Military Communication and Lingo

In this episode of Front Line Surgery: Mastering Military Trauma Care, hosts Drs. Joshua Dilday and Matt Eckert engage with COL Jennifer Gurney, MD, to explore the critical role of military communication and lingo in trauma care. The conversation dives into the operational challenges surgeons face when translating medical realities into terms commanders can act upon. COL Gurney shares insights from her multiple deployments on learning to “speak two languages”—medical and operational—and how credibility, clarity, and humility are vital for bridging the gap between surgical expertise and command decision-making. 

Keywords: Military communication, operational lingo, trauma surgery leadership, combat casualty care, bridging medical and operational language, credibility in military medicine, risk communication, surgeon preparation, military command relationships, surgical mentorship

Literature:
Front Line Surgery: A Practical Approach

Transcript

SPEAKER_00 0:01

The reason Surgeon has that title is because you understand the entire system of care and has that prestige. We've earned the right to be called surgeons because we are surgeons.

SPEAKER_02 0:16

Enter the world of military trauma surgery with frontline surgery, where we bring you expert insights and real-world scenarios to help surgeons stay ready.

SPEAKER_01 0:25

Brought to you by the AST Military Committee. Join us as we engage in conversations with field experts, examine critical battlefield scenarios, and uncover the strategies that keep surgeons ready for anything.

SPEAKER_02 0:37

Stay prepared and stay sharp with Frontline Surgery, where every episode provides key insights into mastering military trauma care. Welcome again to Frontline Surgery, Mastering Military Trauma Care. I'm Joshua Dilday. I'm joined by my wonderful co-moderator, Matt Eckert. And Dr. Eckert, I think this is the episode I've been most excited about this entire season. What do you think?

SPEAKER_01 1:03

I agree. I think this is something that if you've been around military medicine for a while, this is this is the topic that probably keeps you awake and keeps you thinking about your, you know, what you're doing with your life and the decisions you've made after your deployments and before your deployments. And so I think it's great that we've got Colonel Gurney here to talk through her comments today with us. And I know it's going to be insightful.

SPEAKER_02 1:25

Absolutely. And again, this series focuses on helping those early career military surgeons to bridge that gap between clinical excellence and operational effectiveness in deployed environments. But today's episode is special because it tackles a skill that can really make or break your deployment experience. And what that is, is learning how to speak the medical lingo to military commanders. And we are joined by repeat guest and an expert in this field, Colonel Jennifer Gurney. She's she's lived this experience, she does this experience. This is a passion of hers, and this should be a passion of all of ours. She's had multiple deployments advocating for joint trauma collaboration, integration on a global scale, and how to get this medical necessary language to where it really belongs, not siloed in academia, but to the front lines and with the decision makers on the military command elements. Colonel Gurney, thank you one for being a repeat guest, for being the episode and one that Dr. Eckert and I are most excited to record and for joining us today.

SPEAKER_00 2:25

Yeah, thanks, Joshua, and thanks, Matt. It's so great to see you guys. But you know, you are really giving me way too much credit. It was like six deployments before I even realized that we had to communicate to commanders. So I really, I mean, I didn't learn this until my last few deployments. So, like this is a skill, or not even a skill, it's a requirement that we don't even know we have because my goodness, we train for over a decade to become surgeons, right? We train for a long time. We're very focused on our job, we're very focused on our clinical experience. And it takes a while. And so if you're a young guy out there, uh, you know, know that you work for operational commanders. The military military medicine does not have the same boss as civilian medicine. But we think, you know, we're just focused on the clinical stuff. But it this took me a long time to realize, and I'm still not sure that I have have it figured out. But we have to be able to speak two languages. We have to speak medical and we have to speak operational, because in the end, if they don't understand our value, if they don't understand our capabilities or lack of capabilities, then they, the people we work for, are assuming risk, either unnecessary risk, and we're putting our casualties and our patients' lives at risk. So, so anyway, I just uh, you know, thank you for the awesome, really nice, exaggerated, very nice introduction. I wish I was anywhere like half as good as what you said. I've had to learn this through, you know, and Matt, I'd be curious about your thing because you were in a lot, you know, you were in units where this was kind of emphasized much earlier than the conventional units that I've, you know, deployed with, you know, many times. And I just, we don't learn this. Nobody tells us this, like, hey guys, you got to be able to speak the language of commanders. And oh, by the way, if you think that they're gonna speak to you in your language, forget about it. Like they don't have time, they're too busy. You know, ultimately we work for them. And if we don't figure that out, and I've seen some brilliant physicians, you know, talk about things and you see them talk to a line commander, and the line commander looks and like, who the heck is this? And what are they saying? They don't understand us. And so, you know, we just have to recognize that's the space we're navigating because we're not just doctors, we're military officers. And it's funny, I can't believe like 10 years ago, if someone said I would say that line, I'd be like, I'd never say that line. But we are, and we have to be able to communicate that language to be effective. And why do we care about being effective? Because we want to save lives, because that's our job, and we want to return people to the fight, and we want to do really good jobs.

SPEAKER_01 4:52

Well, Dr. We're gonna frame the rest of our conversation around a an operational clinical operational scenario. So just to sort of set things, set the stage for us here. It's day 10 of a high opt tempo deployment at your role two facility. You're supporting active combat operations, and overnight your team handled a mass casualty event from a complex attack. It's the next morning, your summit of the commander's tent, and they're gonna update and brief a plan on medical readiness as well as your ability to sustain care for the next operational push. Your unit's resources are depleted. You've had significant medical concerns arise since then about the overall mission that they're planning. And you're the only surgeon. You're they're one of one, and surrounded by line officers and operational officers speaking their own language about troop movements and logistics and timelines, and you're feeling that sinking sensation of speaking truth to power.

SPEAKER_02 5:43

I mean, Colonel Gurney, in that moment, what are the key things you need to communicate to ensure that that commander understands what you want them to command medical capacity, the risks, the needs, without getting lost in the medical jargon that we spend every day discussing and is so innate into our vocabulary.

SPEAKER_00 6:00

Yeah. Well, the scenario you painted isn't like not a good scenario, but it is a realistic scenario. And I think for the future, that could be a realistic scenario. I just want to say one thing that after the mass count ended, after you looked at what your equipment was and mopped the ORs and checked your blood cooler and everything else, you got to sit down with your team and do an AAR. Have to do it. No matter how tired you are, no matter how much you don't want to do it, you've got to kind of talk about what went right, what went wrong, and what you need to do better. And it's also a chance to reset and it's a chance to also check on your team. So that's one thing. So the next day, now you have at least an idea. You're going to the talk to the commander, and that's hard. And ma'am, we don't train to do that. Um, and if we don't have experience doing that, I think it's one of those things. First you've got to dig deep and be honest. And you have to talk. Now, commanders are are really smart about the military, but they're not, you know, they don't they didn't train medical stuff. So you've got to talk at like a like a level that they'll understand, which means don't use medical jargon. Talk like, you know, talk in terms of risk of of of what their units will, you know, incur if you don't have, okay, I don't have blood. I can't operate on anybody. They will die without blood. Like I actually think we're making some headway with the blood conversation. In that situation, I would write some stuff down. I would write down what I thought the risks were, and I would be honest. And you know what? You don't, people don't want to be honest because we're afraid it makes us look bad. But if we don't have supplies, if our team isn't ready, if we don't have blood, if we don't have class eight, if we don't have evacuation capability, if we haven't been able to move, let's say we had 10 host nationals from the day before, and they're taking up the beds and we haven't been able to move them, you've got to articulate that risk. We're not mission capable. Now, here's the thing they can decide that they still want to do the mission. That's their risk to take. That is 100% their risk to take. And you don't get to say yes or no. You just say, okay, I'm gonna do my job. But like you need to be sure that you've conveyed to them what risk they're incurring if they're doing something without a medical capability. You know, I don't I don't really know if that was the best answer because I can't say exactly what you'd say, but you have to be honest. You have to speak in a language that they're that they understand. And also, what I've noticed a lot, we all do this. I'm actually doing it now. You're asking a question and I'm not necessarily answering it directly. When they ask you a question, answer the question. You don't talk about all the other things, answer the question. So I'm giving the example of how not to do it, I guess. But I think that's also, you know, especially because we start talking about medical stuff, right? They ask a question and you start going and they're like, no, this is what I ask you. Are you ready, or do what do you have, or how many patients can you take care of? Because if they say, okay, how many patients can you take care of, you know, the truth is it depends. You can maybe operate on 10 or you can operate on two, depending on the severity of the operation. But they don't need to know all those details, but you need to be able to articulate that risk simply and give them a number that they can then put into their calculation to make a decision. Matt, what do you think? I'd I actually want to hear, I'm gonna put Eckert on the spot.

SPEAKER_02 8:56

Absolutely.

SPEAKER_00 8:57

But Matt, what what do what do you think? I mean, this this is really hard. And I don't think we're necessarily good at and oh, by the way, we don't train on this as medical providers, right? We get no training on this.

SPEAKER_01 9:09

Yeah, I I think those points are all very salient. I think as you you grow in experience and confidence, you know, as you frame these conversations with operational planners and leaders. I think early on I had no idea what their considerations were, and I was just frustrated by their seeming lack of ability to listen to me. Um, and I think it's, you know, there is an onus on us as physicians to learn their language for sure, to understand what their priorities are. Um, and then understanding that, you know, the planners and the kind of staffers uh they have a mission, and they're that mission is to make the mission successful. They're gonna plan to success for whatever that is from their perspective. Uh and then that, as you mentioned, so importantly, the commander is the risk taker. They're the ones who make the decision and they can choose to make that decision and embrace that risk and they own it. But commanders understand risk, and I think when you, as a surgeon or physician, can receive what their concerns and priorities are, process it, and then present it as how can I help you achieve your mission while framing the risk to those decision makers. That was that was a process of evolution for me and something that I think takes time for for you know young medical officers to learn. And they need to see it. As you mentioned before in another podcast, they need the mentorship from prior experienced medical officers to help frame that conversation, how to embrace that situation. Because you're right, no one teaches you how to do this ahead of time, unfortunately.

SPEAKER_00 10:38

If they're like talking to a command surgeon, the commanders actually think that these guys are surgeons. So if they're so command surgeons could be a uh, you know, physical therapist, a nurse, or or a pediatrician, and and the commanders think that they're surgeons. And so that's the other thing is not being incredibly offensive when you say, look, you like, you know, the reason surgeon has that title is because you understand the entire system of care. It has that prestige, and and and and we earned that, honestly. And I'm not saying that like we've earned the right to be called surgeons because we are surgeons, but these command surgeons will go and many times say, Yeah, we got this. Man, I I've heard many of them say, We got this, we got this, to the point of like, we got the golden 24. Forget about this golden hour. We can keep someone alive for 24 hours. When it's a psychiatrist saying that, but they're telling a commander that, they don't even realize how much risk they're giving to the commander. So I think saying that and also knowing you have to know these commanders' mindsets that they think that any surgeon is necessarily a surgeon and they're hearing advice from different things and establishing credibility. Matt, what would you say? Like, how do we establish credibility? Because I think that's the other thing. Because we're communicating to commanders who are hearing things from surgeons who are not surgeons, and but they that they've worked with them in their staff jobs for a long time. So they've established credibility. What do we do? And I don't, besides being honest and being good at your job and being a good communicator, what do we do to establish credibility to be able to, when we say, look, there's risk with this that they'll, you know, really listen?

SPEAKER_01 12:14

I think that's hard. I think that's um speaking to the soft skills that we mentioned in a different podcast with Jason Bingham, I think there is definitely a difference in this approach between the the folks that are in the special operations world where you have a probably a much, a much closer relationship with a lot of those planners and staffers that are influencing the the commander's decisions. I think the conventional folks are really, I think, are are at a much more disadvantage because they have less access, I feel like, in my experience, uh, to those folks. And uh, I think it really the onus is on the surgeon, unfortunately. I think it's an unfair uh mis uh imbalance of that relationship, but you're gonna have to seek them out and build that relationship probably with that command surgeon or you know, whatever medical officer is gonna be interacting the most with the commander in order to build influence and make them understand the clinical insight that you have that they probably lack. And I don't think there's an easy answer for it, unfortunately. I really don't, because the commanders have so many other things on their plate and so many other people they have to interface with that they just don't have the time to come down, unfortunately, to your level. And as a surgeon, that that that that that's a that's a bit of a dagger in our ego, but uh they just don't. And I think it, you know, you're more likely to influence the people that are gonna are gonna interface with those commanders uh than you are the commanders themselves for the most important.

SPEAKER_00 13:39

And I think it's important to have a good relationship with those guys. Sometimes they can be a bit frustrating because they don't have the medical knowledge and they might not be communicating the medical or surgical or combat casualty risk as much. But you know, having a good relationship with them. And then one other thing I think it's important for us to say when we're in those environments, and you can't say it all the time, but every once in a while you gotta say, I don't know. I don't know the answer to this. Like, you know, and we are reluctant for many reasons to say, I don't know. And and I and so you can't say that all the time, but when you really don't know something and it's too much to make an assumption, I think you just say, like, I don't know, but I'm gonna going to find out the answer to that.

SPEAKER_01 14:20

Yeah, absolutely. That humility helps.

SPEAKER_02 14:22

And that's been a topic. This humility has come up throughout the course of of this season. And both of you mentioned and had this conversation about building credibility. And there's a topic that I want to go back to of the language. And both of you, you know, I I think Dr. Ecker, you're you're no longer a moderator. I think you're an expert panelist here now on this topic. So both of you have mentioned this speaking the language, but what specifically does that mean? I mean, do I just watch Band of Brothers over and over and try to repeat all the lingo? And I'm saying that tongue in cheek, obviously, because I I think I know what you mean, but I think there's been this disconnect because that takes effort. That one aspect is saying you're a surgeon, you need to know surgical elements. And now all of a sudden you're you're you're speaking to do I really need to have that offership officership front and center to be able not just for the credibility and the persona within my team, but even to affect change. How do I, excuse me, how do I learn to speak that language that you're speaking that you're talking about?

SPEAKER_01 15:17

And I'll let you give your how you approach that first.

SPEAKER_00 15:19

I mean I don't know, so I don't know if I know the language. You know, I didn't go to all the schools that everybody goes to. I mean, I my well, I don't think we should be doing on-the-job training for surgical skills and surgical team skills. I do think you can learn a lot on the job just by listening to how to speak their language. Listen first. Listen first, listen to what the concerns are, listen to the way they talk, listen to the words they use and don't use. You know, as surgeons, we're kind of professional students. But so when people say, why don't you go to all the military schools? It's like, well, if I can't learn this and, you know, years and years deployed, then, you know, but listen first. Don't use medical jargon. Just don't use the stuff that we the way we talk to each other when we're talking about cases or patients. Don't try and sound smart. Listen first, understand the question that they're asking and be honest. And you know what? You're not going to get it right the whole time. And then you reflect, you know, and uh, and then and then try and do it again. If you get marginalized because you've lost your credibility, you're probably not getting it back. So the biggest thing is probably don't lose your credibility, which goes to don't like a lot of times to make a point, we might like exaggerate something or kind of emphasize risk where there might not be risk. You do that too much, you're gonna lose your credibility too. So I think that that's just this, and this, I think this stuff is hard. It might be very easy for some people to be able to communicate effectively outside of our tribe. And our tribe is we're surgeons, right? Effective communication will lead to effective execution of your mission. And for our mission, it's being able to get resources to do our medical mission right, to be able to ensure that we're appropriately ready. And we still have a ways to go, to be honest with some of those things. But anyway, that's a roundabout way of answering that because Matt uh turfed that to me first. So here in turn, Eckert.

SPEAKER_02 17:06

Yeah, Dr. Eckert, how how'd you learn to speak the language? And you're in a different environment. Is that a different language? Is it all the same? How'd you how'd you do it?

SPEAKER_01 17:13

Uh it it is definitely a different environment. And it is not a um, there's no one course or one book or one paper you can read, unfortunately, to prepare you for that. I do think um it it's a little unfair. I mean, obviously, as physicians, you have a lot to keep up on. You have all your clinical stuff, your best evidence, everything else that you're responsible for. Um, but you're gonna have to put in the time and effort to do a little bit of self-study. And I think that goes a long way. Um, you know, there's there's plenty of this is not classified stuff. You can open up any any army regulation and all the stuff that's online you can find anywhere. And that can be challenging and frustrating to read those types of things as sources, but I still think one of the best things is to do is is to try to go to planning meetings and to sit and listen. As uh Dr. Kearney mentioned, just listening, uh taking a notebook, writing down the things you don't know, and then finding that e-collaborator to ask questions about afterwards can be really helpful. Um, you know, when you when you do start deploying, uh, if the gets available to you to go to planning meetings and briefings and you know the commander's updates and those types of things, there are more things to do. They disrupt your you know, happy schedule when you might want to be sleeping or going to the gym or something, but uh, it really does provide insight. And if you show up and you're not disruptive and you maintain that credibility, you gain more credibility. And people start to ask your opinion. And that's the time when I think you can really be a contributor and not just somebody else on the bus. And um, it's it's a challenge and it takes time and it's not something the doctors inherently want to do. But I I think reading the con ops, listening to the planning meetings and understanding that this is a different world and as a civilian now, it's the equivalent of me as the surgeon going into the hospital budget meeting and thinking I should have gotten an MBA before I showed up here. Um recognizing with that humility that I've got a lot to learn and I'm just gonna, you know, keep my head down, keep my mouth shut, learn as much as I can and make friends and allies and try to contribute.

SPEAKER_00 19:21

And Matt, I'm glad I'm glad you said that because like, you know, I I do think we can learn that stuff, but you do have to enter it with humility. I've learned so much from planners. You listen to the way planners talk, it is like a completely different language for us. And we have to pay attention and listen. And I think we can learn. I think reading about leadership and reading about communication, all that stuff. And I know I said, you know, before, like we're surgeons, we're professional students, we are. We can pick this stuff up, but we've got to go into it with an open mind and humility and knowing that, you know, these guys, whether it's planners or logisticians, you know, all these guys, we can learn a lot from the way they speak, and that will make us much more effective trying to communicate stuff about, you know, casualty care uh or whatever, surgical team planning or whatever. So yeah, thanks for you know emphasizing that.

SPEAKER_02 20:08

Yeah, and it and it seems like uh a topic both of you hitched it was proximity. You have to be there, whether credibility to learn, learn by exposure. But Colonel Green, you mentioned that in the non-special operations community, being a part of those meetings before deployment may be really difficult. And yet this podcast is really designed for that early career surgeon before their first or second deployments. And you've already mentioned that it's gonna be hard for them to get that relationship or proximity with leaders or let alone their team before their boots on ground. Yeah. What do they do now? What can I do to learn how to speak the language on my next deployment or for those other listeners learning without being in the special operations community?

SPEAKER_00 20:47

Well, I mean, then I'd say, you know, going to some of those military schools, like, you know, ILE or those things, it's probably you get exposure to that. I've never done that. So I'm but I'm assuming that you would get exposure that you'd kind of meet a when you enter so the for the first or second deployment, you know, when you enter that, going to, like Matt said, the bubs, the cubs, the battle update briefs, the commander's update briefs, and just listening. Just listening. And, you know, you will realize very quickly that you're out of your element. And then you just assimilate that information, ask questions when you, you know, not in the group afterwards to try and like learn things, and you'll just continuously get better at it. We've got a lot to learn as surgeons, you know, like, and we're constantly having to learn how to do our surgical job, you know, and get better, especially when you fit first finish. You should be focused on everything, being the best surgeon, the best clinician possible, trying to like understand the whole operational environment. It is an additional education. It took me years to understand the importance of it. And probably that's the difference between the conventional and special operations worlds, too. You know, Matt probably got much more immersed into that earlier, being part of the special operations community. And um, but going into it with an open mind, humility, and you know, we we can learn this. We can. And I would say we have to learn this to be effective. Um, and and if we want to be so we can be incredibly effective surgeons and we can save lives in the operating room and we can save lives with our team and we can make our whole team better. But if you want to be effective at like the system level, which is important to be effective, you know, when you look at especially for the risk of Lisco, then you have to know how to communicate and you have to know how to communicate their language and be willing to get better, be willing to mess up, and then be willing to continue like work hard to get better. It really makes us unique as military surgeons. Now, civilian surgeons have to do this in the boardroom and you know, in the financial world. Like they're, you know, it's not totally like being able to communicate outside of just your surgical specialty is not unique to military surgeons, but it's essential on the battlefield. And I'm glad you guys are doing this. I hope we get some feedback from the podcast too, and you know, have a chance to learn more and relay messages that other people have learned about effective communication in these environments because it's part of the whole picture to help us get better at saving lives.

SPEAKER_02 23:02

Well, it sounds like this is a necessity. It sounds like if the hard skills can save a couple of lives, this will this will save thousands. And you're hitting on the point that this is a necessity. We can learn it, we must learn it, especially in the changing geopolitical climate, what's coming down the line. So I think myself as well as the listeners will take this to heart and really focus on what it takes to speak this medical necessary knowledge to the point to where it matters matters the most at the front line, at frontline surgery, which is exactly what this podcast is named after. So, Dr. Eckert, I I can't think of a better way to end season one than this episode with with Colonel Gurney. Yeah, I completely agree.

SPEAKER_01 23:37

And Jen, your insight is uh is tremendously beneficial with your cumulative experience. There's nobody on active duty right now that has your experience, you know, at the kind of enterprise and then the clinical level. That's that is unique. And uh as Josh said before, you know, if we can't record these things and share them, then we're gonna lose them because Gurney can't stay on active duty forever. Thanks again for joining us. Uh, thanks, Dr. Gurney, for joining us and sharing your time here on frontline surgery, mastering military trauma care. Communicating effectively with commanders isn't just about speaking clearly, it's about ensuring your surgical team can operate at peak readiness and that medical realities are factored into the fight to accomplish the mission and save lives. We hope today's episode helps you prepare not just as a surgeon, but as a trusted advisor to the operational commanders and leadership. Until next time, stay sharp, stay ready. Thank you for tuning into this episode of Frontline Surgery. We hope today's discussion has provided valuable insights into military trauma care.

SPEAKER_02 24:36

Be sure to join us next time for more expert perspectives and battlefield ready knowledge. Until then, stay ready.