support system for soldiers of the Polish Armed Forces in the West are described. The last part of the paper describes the course of Dr. Konstanty Świder’s professional stabilization as an immigrant in the USA and his activity in the Polish diaspora in Chicago up to his premature death in 1965. Moreover, examples of Dr. Świder’s literary work and information on the status and professional activity of his children in the USA are presented.

Medical Student Experiences in Operation Bushmaster 2019: “I Now See Myself as Equal Parts Physician and Leader.”

ABSTRACT Introduction Operation Bushmaster, a 5-day high-fidelity medical practicum bringing together fourth-year medical students, graduate nursing students, international students, and physicians and other medical professionals in emergency and operational medicine from across the world, is the capstone event of the Uniformed Services University of the Health Sciences’s Military Unique Curriculum. It is designed to simultaneously test students’ medical knowledge, leadership skills, and grace under fire. For many students, this experience represents one of the first times that they concurrently inhabit the dual roles of military officer and (soon-to-be) physician. This is likely the most “tactical” and stressful military simulation that many students have experienced. Methods In this qualitative study, we analyzed a data set of 49 de-identified reflective articles written by fourth-year medical students following the completion of Bushmaster, in order to understand what students gained from the experience. Additionally, we evaluated students’ responses through the lens of the threshold concept, looking for ontological shifts, integration, discursiveness, and troublesomeness during students’ Bushmaster experiences. Results We identified 10 themes throughout the essays that highlighted the lessons learned during the Bushmaster experience, including its importance in guiding professional identity formation and students’ deepened understanding of the unique responsibilities and pressures of the role of military physician. Conclusion One of the resulting themes, “the military physician,” met our criteria for a threshold concept, in that it was transformative, integrative, and troublesome. Before Bushmaster, many of the students saw themselves simply as medical students rather than as almost doctors. Following the field practicum, some identified more strongly with the role of military physician, while others continued to overestimate the amount of time remaining to complete the transformation from student to doctor or to integrate the roles of physician and military officer. Moreover, we identified the entirety of Bushmaster as a threshold experience. This work serves to further describe the liminal space in which military medical students reside on their journey to physician, as well as the moment of realization by many that becoming a military physician encompasses more than simply the sum of the roles of physician and military officer.

History Page: Leaders in MSK Radiology

Military physician Etienne Henrard has played an important role in both civil and military radiology. He was adjunct at the radiological department, created in 1897, in the military hospital in Brussels. In 1900, he equipped one of the first private cabinets in Brussels. He was especially interested in bone radiology, stereo-radiography and the localization of foreign bodies for which he invented, during the “Great War,” a device for their extraction. In 1905, he was one of the founding members of the Belgian Radiological Society where he also held many functions. In 1931, he was promoted to the rank of Physician-General.

Swimming-Induced Pulmonary Edema in an Active-Duty Female Triathlete

Swimming-induced pulmonary edema (SIPE) is a noncardiogenic form of acute pulmonary edema infrequently described in the general military literature. Its pathophysiology is poorly understood. Treatment is supportive. Knowledge of SIPE is important for the military physician and should remain a top differential for any patient presenting with acute pulmonary edema following a water sport. This is the case of a patient with SIPE occurring during the swim portion of a Half Ironman Triathlon.

“With colleagues like that, who needs enemies?”:Doctors and Repression under Military and Post-Authoritarian Brazil

As young medical students at Guanabara State University, Luiz Roberto Tenório and Ricardo Agnese Fayad received some of the best medical education offered in 1960s Brazil. For six years, the peers in the same entering class had studied the principles of the healing arts and practiced their application at the university's teaching hospital. They had also witnessed the Brazilian military oust a democratically elected president and install a dictatorship that ruled the country for 21 years (1964–85). After graduating, however, Tenório and Fayad embarked on very distinct paths. The former became a political dissident in opposition to the military regime and provided medical assistance to members of the armed left. The latter joined the armed forces and, as a military physician, participated in the brutal torture and cruel treatment of political prisoners. At the end of military rule, Brazil's medical board would find him guilty of violating the Brazilian code of medical ethics and revoke his license.

Phantom menace: novel psychoactive substances and the UK Armed Forces

Novel psychoactive substances (NPS) encompass a large group of synthesised compounds specifically designed to mimic traditional recreational drugs. Current UK Armed Forces compulsory drug testing does not screen for these substances, making them tempting to the small proportion of UK Armed Forces personnel who indulge in recreational drug use. The acute and chronic sequelae of NPS misuse are widely variable and associated with high morbidity. In this paper, we discuss NPS pharmacology and clinical presentation. We describe toxidromes and management of patients who have misused NPS.Finally, we reflect on the legal, ethical and military consequences of NPS misuse for both the service person misusing NPS and the Military Physician providing their care.

Deployed military general internal physician’s toolkit: the recent past and near future

IntroductionThe role of the military physician in Deployed Hospital Care involves the diagnosis and management of a wide variety of disease states. Broad clinical skills need to be complemented by judicious use of a limited array of investigations. No study has specifically quantified what investigations physicians use on operations.MethodsA retrospective cross-sectional study was performed to ascertain what investigations were undertaken on all patients managed by the General Internal Medicine teams over a 14 month period during a recent enduring operation in Afghanistan. A record was also made of investigations that were unavailable but considered desirable by the treating physician in order to inform clinical or occupational decisions.Results676 patients were admitted during the study period. Blood tests were performed in 96% of patients, plain radiographs in 50%, CT in 12% and ultrasound in 12%. An ECG was performed in over half (57%) and a peak flow in 11%. The most desirable, but unavailable, investigations were cardiac monitoring and echocardiography (24% and 12% of patients, respectively).DiscussionThe data produced by this study both identified and quantified the investigations used by physicians during a mature operational deployment. This can be used in addition to accurate medical intelligence to inform and rationalise the diagnostic requirements for future operations as well as the provision of training. Technological advancements, particularly in weight and portability, are likely to enable more complex investigational modalities to be performed further forward on military deployments.