The single scariest moment in my medical career was not as a student, or a resident with the first dying trauma patient in front of me. Nor was it in Iraq on November 2, 2003, when two Chinooks were shot down and my ER was overwhelmed with trauma after trauma. It was the very first day as an attending in the ER. Up until then, in every single case in front of me, I had backups in the form of senior residents or attendings. That first day as an attending, the buck stopped with me.
On that first day, my first patient was a coding MI, a middle-aged obese male. I had hoped for a cold or a hangnail. Instead, the entire world was looking at me for the answers to bring that man back to life, including his screaming wife. I recently reflected on that moment and the most devastating of days I had in Iraq. I reflected on those days listening to the hearings of the stalled nomination process of Surgeon General nominee Casey Means, MD.
Clinical experience versus public health policy
She has never seen a patient unsupervised. She has had no public health training, which was quite evident when she confused public health policy with personal health decisions made with individual doctors, or what we call in the ER as shared clinical decision-making.
I reflected on my time in Iraq listening to the hearings because the difference from the first day as an attending to the days in Iraq was like night and day. I had experience, made mistakes, and learned from nurses, PAs, residents, and colleagues. I grew from my experience to become better for the person struggling in front of me. I have always felt if I delivered honest information from what I learned in life and medicine over the years, it would be sufficient. And that has always been my approach to my patients. Medicine is an art.
The standard for the U.S. Surgeon General
The Office of the U.S. Surgeon General should be filled by someone who has had those kinds of active experiences and a sense of public health policy to make population-level recommendations based on evidence-based guidance. Means does not have those experiences, and I simply do not understand how she even got this far. She certainly has the popular narratives of “getting to the root of disease,” “whole health good,” and “sick care bad.” Those are popular phrases that I am sure will pop up in comments here.
My standard for U.S. Surgeon General is people like Dr. C. Everett Koop. He was appointed Surgeon General under President Ronald Reagan and faced fierce criticism from both conservatives and the public for prioritizing science over ideology.
During the AIDS crisis, he rejected moral framing and instead launched a bold national education campaign, mailing explicit safe-sex guidance to every American household and advocating early sex education. He also took on Big Tobacco, declaring nicotine as addictive as heroin and pushing for stronger warning labels, efforts that contributed to smoking rates dropping from 33 percent to 26 percent during his tenure. Despite personal anti-abortion beliefs, he refused political pressure to claim abortion caused long-term psychological harm without scientific evidence. Initially controversial, Koop ultimately became respected for placing medical integrity and public health above partisan politics.
Evaluating the nominee
Based on Means’ podcasts, social media popularity, and desire to sell everyone a continuous glucose monitor, the lack of managing patients on her own in a crisis, and the inability to understand the difference between public health policy and personal health decisions, I do not think she has the ability to serve as U.S. Surgeon General.
Ben Gonazlez is an integrative and functional medicine physician.
