From 4-F to U.S. Navy Surgeon General Cover

From 4-F to U.S. Navy Surgeon General

A Physician’s Memoir

Harold M. Koenig

McFarland, Jefferson, North Carolina, 2019, 215 pages

Book Review published on: January 14, 2022

From 4-F to U.S. Navy Surgeon General: A Physician’s Memoir is the autobiography of the career of Harold M. Koenig, MD. Initially admitted to the Naval Academy, a failed physical forced Koenig’s release after his first year and set him on a path to be a medical doctor. A series of events allowed him back in the Navy, where he retired as the surgeon general of the Navy. This book chronicles his work and adventures in naval, Department of Defense (DOD), and U.S. medicine up until his retirement as a vice admiral.

Koenig uses a chronological storytelling style throughout his book. His writing is easy to read and filled with stories and anecdotes. He starts with life before the Navy and his application and acceptance to the U.S. Naval Academy. Unfortunately, during his plebe year, his physical revealed a significant hearing loss, classifying him 4-F, which was too much to remain at Annapolis after the first year. He transferred to Brigham Young University for his bachelor’s degree and then to Baylor University for medical school. This was during the Vietnam War, and he was notified just before his last year of med school that he would be draft eligible once he graduated. Instead, Koenig signed back up with the Navy in a special program that allowed him to be commissioned in 1965 with the Navy paying him a lieutenant’s (junior grade) salary and for his last year of schooling.

The book then details Koenig’s assignments as a newly minted general medical officer in Japan and how he moved to pediatrics and eventually specialized in pediatric hematology-oncology at a time when advancements in the field were starting to pick up. More importantly, he talks about his decision making, both as a doctor and as a naval officer. His work ethic and acumen were recognized by the Navy, and he moved up in rank steadily. Koenig discusses how he learned the importance of leadership among physicians as he helped the residency program at Naval Medical Station San Diego’s release from probationary status.

This success led to a course at Yale University and additional responsibilities such that Koenig was promoted to captain by 1980 and assigned as executive officer at Portsmouth Naval Hospital in Virginia. He understood he was moving into executive medicine, where his clinic time decreased and leading doctors and naval medicine to the future increased. He includes details of decisions he made with problematic doctors or hospital processes. His success found him back to San Diego as the hospital’s commanding officer, where he again helped right a probationary program and continued construction on the new hospital.

These successes propelled him ever upward in the Navy and Koenig continues telling his story with his easy-reading style as he covers command at Health Science, Education, and Training Command in Bethesda and then Naval Medical Command, Washington, D.C., to finally surgeon general of the U.S. Navy. Along the way he continued to detail his decisions in taking care of people and leadership decisions within the DOD during events like preparations for Desert Storm, Base Realignment and Closure, and other significant events. His surgeon general time covers the last third of the book, detailing travels around the world to check on Navy medicine in action right up to the day he retired as vice admiral on 30 June 1998, as the last man “over the side” of his initial Naval Academy Class.

I found the book extremely easy to read even as Koenig condenses his career to 215 pages. He connected with me because his career overlapped my Army career for eighteen years, and even more so because my dad was a career Army Medical Service Corps officer and I grew up around the Army Medical system, TRICARE’s implementation, and other advancements in DOD medicine.

I found some new leadership knowledge as Koenig detailed his decisions. I found his goals as surgeon general insightful. Some of the goals included taking health care to the deck plates; move information, not people; improve business practices; and make TRICARE work. His second point, move information, not people, is perhaps one that DOD medicine can refocus on today. Koenig wanted providers to communicate first with specialists and pass the knowledge back to patients, if possible, to avoid sending patients to specialists. In today’s system, it seems any patient nonminor medical issue is immediately referred to a specialist, and the patient moves to them.

I’d recommend the book to leaders, especially leaders working in fields containing specialized knowledge and experts. Koenig spent his career working specialized medicine and around experts at some of the highest levels in the DOD. It’s also a good initial historical reference for those researching that era of military medicine.

Book Review written by: Mike Bizer, Fort Belvoir, Virginia